Should you ever not listen to your doctor?

Steve Calechman
Steve Calechman, Contributor

Since I got married seven years ago and had two kids, I’ve had to shed parts of my life, like the hockey package, going to the movies, and slow-pitch softball. None were hard sacrifices, but the casualty that hurt the most was giving up my doctor of over 20 years. I met him soon after I got out of college and he was early in his career, and while I never needed him for much, I knew he was on top of everything.

Even after my wife and I moved north of Boston, I wanted to believe that I could keep him, that an hour-long drive into town without traffic was possible, because how often did I ever have an emergency? Well, in 2014, one month into our first year of preschool, my son got hand, foot, and mouth disease, and then I got it. After a walk-in clinic visit, the breakup process began.

I got a recommendation and met a new guy. He was nice, competent, and gave ample time on the first appointment. He also wanted to prescribe a low-level statin for some elevated cholesterol. I was 47 years old, active, in good shape, had never had high cholesterol, and had no interest in being on regular medication. He said I could retest. I did several months later and my numbers went back down. I was happy, but also wary. If I had complied, I’d probably still be on the drug. When I asked for his rationale at our second appointment a year later, I wasn’t satisfied. I felt I got lumped into a large group of “what people usually do.” I now had doubt.

And there was another thing that added to it: he wasn’t in the best shape. It was a complete nonissue at first. I wasn’t looking to a doctor for fitness advice, but after the statin conversation, I wondered if I could take long-term health advice from someone who didn’t look so healthy. So, I asked Charles Morris, M.D., associate chief medical officer at Brigham and Women’s Hospital, if I had cause.

Based on the doctor’s apparent shape, no. And I knew that. There’s no correlation between belt size and skill. On being depersonalized, yes, there was a valid concern. “You want to feel like the doctor’s advice was tailored to you and not just people like you,” Morris says.

But this brought up some bigger questions. Medical care feels more restricted, more expensive, and time feels increasingly rushed, so in this dynamic, what’s reasonable to expect? What should you find out, and what should be in place from the start to let an otherwise healthy person know that this is the right doctor for the long term? Morris has some ideas:

  • Family history. It’s routine with the initial exam, but it’s more than checking off boxes. It should involve the doctor asking whether your parents are alive; if not, how old they were when they died; and what conditions your parents and siblings have been treated for on a regular basis. All this information hints at what you’re at higher risk for, and depending on the answers it can set an earlier and more focused timeline for screenings.
  • Ask what the doctor’s team looks like. Everyone wants to be able to reach their PCP directly on all occasions, but that’s not happening — there just isn’t time. It is realistic to ask who you should follow up with, and who will be getting back to you and when. Offices have a triage system, and in general, non-urgent matters should get a return call within 24 hours.
  • You should be asked something like, “If you had free time, how would you spend it?” The doctor wants to see what, if any, outlets you have and whether you’d rather hit a bar or go skiing. If there’s concern, a doctor should be trying to guide your habits when life is less complicated, so you’re not digging out of a hole in your 40s. And related to that, there’s the issue of…
  • Mental health. The free time question touches on how happy or full your life is. Another tool that doctors use is the first two questions from the Patient Health Questionnaire. Over the last two weeks, how often have you been bothered by: 1. having little interest in doing things? 2. feeling down, depressed, or hopeless? It’s not all-encompassing, but it gets at how prevalent depression might be.
  • At the beginning of every appointment, there should be an exchange that goes something like, “I have things I want to cover. So do you. Let me hear your list and we’ll prioritize the top eight.” You’re a team. The agenda should be mutual, and ensures you get time to be heard.
  • You can push back on anything. If something doesn’t feel right, ask, “How am I different from other people in that category? Is there anything I can do to change that recommendation?” Again, it goes back to getting tailored advice and ultimately feeling like the doctor gets you. If you don’t feel comfortable asking questions, you’re in the wrong office.

Related Information: Navigating Health Insurance

Comments:

  1. david smith

    You may have saved yourself from a nightmarish remainder of your life, which is what happened to me immediately subsequent to taking a statin drug. Statinvictims.com describes what can happen, and Stopped Our Statins on Facebook does the same.
    Proof of benefit for primary prevention from statins is still in debate. The possible adverse effects–both the severity and the frequency, are not known. They’re not known because our system doesn’t require anyone (certainly not our doctors) to report adverse effects. Call FDA if you want to know how the system (doesn’t) work.

  2. Pavel Riha

    It seems to me, that all of you above are yearning for a different style of healthcare system. One, in which the art of medicine is not buried by algorithms, but rather individually tailored to your needs. One, where the physician’s experience, knowledge and wisdom plays a decisive role in healing. I am all for it and try to deliver care in such a way. But it is an uphill battle against the institutionalized medicine, and survival is close to impossible. So, just as you are being advised to speak up in the doctor’s office, I would ask you to demand from your government changes, which truly matter to you.

  3. D Gustafson

    Medicine is in my opinion 30% science 20% “art”, and 50% hokum;
    the skill/talent level of MD’s, medico’s etc varys incredibly….
    and I/you should judge, choose to the best of your ability if YOU can;
    a hard scientist opinion who judges his work to be perhaps 70% “science” and similar proportions of the soft fuzzy if not foolish stuff stuff….
    DG

  4. Guy Gagnon

    In 2012 I had my right knee replaced and because I elected to do this (had no choice, distance runner for over 30 years )Because of arthritis in other joints I now consider this the best joint in my body. I’ve been told by my doctor not to run anymore, the new knee (Depew. Johnson&Johnson) may wear out too soon. I’m going to be 80 years old this year and still quite healthy but the other knee is starting to act up. I really don’t want to go through another replacement. I heard of a stem cell cartilage re-generation program at one of the Boston hospitals. Not sure how successful it is by my understanding is that it is not covered by insurance because it is jot FDA approved. Out of pocket cost is about $10,000 for each injection, and probably three would be needed. Can you bring me up to date on this whole program regarding cost, success rate, availability, best hospital for procedure. Is there anything better than this for someone my age?

  5. Mike

    Problem is how to find a good doctor. Its not like shopping for good food and you just stick to buyimg whole unprocessed foods or you read consumer reports. Getting a new doctor involves a lot of time and then you find out its not what you want and you have to go through the whole process of finding another one. Hit or miss🤔

  6. Chris Cage

    I’m impressed. I never expected Harvard Med to circulate an article about doctors being wrong. My doctors ignored worsening heart failure for 18 months. When I was finally hospitalized, I stayed in the hospital for two and a half weeks and lost 96 pounds of excess fluid. You need to run more articles about mistakes and what patients should do.

  7. JohnnyRojo

    Doctors increasingly use cookbooks that say things like: A 70 year old male with elevated cholesterol will, on average, live longer by taking a statin. So to lower your theoretical risk of a CV event, they’ll prescribe the statin, without taking into account much else about you.

  8. Emily Cahan

    I recently had my first annual with my new p.c.p. I presented in rather acute back pain which flew my new doc. That evening, I sat up in bed and realized “Darn it — I know what this horrific pain is about — it’s the return of Polymyalgia Rheumatica,” a very painful systemic inflammatory disorder that was listed second on my current list of conditions. I called the nurse the next morning, she concurred, ordered the relevant blood tests and started me on Prednosone. My doc has not said a word about her oversight and I don’t know what to think. Stop putting us in boxes and treat us as complex individuals, please!

  9. Fran Patalcant

    “You’re a team….the agenda should be mutual..”
    I totally agree that that’s the way it should be. And yet, the physician establishes his/her authority from the outset in subtle ways. It starts with the long wait in the waiting room. Yes, doctors are busy, but everyone’s time is precious. This problem could be addressed by avoiding the practice of double-booking, which is employed an all too frequently in order to maintain a physician’s high income. Then comes the introduction: Hello, I’m Dr…..”. Nothing wrong with using a professional title. But what follows is the doctor’s use of my first name. I am in my late sixties and have always resented the one-way informality of being called by first name by a doctor. It immediately establishes a hierarchy. Moreover, the more recent practice of asking me, “What do you want to be called?” puts the patient on the spot. Give me the respect of calling me Ms. or Mr; there is no reason why that should not be the default greeting. I am further subtly demeaned as a patient when the doctor stares at his/her computer during the entire visit, failing to make eye contact for all but the briefest moments. And finally, I don’t appreciate meeting a physician for the first time in a johnny. Allow me the dignity of being fully dressed at the beginning, at least when first getting to know the physician. Resolving these issues would go a long way in building team spirit between doctor and patient.

  10. Luna Cooper, PHN

    ‘You can push back on anything’ advice is good and appropriate anytime a patient doesn’t understand or agree with the advice or plan of care recommended by their doctor. However, that approach is still not well received by most doctors/providers. Even though ‘shared decision making’ , developing a partnership with your care giver, informed consent, medical homes etc., etc., is promoted, in most instances it doesn’t happen. Unfortunately doctors and providers still resent patients questioning or appearing to challenge the recommendations advice that they are giving the patient. many doctors continue to have the attitude towards a patient of if you’re questioning my advice or recommendations then you need to seek care elsewhere.
    There is no shared decision-making or partnership or agreement that occurs in most medical offices. That approach mat be ideal but in the real world of patient care it’s not happening.

  11. Joseph C. Shapiro

    Simply explain that a second opinion is sought, preferably from the designated specialist co-practitioner. To be denied such a request is unethical and cause to reject the “rejected” doctor. Look elsewhere !

  12. MICHAEL HOWARD

    I HAVE FOUND A NUMBER OF DR’S RECENTLY TO BE DISINTERESTED IN DISCUSSING THE MOST RECENT RESEARCH RELEVANT TO MY SITUATION. THEY SAY THE SAME THINGS OVER AND OVER. I THINK OF THEM MORE LIKE DOING A BUSINESS THEN CARING ABOUT WHAT MAY IMPACT MY LIFE. AND SINCE IT IS MY LIFE I FEEL I SHOULD BE EDUCATED BEFORE I GO TO AN APPOINTMENT . MY SCIENCE BACKGROUND IS HELPFUL AND I LIKE TO TALK ABOUT THE OPTIONS I FOUND FROM THE BEST AND MOST RELIABLE SOURCES. THEY ARE NOT INTERESTED AND GIVE YOU A HARD TIME BEFORE SAYING YOUR TIME IS UP. WELL I THINK THAT IS PRETTY RUDE AND UNEDUCATED TO NOT DISCUSS IDEAS WITH A PATIENT WHO IS SMART ENOUGH TO UNDERSTAND. I WANT A DR WHO IS GOING TO GIVE ME HIS/HER INPUT AND ALLOW ME TO DISCUSS WHAT I KNOW. THEN I CAN DECIDE WHAT I WANT TO DO. IT IS MY LIFE. THANK YOU.

  13. Thomas Braun RPh

    When physicians are compensated for taking a good health history and determine the potential for future health risks due to lifestyle, then we will make progress in medicine. Prevention and reversal of the potential for disease states is just as important as the need to ameliorate acute symptoms of disease states with a Rx. Helping to bring the patient’s body back into a state of homeostasis should be key.

  14. Thomas Braun RPh

    Will someone explain to me why it is not “Standard of Practice” that if a statin is prescribed, then Co Q 10 is also needed to be prescribed. Merck Researchers identified this need in 1989 and the FDA ignored the need when they approved the first statin.
    In Europe, it is standard practice. I agree, we need to look beyond the LDL number and identify the source of the arterial inflammation and reverse it. Merck patented their statin with Co Q 10 but never brought it to market.

    • Betsy

      I agree. My husband has been on a statin for some time and this year was diagnosed with diastolic dysfunction. He was never told to take CoQ10. Turns out CoQ10 deficiency can cause DD!

      I also take exception to the edict that doctors should screen everyone for depression. Antidepressants are overprescribed, and are addicting in the sense that they are very difficult to come off of. Getting someone hooked on them because they are unhappy about a break up or job change is almost a guarantee for Big Pharma to have a customer for life! GPs are prescribing antidepressants now like they are NSAIDs, inappropriately!

    • Lorraine Manson

      Thank you for your post! I have chemical sensitivities so I try to avoid as much medication as feasible; my doctor wants me try a statin again so I agreed on a low dosage every other day. He’s never mentioned CoQ10 but I’d seen it many times in my research. Before purchasing the prescription I asked the pharmacist about taking CoQ10 with it and she agreed I should. I wrote my PCP and told him the statin would interact with my BP med so I would alternate the two and was taking the CoQ10. He simply wrote back and said, “Good plan.” I’ve been trying to get some type of diagnosis for the MCS but although the practice has many offices in various cities, he could not give me a referral. I’m considering striking out on my own for a new PCP–especially since the last referral doctor refused to acknowledge that the med he placed me on was too strong; I had to find a specialist on my own…what’s the point. I’m not on Metformin because that’s the first thing doctors prescribe and I knew I didn’t need 500 mg. Through my own research I agreed to another pill at the lowest dosage 2mg and found that I only need half that. Too many patients are hesitant to ask questions or voice concerns. I’ve seen people on 19 meds that were masking their symptoms. I’ve found the pharmacists to be more help than the physicians and I follow their advice. I’m not on a lot of meds that have been prescribed in the past–my depression comes from unreliable healthcare services.

  15. Patty

    I read this article because I recently had a diagnostic procedure involving my lungs whose value was unclear to me but recommended by my cardiologist who had put me on a blood thinner. After the procedure I developed cold symptoms that I mentioned to the lung doctor and he prescribed an antibiotic. The symptoms were pretty mild but I didn’t question his prescription. I did ask regarding side effects and he mentioned a few not very worrisome things. So I began the pills. They came with significant warnings of major possible side effects. I developed leg pains I asked the doctor about and he said take an ambulance to the emergency room. In a follow up an internist took me off the blood thinner and the antibiotic saying I’d been given too much of the latter and both may be involved She also said I should take two months off work. I’m in pain and waiting for further tests. I’m not sure of the take home lesson of this saga so far but one would seem to be: speak up and be absolutely clear in your own mind that you can endorse the recommendations of your doctor. This means asking him/her if a significant procedure or antibiotic or other pill really is necessary and why. Are there reasonable alternatives? Check the pill manufacturers discussion of side effects yourself and double check with the doctor if they are worse than you are willing to risk. It’s the patient’s body, not the doctor’s and the doctor is an advisor not a boss. I wonder if most doctors would endorse that attitude: that we are a team and the patient is in charge? Often it seems not as another poster said. I suspect most patients shy away from it also. Of course we lack the training etc. But people make mistakes and it is up to the patient to be his/her own advocate.

  16. Thomas Braun RPh

    Have we lost our way?
    Prevention and reversal of disease states is just as important as the treatment of a disease state. Our Father of Medicine understood this. Hippocrates of Kos, also known as Hippocrates II, was a Greek physician of the Age of Pericles, and is considered one of the most outstanding figures in the history of medicine.

    When physicians are compensated for evaluating the lifestyle and current health of the patient in detail including nutrient deficiencies we will turn a corner in medicine.

    Beyond comprehension why we can’t wrap our minds around the fact that we have a major deficiency in Vitamin D in the American population due to lifestyle changes and our nutrient poor food sources laced with a myriad of trace toxins.

    Physicians goal has to be to bring homeostasis back to the patient without doing him harm.

  17. Damon Baragwanath

    A wonderful article, furthermore, one which will serve to empower many readers. Personally, my view is that “we” the public and potential patient would be well advised to start adopting a more infomed and proactive role in not only our own health, but also our families health. Otherwise, it is often a case of the “blind leading the blind.” The we “cry wolf” due to medical errors or misadventure. Thank you, a d wishing you a wonderful New Year with abundant great health and happiness – Damon

  18. Daniel Healy

    I had a psychologist tell me I didn’t ‘act’ sober. After 37 years of sobriety. How do these people get out of middle school. My psychiatrist just raised his eyebrow in disbelief. Doctors, some are ok but MOST aren’t.

  19. Marilyn Morris

    Excellent article, I couldn’t agree more. I especially appreciated the list of what you should look for in a doctor. Thanks for the tips.

  20. Thomas Turk

    What the article fails mention, as did the new doctor and as would all doctors.. is that although statins are prescribed to lower LDL, the ‘bad’ cholesterol.. LDL is merely the MARKER for the amount of ongoing inflammation in the arteries. It’s this inflammation that leads to calcification from this cause. 2 other main causes are high blood: homocysteine and high triglycerides.

    Anti-oxidants are needed to lower/stop this inflammation. Apart from supplementing.. 2 egg yolks daily have sufficient anti-oxidants to serve this purpose.. selenium, l-cysteine, l-tyrosene etc amino acids and vitamins. For best results the yolks should be eaten raw, (shells well washed, whites cooked). The yolks can be gently mixed into a breakfast blend/yoghurt etc. Salmonella risk is 1 in 30K from a raw yolk.

    Statins do alter the LDL marker, but this by interfering with normal gut or liver function, depending on brand. This chemical process gives the side effects, including he unwanted one of blocking enzyme Q10 synthesis, that needed for heart muscle function. As statins lack any anti-oxidant, they can neither slow nor stop arterial calcification.. from this cause. The insert in the statin packet clearly informs that statins do not stop arterial calcification. Many I know who religiously followed their doc.’s ‘precautionary’ statin intake went on to have stroke, stents, bypass and some.. sudden death.

    Idiotic Mainstream advice, (most times), is for 2 eggs a week. I’ve met many who then believe eggs have too much ‘bad fat’, stop eating them, and sadly also restrict/stop their offpring’s egg intake. I have never seen eggs advised for school lunches. Well meaning, poorly informed parents thus rob their young of the vital brain and nervous system foods in the yolks.. the phosphotidyls serine and choline..plus the anti-oxidants..

    I eat at least 3 raw yolks daily, sometimes even up to ten total, and have for nearly a half century. At 80 my arteries are clean as shown by a high speed camera during a heart scan a few year ago. (Matilda Hospital, Hong Kong). How is my blood profile? Dunno! My last check-up was a freebie in Hawaii in 1979 at an Health and Fitness conference. The doc said all is fine. I told him I ate up ten yolks a day, globs of butter, and chose the fattest meats. He said.. you must be joking!

    • Harvey

      Your genes allow you to get away with a diet that would kill most people. Be grateful!

    • Mike

      Glad your healthy! However as a person with familial hypercholesterlemia I can assure you high LDL kills people. My father, uncle, grandfather all died in their forties due to high LDL from a genetic cause. The liver just makes a lot of ldl regardless of what you eat! Their descendents are all doing fine including me because statins resolve the high ldl. IAC, YOU DO NOT PROVIDE ANY SCIENTIFIC EVIDENCE FOR YOUR CLAIMS. The case for statins is overwhelming.

  21. Norman Holly

    Six months after I enrolled for a PhD at Harvard, I began noticing troublesome symptoms that grew progressively worse. Because I was in the student medical insurance plan, I went to a Harvard physician.
    I deteriorated steadily, but the MD did nothing, and then I had bouts of violent shaking and loss of memory, which I called the MD to witness. He declined, saying it was only my imagination; then admitted his inattention derived from my health insurance, which he called “immoral” – “I mean it. Anyone incapable of paying out of pocket for his own health care doesn’t deserve to have any”. Feeling I was about to die, I went home, and had another attack. My mother called the first MD in the phone book, and I was lucky – it was a immigrant from Poland who had survived in the WW2 underground.
    Within two hours he had correctly diagnosed myxedema, and as it was 2 – 3 years along, he said I was weeks away from a myxedemic coma which had a very low survival rate at the time. He brought me back gradually over six months to avoid a deadly shock, and then I experienced 2 painful years after the subcutaneous fat wore off. I happened to bump into the Harvard MD on the street one last time, and asked if he had heard about my diagnosis. He said, “Yeah. Well, those things happen now and then” and walked away. I was so startled that I forgot to beat him to a pulp on the spot.

  22. Nathan Kemalyan

    health maintenance is a partnership. I would suspect your internist has 2000+ patients for whom he is at least nominally responsible. Receiving a recommendation based on your age, gender, etc. is not unreasonable. Asking more questions and offering your reticence to take medication is appropriate and should be encouraged. Perhaps you are expecting more of him and less of yourself than is appropriate. I would interpret your story as a pretty benign interaction, without much cause for critique. Engagement in your plan of care requires that you speak up if your needs are not being met. Your physician is not required to read your mind.

  23. John L. Hodge

    I had three doctors who wanted to give me diuretics to reduce my blood pressure. They could not even explain to me why they thought I had high blood pressure, when my blood pressure measurements at home placed my systolic pressure in the mid-130s, and I am well over 65 years old. (My diastolic was never an issue.) I had “white-coat hypertension,” which seemed to get worse the more I questioned their advice. A fourth doctor said that I should try reducing my salt intake, which I did. Two months later my at-home systolic pressure had dropped a few points. This fourth doctor said my lowered blood pressure was fine, and no medication was needed. Yes, we should question our doctors, especially when they seem too eager to prescribe drugs in marginal situations. If you do not get satisfactory answers, search for someone who will respect your questions and give thoughtful, sensible answers. And be a knowledgeable patient–read health letters regularly, and research your ailments and the side-effects of proposed drugs.

  24. Charles Blackwell

    Re.: “Should you ever not listen to your doctor?”
    To the writer: what is the meaning of “maximal healthiness” to you? Therein lies the key; the answer is not the same for everybody. I would say that if you are going to ignore your doctor, get another doctor.

    • Lisa Rice

      I had to go to the local ER because my long-time doctor chose to put me in anti-reflux meds instead of x-rating my lungs to make sure I still didn’t have bronchitis. I’m very glad I did that because I had an allergy to 3 of those drugs and I needed stronger antibiotics because I still had bronchitis. I was super happy I was educated by the hospital about the dangers of anti-reflux drugs thickening mucus in lungs – I would have gotten pneumonia if I kept taking the previously prescribed medications!

  25. Evelyn F Thompson

    Good article, but the statement “you are a team” does not hold water.
    As long as providers insist on being called dr, a dominance hierarchy is established with the dr at the top and the patient a rung down. So, under
    this established hierarchy a patient is not going to question the dr or
    feel they are a team. And drs will always feel on top. Most patients just do what the dr prescribes. My hat is off to this patient to question.

  26. Anne

    All advice from doctors is not equal. It is always sensible to ask questions before starting on medication. Often minor changes can occur over a period of time and then stabilise, so retesting is necessary. Plus lifestyle is important in the medical decision making process.

  27. Nerd

    Suppose you want another doctor in the same office because the doctor is a specialist you need; what do you day to the rejected doctor?
    I want to see a better rheumatologist at the same facility.

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