Screening Patients, Part 5: Competition & Conflicts of Interest

Here we are, in the fifth installment of a post series about screening patients.  All of my previous disclaimers still apply; I’m not trying to be judgmental or exclusionary, nor am I trying to be mean.  Doctors and patients alike are human beings, subject to error and imperfection, and I would be lying if I said emotions never came into play.

Today’s topic involves patients involved in competing interests, the type that run the risk of working against themselves–and the care that you (talking to the doctors among us) are trying to provide.

Screening potential new patients before they enter into a care plan, or even before they enter your office, can provide the doctor with important and valuable information that may make or break that patient’s progress–and by proxy, your reputation.

This post will focus on screening patients for several types of these competing interests:

  • Self-treaters
  • Straw-grabbers
  • Those working with other similar types of practitioners
  • Skeptics (who would hold you in inferior esteem to that of their conventional provider, their local health food store employee, a charismatic consumer-based supplement company representative, or even Dr Google)

I’ll explore these in order.

Self-Treaters:

These are the people who habitually engage in taking care of their own health issues, or so they believe.  They usually start by looking symptoms up online and diagnosing themselves, but sometimes they obtain a diagnosis from a licensed healthcare provider before disappearing into the void.

Either way, though, they can be found online, purchasing products that may or may not work, that may or may not be appropriate for their problem.

Usually, it isn’t.  Because they’re still dealing with symptoms, and they still end up seeking care at our office.  Despite the fact that their go-it-alone approach didn’t work for them, however, many still continue to engage in this behavior while under a doctor’s care.

This can become incredibly frustrating for both parties.  It’s frustrating for doctors for several reasons.  One is that they have no way of knowing what remedies a patient is trying, and some of these remedies might interfere with or counteract those the doctor is trying to use in order to help the patient.  Another reason is purely psychological-based: the patient is going against doctor’s orders, which creates stress and doubt for some doctors.  And another involves the inevitable complaint that the patient is too financially strapped to follow through with all of the recommendations made by the doctor–because the patient is spending too much on the side, online.  And last but not least, the patient often fails to make the progress expected by both.

Those last points segue into the headaches created for the patient: lack of money and lack of progress.  Which, of course, more often than not, gets pinned back on the doctor in the form of blaming them for failing to get the patient better.

Other issues for the patient include confusion and frustration. The patient is not only under the care of a doctor, but is also trying remedies learned of through online searching, and is still not making any progress.  This is where the frustration comes in.  The confusion enters the picture when the patient does feel differently, either better or worse, but with so many remedies in use from so many different places (and possibly people), it’s difficult to tell which remedies are helping, which ones are hindering, and which ones may be having no effect.

Self-treatment, on its face, might sound positive.  “Heal thyself!”, exclaim various websites, promising people that they don’t need any help from those “evil, money-hungry, ignorant doctors”.  Healing oneself sounds empowering and proactive.  It sounds liberating.  It sounds utopian.  Wouldn’t we all love to be able to do that?

But the truth is that certain conditions can’t be healed on one’s own.  How does a layperson get a full grasp of immunology or biochemistry or diagnosis or even nutrition without having had formal training?  And in the event that one was able to study for years from textbooks and online courses, and they were somehow able to nail their diagnosis and figure out a bunch of findings, how are they supposed to know in which order they should address them?

Case in point: heavy metals.  They might discern, maybe correctly, that their symptoms are being caused by mercury overload.  They might even order their own hair analysis to confirm it, and it might indeed be confirmed.  Great!  So what’s the next step?

If you answered “heavy metal chelation”, go to the back of the class.

That’s not the right answer.  The answer is, there are a lot more assessments to do, many more issues to screen for, and many more findings to address, before chelation even becomes an option.

If most doctors don’t even get that answer right, how is a patient supposed to?

The big issue with self-treatment is that because it sounds so good, and up until this point, it might have been their only remaining option, it can become a habitual compulsion.  It’s almost addictive.

I require that before I’m going to touch a patient, they first discontinue everything they’re currently taking, with the exception of pharmaceutical medications (because my license doesn’t allow me to tell a patient to stop taking meds).

Straw-grabbers:

Straw-grabbing can run in tandem with self-treatment, but not always.  It’s a different phenomenon entirely.

Straw-grabbing is when the person runs from place to place, trying different remedies and approaches, but never sticking with one long enough to see it through and allow it to work.

Straw-grabbing comes in all shapes and sizes.  Sometimes it goes hand in hand with self-treatment, and other times it results in bouncing from one doctor or practitioner or guru or author or product or expert or friend or family member or support group to another.

You may hear a lot of “so-and-so says This” or “this guru said That”.  To the point where you might find it hard to stop yourself from rolling your eyes out loud.

Don’t feel too bad; they’re probably doing the same thing to their other contacts, too, with your name and what you say.

But it doesn’t make it any less frustrating when it happens.

Those working with other similar types of practitioners:

This category is pretty self-explanatory, in terms of its definition.

Some may be asking, “what’s so wrong with that?”

And, I will tell you.

Occasionally, the answer is: nothing.  Everybody has their role and knows their place.  Toes never get stepped on.  Everyone’s content to fill their role and life is good.

But most of the time, in my experience anyway, that’s not the case.  Each practitioner is not always content with filling their role, and they feel they must venture outside their sphere…and into yours.

For whatever reason(s), one provider might feel compelled to start giving herbal advice when they’ve been assigned a therapeutic food-based role.  Or they want to give dietary advice when they’re supposed to give treatments using a specific device. Or they–you get the point.

The problem is, those providers don’t know when and where to stop, to draw the boundary line and say, “that is outside my specialty” or “nope, this is as far as I go”.

Some providers lack ethics.  Or they’re like that nosy neighbor who wants to gossip but gets all the facts wrong, but doesn’t know when to shut up, and thinks they’re doing everyone a favor, a community service or something.

Other times, it’s the patient’s fault; they keep one foot in too many kiddie pools, and forget to let go of one provider when starting care under a new one.  Or maybe they like the attention, feeling important when multiple providers dote on them.  Maybe they feel more knowledgeable or “in the know” if they can maintain positions on multiple people’s radar.  I don’t know.

What I do know, however, is that with these patients, you’ll probably never be the only voice in their ear.  And you’ll probably have to work extra-hard to shout above all the other voices in their ear if you want to be heard.

Skeptics (who would hold you in inferior esteem to that of their conventional provider, their local health food store employee, a charismatic consumer-based supplement company representative, or even Dr Google):

Yeah, this one says it all, doesn’t it?  You’ve probably come across this type before.

This type usually doesn’t stand alone; usually they’re flavored with straw-grabbing and/or self-treatment.  It all depends on to whom you’re playing second fiddle; if it’s Dr Google or an author or anyone else they haven’t personally met, they’re more the self-treatment type; if it’s anyone else, you might be dealing with a straw-grabber.  In the case of the latter (straw-grabbing), however, there’s an air of desperation that is not necessarily part of the unofficial “diagnostic criteria” for the skeptical type.

The skeptics are just that–skeptics.  They’re tough to handle at times because, by their nature, they’re not sold on what you do.  They’re not sold on much of anything, usually; maybe there’s a belief that by questioning everything, they’re somehow “more enlightened” than “those other patients out there”, and sometimes there might be a compelling urge on their part to go tell it on the mountain.

All this might accomplish, though, is that they may have convinced themselves.  Because when push comes to shove, chances are that they’ll need all the convincing they can get.  That’s why they’re skeptical.

Don’t get me wrong, there are plenty of reasons why skepticism is good for the soul.  There is nothing inherently bad about asking questions and whatnot; the issue I take with this behavior is that by spending time asking lots of questions, the clock is ticking on that patient and they’re wasting time, particularly if they’re repeating themselves just because they didn’t like my answers to the question the first 17 times I answered it.

This type is difficult to handle because if they’re not convinced that your way is the way to go or they’re not sure you know what you’re talking about, then that makes it hard for them to take your advice and it makes it tough for you to have a significant positive impact.  I’m perfectly cool with people wanting to know more about why I’m prescribing a particular remedy or why they should have that lab test or diagnostic imaging, but there is a fine line between extra curiosity and a desire to be maximally informed, and a point where you’re just butting heads and pulling teeth.

And who has time for the latter?

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