You gotta meet people where they are, and where their bar is set
Several of you brought up great points about the screening post from yesterday. And trust me, I love where your brains and intelligence are, because you are all spot on. And I agree with you 100%. Do I like the ACA? Heck NO! I hated when that horrible bill passed and the massive trouble it has caused for healthcare, the cost of healthcare, etc. I want government out of healthcare as much as humanly possible.
But sadly, un-doing the mental training that healthcare has done is not a linear process, and many people are not where “we” are.
Some examples:
“Oh no, I said heck no to the covid booster, not getting anymore. I just got my Flu/Pneumonia/RSV shots this time.” OK they are listening and have picked up on the dangers of the covid shot, but do not realize the dangers in the other shots.
“I really want an SSRI for my depression”. I will discuss the STAR report about the efficacy of SSRI’s being barely 15%, it was a robust study of 160k+ people, inform about side effects of SSRI’s….and then tell them “I will always meet you where you are and what is comfortable for you, what would you prefer?” 85% of the time I hear “well my friend did great on Lexapro/Prozac/Effexor and I was really wanting to try that”.
So to toss this question to all of you: are we doing harm or good if we don’t honor what the patient wants in ALL settings of healthcare? Not just the covid shot arena. We have all fought so hard for patient autonomy and to be heard…..but if the message the patient tells us is not what we would choose personally, does honoring the patient make it wrong? I would compellingly argue that you gotta treat accordingly with what the patient wants and feels comfortable with, so long as it is clinically appropriate, they have given informed consent, and they know risk/benefit profile. Now I am not going to honor a request that is absurd and unsafe, outside of treatment guidelines, etc. But if I refuse to order the MRI that a patient wants, or the mammogram, or the colonoscopy, because I think we overscreen for everything in healthcare…….yet guidelines still say we should screen…..am I doing right or wrong?
If I don’t meet the patient where they are, then I am no better than a covid vax pushing provider. Because isn’t that what they were doing? Imposing their own agenda or their facility agenda on a patient, and ignoring what the PATIENT wants?
So in terms of being happy that the SCOTUS decided to continue the ACA requirement for insurance to pay for screenings, yes, I am happy that happened, because I have patients who want those screenings. And who cannot afford to pay out of pocket when insurance will deny coverage if protections are removed. Do I personally want those screenings? No. Do I personally think government or insurance companies should dictate your care? Absolutely hell no. But not everyone is on the same page as we are my friends. For every “awake” person, there are dozens who are blissfully unaware of the minefield that healthcare is these days. We cannot topple the apple cart onto their laps in the name of our belief system.
I am in the world of playing Jenga. I have to balance what every patient needs/wants regardless of my personal beliefs. I have to honor their requests with compassion and clinical practice. And yes, if they want 12 mammograms and 5 colonoscopies, then I have to honor that. Because to do anything less would at the bare minimum make me the most horrible hypocrite on the planet. If I want my body autonomy and health choices honored, we gotta do that for every single patient. And that means making sure the patients who want these screenings can afford to get them. If SCOTUS had ruled the opposite……insurance companies would go into “deny” mode faster than you could turn your head. And THAT becomes the same problem as mandating a covid shot. The pendulum has to swing in the middle, not to the extreme.
Some of you will agree, some will not agree. But this is the reality of navigating healthcare these days. It is cumbersome, messy, amazing, hopeful, and exhausting. Those of us fighting the good fight for all of you are trying our best. The one thing we do not want is to have a single patient go without what they need and what they believe in on their personal journey to health and staying well.
Go forth and take good care of each other! ♥️
Well said Jennifer. I am retired. Was not a healthcare provider but i have researched the problems with the covid vaccine and other vaccines. I have a retired friend who knew i had done this research and asked me for an opinion on if she should get the RSV vaccine. She has COPD and i sent her studies that at least on children, the RSV vaccine had negative efficacy. So she did not get the RSV vaccine and about a month later had to be rushed to the hospital in middle of the night because she had RSV and could not breathe. Well dont you know i felt awful that i recommend that she not get the RSV vax. So i see your conundrum on a large scale. A real Catch 22😟.
I have firsthand experience with Dr. Funtimes approach to treating “The Patient”. The thing that impressed me right off the bat was that she LISTENED to me. I hadn’t encountered that approach in a medical setting for a very long time. Once she had determined what MY treatment goals were, she developed a plan. The goals changed over time and Dr. Funtimes adapted the plan. Don’t get me wrong, Dr. Funtimes is not a pushover. She will set you straight if you are on the wrong track. I have never felt like I was serving her agenda. It is medical care about me. I believe it takes tremendous bravery/integrity on her part to treat the patient. Not push an agenda. I consider myself fortunate to have stumbled into her practice. My life is better for it.