When you go to see a doctor you may assume that he/she will provide you with a diagnosis and tell you all you should know. That could well be a wrong assumption!
Many doctors don’t give you, the patient, all the information you need. Why? is a good question. Maybe it’s because the doctor doesn’t or can’t spend enough time with you.
Maybe the doctor doesn’t think far ahead enough to consider consequences of diagnosis or treatment. Maybe the doctor doesn’t think you can handle the possible outcomes or understand the possibilities. Still, a thinking physician should provide the patient with the information required for him or her to make an intelligent decision.
But what if the patient does not get the information he/she needs? The answer is it is up to the patient to take control and ask questions. A thinking doctor may begin, “Tell me what’s troubling you and why you are here.” Still, it’s up to the patient to ask questions—even if it is embarrassing. Or you’re afraid that just telling the doctor what you fear may make it come true—or a friend or relative suggested something you are afraid may apply to your case. In other words, you must empower yourself to take charge of yourself and your health.
In an OP-ED piece below, Ralph Alterowitz, well known author and sexual counselor, offers advice and help in instances where doctors do not provide information a patient needs. We’ll offer more on this subject as time goes on.
The Doctor Didn’t Tell Me
By Ralph Alterowitz
“Empowering the patient”, so often mentioned, infrequently understood and less often practiced, means the patient should be involved in his or her care.
Medicine used to be much simpler. Go to the doctor, get diagnosed, be told how to treat the condition– sometimes return to the doctor’s office, assess the progress in taking care of the problem–. was the straight-forward, cookie-cutter approach to treatment, regardless of the ailment and the doctor.
After 16 years of counseling cancer patients, the comment I’ve heard most often, is something like “The doctor didn’t tell me that.” With the complexity in medicine, an expansion in drugs available, more information on treating diseases and ways to treat them, it’s hard for any physician to stay current on the nuances. Then, of course, they are limited on the amount of time they can spend with each patient. So many other factors are in the doctor-treat-patient scenario, that unless the patient grabs the empowerment sword, sticks his/her nose into the battle for self-care, the patient is at least partially to blame for problems. Today, most patients have access to the Internet, and that can be helpful in providing needed information when reliable sources are consulted.
Using men with prostate cancer as a sample population rife with “Why didn’t the doctor tell me?” let’s talk about taking a PSA test. Men who are in the higher age groups are now sensitized to PSA tests, biopsy and prostate cancer. And men who have been treated for this cancer agonize over whether the next PSA test will mean the cancer has returned.
Most men will not know (i.e., haven’t been told) that they should not do anything that will irritate the prostate at least 48 hours (I ‘m conservative so I say 72 hours) before the test. That would mean no sex, mainly ejaculation or bike riding. Why? Because both of these affect the prostate gland. Ejaculation causes the prostate gland to contract to squeeze out the semen. Just like any muscle when it works it gets irritated and, therefore, more protein (PSA) is produced.’ If the man rides a bike, the front of the seat can rub the area between the legs (called the perineum) and irritate the prostate, which is directly above, and once again more PSA being produced.
Some doctors will see a high number and become concerned that the man may have prostate cancer.’ Depending on the man’s history and how well the doctor knows him, the doctor may check the patient for another cause such as prostatitis, Usually, doctors will rule out other causes such enlarged prostate and age. (As a man gets older, the 2.5 which is normal at 40, could easily be 4.5 at 60 and higher at 70.)
Certainly, if the man is in the hospital and has been catheterized, everyone should know the PSA will be higher than normal.
Staying with PSA tests, patients and doctors will try to track if the PSA is getting higher and how fast it is rising. This is a bigger problem than one might think. There are several techniques for determining (assaying) the PSA level. Test results are difficult to compare since each technique is completely different. In one case, the doctor divided one sample and put it in two different tubes that were then sent to two different labs. One of the reports showed a normal PSA. The other lab reported a sharply elevated result that would have prompted the doctor to suspect prostate cancer had he not known the patient.
This comparison issue gets even crazier. One man who had prostate cancer had appointments with two doctors several hours apart. Each one drew blood for a PSA test and sent them to the same lab. Obviously, the same technique was used on both blood samples. Yet the results were markedly different. One result indicated that the cancer has recurred.
Regarding PSA tests, levels in blood may vary from day to day and week to week. Authors of a study led by Memorial Sloan-Kettering Cancer Center stated that it is “prudent to recheck the PSA level at least six weeks after an earlier test– before advising a patient to have a biopsy.”
When it concerns the famous “blue pill” ( Viagra) and others like it, many doctors fail to mention that the man must be aroused to even have the conditions for an erection. It could take an hour to get an erection. Taking erection pills often lowers blood pressure. The caution to be given is that people with cardiac disease taking nitrates should discuss this with their doctor. Less often mentioned is that men on blood pressure medications should also bring this fact to their doctor’s attention. The combined action of an erection and an anti-hypertensive pill may cause a man to pass out while making love.
Men don’t often learn that doing the well-known Kegel exercises for at least a month before prostate surgery will help them to retain more of the erectile capability. Nor do they find out that that beginning penile rehabilitation within 60 days of their surgery will help them in regaining erection capability. Doctors may fail to tell them.
Some men take injections to have an erection. Most doctors don’t tell them to press on the site of the injection to control bleeding. Rarely will men see any bleeding because the larger blood vessels are not near the surface. The blood vessels are about an inch or more in from the side of the penis. They can bleed. Unless the bleeding is stopped, they can produce internal scarring that over time will prevent men from being able to have an erection. Pressure must be applied at the site of the injection for five minutes to preclude the scarring.
But paying attention and learning about your medications and tests goes beyond the prostate. You need to be probing about anything medical that you are involved in. For examples, if we go to other blood tests for a moment, take the routine blood urea nitrogen test. High levels can indicate the kidneys aren’t functioning correctly. Two common reasons are that the person may not be not drinking enough water or may be eating too many foods with high levels of potassium.
The bottom line message here is that patients need to check out side effects, precautions and the guidance for any medical procedure and treatment. Ask questions because you have more at stake in treating your condition. What you learn may help and even save your life.
Ralph Alterowitz is co-author of The Lovin’ Ain’t Over: The Couple’s Guide to Better Sex After Prostate Cancer by Ralph and Barbara Alterowitz published by CIACT, Inc Publishing