“Do you know what we’re treating you for?”
That’s one of my favourite questions to ask the people I see in the course of my work. I tend to get two common answers. One answer is, “No, what?” And the other is something along the lines of, “Um, mental problem?”
Neither of these two answers is particularly encouraging. The first one indicates complete cluelessness about what the problem is. The second is an example of the misconception that mental disorders are one big amorphous group of health conditions. (See my thoughts on that in a previous post: We talk about mental disorders like white people talk about Africa.)
But both answers suggest an even more important problem. To understand why, we need to remember one thing:
What I learned about mental disorders from my mechanic
Allow me to use an analogy. I’m not keen on visiting my mechanic. It’s stressful to get to his place, plus I know I’m going to spend money one way or another. But even before he fixes stuff in my car, I will typically ask him what the problem is and what he thinks it’s best to do about it. And when he’s done, he’ll usually show me the part he replaced (if replacing was the solution or at least demonstrate to me that the problem is no longer there).
The reason I do this, of course, is simply so I have a better idea how my own car works. And it’s helped me more than a few times too: over time, I’ve developed a better sense of what might be wrong when there’s a problem, and that’s helped me know how much I should be worried, or whether I need to call my mechanic ASAP.
The thing, though, is I don’t believe this behaviour is unique to me. You do it too, I’m sure. Most of us do. Except, it seems, when it comes to our own bodies.
Because again and again, I find that many people getting treatment for mental disorders (and long-term illnesses in general) don’t have a clue about:
- What diagnosis they are being treated for
- The names and doses of the medication they are are supposed to be using, and how long they can expect to use it for
- What their meds are supposed to do and potential side effects
- What changes to expect about in their condition over time, good or bad
The problem with this comes down to something really important about long term medical conditions: it’s those with enough knowledge to be in charge who are most likely to rise above it.
Let me try to unpack that.
With short-term (known medically as acute) medical conditions, the doctor can easily take charge, and often does. Take malaria as a very common example. You show up at your doctor’s with complaints of a rising temperature, splitting headache and joint aches, he thinks you’ve got malaria fever, and takes blood samples to do a couple of tests while initiating treatment. He may not explain a whole lot at that moment about the tests he did, or the medication he prescribed (although you really should ask), and it probably doesn’t matter much. In fact, in a sense, it’s fine that the doctor takes over your care at that point, sort it out and let you get back to work.
But when what you have is something that takes more time—we’re talking years and months (what in medicine is called “chronic”)—it’s not even realistic to expect someone to take charge for that long. For the simple reason that they can’t be there all the time. If you should run into a crisis and you’re by yourself, you’ll be in real trouble if you don’t know what to do.
And that’s the thing…
You can’t “rise above it” if you don’t know what “it” is… (Tweet this!)
Knowledge is power. Whoever first said that knew what they were talking about. Like I like too say to my patients:
I’m the expert in your mental illness, but you’re the expert on you. If we can bring our areas of expertise together, we can make things happen. (Tweet that!)
It’s true. The people I’ve known who’ve risen above their health conditions to the fullest have been those who knew it almost as well as their doctors. I tell people they should know about their condition because for them, it’s beyond even theory and practical, it’s part of their everyday experience.
- They know the diagnoses they’re being treated for—the symptoms, the early signs, what to expect over time, and what treatment options are available.
- Those on medications know what their meds are called and even the different brands available. They know what the meds are supposed to do for them, what side effects they experience and how they can work around them.
- Conversations during follow-up visits can be a kind of mutual negotiation, where both doctor and patient consider available options, as equals with different areas of expertise: the doctors on the health conditions and the patients on their own selves and experiences.
When people get to this point in their health journey, you can be pretty confident of much better outcomes on the whole. Of course there are other factors involved, the most important being that this places a lot of responsibility on the person with the medical condition. And sometimes they’ve been ill for so long that they can’t as easily support themselves. Pretty often though, there’s another problem: we Nigerians (and maybe Africans in general, but I’m not so sure) don’t ask questions of our doctors.
It’s weird, and I see this even among the well-educated who you’d expect to know better. I’m not sure why, maybe it’s an ingrained belief that the doctor knows what he’s doing, or that it’s not their place to ask. But again and again, I meet people who can’t answer the question. Sometimes they say they actually asked and didn’t get an answer.
So ask again. I know we doctors often tend to be economical with information. That’s largely a residue from back when information was something people hoarded. And yes, part of that was because it might have been dangerous to put too much of it out there in a time when it could easily get into the wrong hands. But not anymore: there isn’t only more info out there than ever before in human history, it’s also easier than ever before to fact-check. So ask. And expect an answer. And if you don’t get one, ask again. Because you really need to know.
It’s your body, after all, and your health. You can’t afford not to know what’s up with it.
I wonder, do you think this could happen anytime soon in Nigeria? Or elsewhere? Speak out in the comments!
The problem sometime is the patient asks, the doctor acts as if the patient is a nuisance thereby intimidating the poor patient. I have had occasions when I tell a doctor my reaction to a particular medicine and he/she goes like that can’t be- making me feel foolish. But I know my body and I know what i feel.
You’re very right, and that’s part of what we doctors need to work on ourselves. On the other hand, people sometimes misattribute symptoms to medication—I’ve had complaints of “side effects” that turned out, on closer questioning, to be part of the condition we were actually treating.
The key for we doctors, I think, is never to discount what anyone says they feel, and to try to make the conversation really a conversation: the patient and the doctor trying to figure it out together, not the doctor insisting on their view.
I totally agree with you doctor, there is no way I will not ask d doctor about the drug in the prescription sheet. It is my health and I must have 100% info on what in going on. The nurses pisses me off a lot saying you can’t see the treatment chat and most of them don’t read the treatment chat to check if any changes has been made before administering drug but as for me, I gave them a run for it when my sister was admitted. A lot of reorientation is needed by our medical practitioners on the gains of fully informing their patients about their health n drugs. And patients and relatives should also please ask questions about the health condition and the drugs been administer. And what on earth happened to Google if you are really scared to ask your doctor!!!! I confirm whatever the doctor says with goggle cos no body is perfect!
In healthcare, Google really is your friend o! Lol! (One does have to be careful of the sites though: there are a good number of disreputable sites handing out dubious info out there. In fact, I will do a post soon on useful resources to check out.)
Thanks for dropping by!
Love this… I think it’s helped me appreciate my tendency to ‘bug’ my doctors even more. But you have a very valid point – if you take ownership of the process of your recovery, you’re much more likely to get results.
Well done! you have raised very important points and it is true that people should take more interest in thier conditions. However, I think many people dont know much about thier sicknesses cos d doctors they see dont care to explain to them and so do not demystify the illness. People then tend to rely solely on d doctors expertise, cos they dont know how they can also help themselves. How do we explain Docs writing prescriptions illegibly, and the pharmacist also refusing to label it. So when you are actively prevented from knowing things bout ur conditions, you end up thinking it’s more dreadful than it actually is. (apologies for d typos- phone probs)
You’re right, and I agree that we doctors still have some way to go as far as communication is concerned. But my point is that it’s also easier than ever for patients to empower themselves. And if we aren’t stepping up fast enough, thenm maybe the pressure from our clients might push us to. Which, I think, is pretty much how most areas of human endeavour move forward.
As for illegible prescriptions, that’s not the intentional thing people often assume it is. It gets pretty tedious to write as much by hand as we do, in a time when we’re all doing less and less longhand writing. Again, not to justify the prescriptions: just to say it’s not an intentional attempt to be cryptic.
I think one reason why doctors have been able to get away with not explaining what the drugs they’re prescribing do & their side effects is cos they’re hardly or never sued for medical malpractice. in the US, the doctor will explain everything to you, and ask if you agree to take it so that it can be on record that it was your decision in the end. Just in case sth happens, he’s protected. Personally, I’ll bug the doctor for what is it he’s prescribing for me and all the info I need. But it’s easier for me cos I rarely ever go to doctors I don’t know on a personal level. I think that smoothes it.
You do have a point, Mark. But that too is changing. They don’t make prime time news, but malpractice suits and medical tribunals are happening here too. I know people. That said, the amount of litigation in the US (the highest in the developed countries) doesn’t help anyone either: it leads to defensive medicine, where you do things just to avoid being sued, even when you probably needn’t. Over treatment and over-testing are part of the consequences of that. Another one is information overload: you tell the patient everything, but it’s more than they can take in all at once. But they sign the paper all the same. (Think the software licence forms many people agree to without really reading them.) And yes, it’s happening here, too.
And, do you have any idea how hard it is to resist a patient who actually expects you to make a decision for them? They think you know enough to, but you’re there trying to give them the options and say, “No you make a choice.” (Consider that in most other professions, you simply tell people what to do and it’s up to them to decide if they’ll do it or not.)
That said, we are still more on the other extreme, and we have a long way to go here in term so of regulation. Not just in the profession, but in all the allied ones as well (think the easy availability of drugs that should really only be available on prescription, for example).
You should keep bugging your doctors, though. I’m sure it helps that they’re often personally known to you, but you can also encourage your friends and relatives to insist on knowing what’s going on.
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