When I was a child, my stepfather worked for Dr. C. Everett Koop, Surgeon General of the United States. One day, I got to meet Koop, and I'll never forget his advice to me:
"Your body is a beautiful system. Keep bad stuff out, put good stuff in, and it will serve you as God intended."
Or something like that. Perhaps Koop was ribbing my stepfather, who smoked two packs a day while helping write Koop's anti-smoking reports! But his words landed on me with the authority of his station, and thirty years later I still think of my body as a beautiful system.
So how does this thinking inform my choices? I choose the least disruptive option. Here are a few examples of my bias in practice:
- When treating my disease, I negotiated with my doctor to use standard therapy (oral MTX, plaquenil, prednisone), and resort to infused biologics if necessary. It was not necessary.
- When Urgent Care directed my 92 year old aunt to the emergency room for high blood pressure, we went home instead. We sipped tea and chatted until late in the evening, when she went to bed. The next morning, her primary care doctor measured her blood pressure at 90/60.
- Persistent, swollen lymph nodes in my son's neck had us all worried. But his pediatrician and a pediatric oncologist were comfortable with watchful waiting (following a clean FNA and normal blood work) rather than an excision biopsy. After six months, those damn nodes are finally going down.
Resisting treatment can be scary for patients and doctors, especially when the stakes are high. It's a brave patient who says, "Let's wait and see." It's a brave doctor who says, "Let's wait and see."
Patients need doctors to help them evaluate options. Doctors need patients (caregivers) to be honest and thorough. We must listen to each other and work together, to keep our "beautiful systems" beautiful.
A few conversations that I follow include