Making Sense of Medicine

I just rented a car and, though I had made a reservation online for the cheapest option – a subcompact – at the counter the agent tried her best to sell me a big upgrade, then a smaller upgrade, then various insurances that I don’t need because I’m already covered, then a full tank of gas at an inflated price, then a GPS and finally XM Radio. And though I knew I’d be offered these things, and I had steeled myself to say no to everything, I wasn’t prepared for the force of her persuasiveness. She was a salesman. 

First she charmed me with her interest in why I was in town. She was warm and funny. After a minute of chit-chat she glanced at her screen and her face brightened. A big upgrade was available at only $15 extra a day. No, thank you. Her brows furrowed as she expressed concern about my need for more legroom and then studied her screen. Her face lit up again and she offered another car that would provide this need for only $10 extra a day. No, thank you.

As she moved into the offers for insurance, and I declined each one, her tone was increasingly disapproving. I’d be responsible for all expenses in case of damage. Guilt washed over me and I felt myself wavering, but managed to hoarsely croak: No, thank you.

You’d think she would give have given up on me at that point, but I guess not, because she somehow made the gas, the GPS, and the XM Radio seem like amazing deals. But in my heart I knew they weren’t, and again said: No, thank you.

As I drove off the lot in my Chevy Aveo (which, by the way, has plenty of legroom) I thought about her methods of persuasion. I use some of those methods, myself, though my intent is not to sell my patients anything, but to try to convince them to exercise, or to stop smoking, or to take their medicines as prescribed. I tailor my approach to the individual. What “works” with one person will be different than with another. With most people I try to use humor to make a connection and lighten the mood. With a few I’m deadly serious.

I guess I am trying to sell something – health. I want my patients to live long and thrive. I want to be the best salesman of a healthy lifestyle that I can possibly be. For what I want for my patients, ultimately, is exactly what they want for themselves – a full and vigorous life. 

Responses to my last post, “The End of Life”, have reminded me of the importance of talking about the possibility of death when someone has a serious, potentially fatal, illness. Why do we shy from having this conversation?

I know why. It sounds like we are giving up, that we are no longer anticipating a cure. That is certainly the struggle that doctors have, when deciding whether to bring up the subject. I find that I can bring up awkward subjects more easily when patients are alone in the clinic room. When I’ve been people’s doctor for a while, I’ve had a chance to study their personalities, and can anticipate how they will respond to the information I want to share. I choose different words depending on how I want to approach an issue.

But when people are being treated for a serious illness, they are more likely to have family members or friends with them. I usually don’t know these people as well. How are they responding to this delicate conversation?

Don’t get me wrong – I love having family members and loved ones with patients in the clinic. Having extra people adds texture and depth to the doctor-patient relationship. I see people in a bigger context, getting a glimpse of the parts of their lives that doesn’t involve medicines and health.

The goal is twofold: One, to keep trying, keep working to beat back the disease, keep maintaining hope. And two, becoming prepared for the possibility that this will be the thing that leads to death. (There is a 100% death rate for humans, unless you are Enoch or Elijah from the Bible, who were taken straight to heaven.) Keeping these two goals in balance is tricky. Not impossible, but tough to achieve.