second guessing a doctor

[kaysixteen]

So I have this ongoing degenerative eye disease, 'diabetic retinopathy', which I have had for about a dozen years, and which has always been much worse in one eye.   Both eyes had been stable for probably about 4 years, and I did have a comprehensive exam two months ago, and was told I was in good shape, come back in a year.   But less than a month later, it flared up badly, in my heretofore good eye.   I called for an emergency appt, with a doc I had seen in the past, having seen other docs at the practice for the last couple of years.   She looked at it and gave me a steroid injection, which is not a permanent solution, is less invasive than the laser treatment (which is usually a cure, unless the dissease rebounds).   She did not ask me whether I wanted the laser treatment, which I admit I thought she would give me, but I have had these shots before and they have been effective.   She made another appointment for me to come in in two months (shot cannot be given quicker than 28 days), and told me she might take the eye picture scans then as well.   Problem is, this shot has not proved effective.   Really, it has not.   I have been thinking about calling up and getting another appt to go in starting next week, when I would have hit the 28 days and she could theoretically give another shot, should that be her wish, but I am not at all comfy with second-guessing her, and I do not want to piss her off.   Yet, as I said, this shot has been ineffective.   I am really very reluctant to go all PhD on MDs-- I have seen this woman off and on for 8 years and she does not know I have one--  I probably should learn to become more assertive with MDs?   thoughts?

[mamselle]

Your degree has nothing to do with it.

You're a patient for whom a treatment plan hasn't worked.

Just call, let the service know the status of your situation calmly and objectively.

They know stuff, too. Like, preferred treatments might become ineffective after a time, there may be something else going on which is why the shot didn't "take," whatever.

It's a conversation, not a competition.

You both have the same goal in mind: to restore health, generally, to your system.

I'm guessing your worry about this is blurring your inner sense of vision, making you wish you had some advantage in the situation, and educational status just crept in there peripherally, somehow.

It's a distraction. Ignore it. (You also don't have hands-on treatment experience and ward training, whatever your diploma may say about the letters that follow your name. 48-hour on-call ICU duty? Sixteen op preps in one day? Three weeks' rotation of nights?)

Your MD always prefers to hear earlier rather than later about a treatment result because trying the next thing on the list is more likely to work if complications from a delayed assessment haven't set in.

But--meant kindly--Get over yourself and just call.

M.

[apl68]

Your degree has nothing to do with it.

You're a patient for whom a treatment plan hasn't worked.

Just call, let the service know the status of your situation calmly and objectively.

They know stuff, too. Like, preferred treatments might become ineffective after a time, there may be something else going on which is why the shot didn't "take," whatever.

It's a conversation, not a competition.

You both have the same goal in mind: to restore health, generally, to your system.

Your MD always prefers to hear earlier rather than later about a treatment result because trying the next thing on the list is more likely to work if complications from a delayed assessment haven't set in.

But--meant kindly--Get over yourself and just call.

M.

Seconded.  Tell your doctor that the treatment isn't working and ask some questions about why and what else might be possible.  And listen carefully to her answers to those questions. 

I'm guessing your worry about this is blurring your inner sense of vision, making you wish you had some advantage in the situation, and educational status just crept in there peripherally, somehow.

It's a distraction. Ignore it. (You also don't have hands-on treatment experience and ward training, whatever your diploma may say about the letters that follow your name. 48-hour on-call ICU duty? Sixteen op preps in one day? Three weeks' rotation of nights?)

Mamselle has a point here.  Several times over the years you've trotted out your educational credentials and seniority as evidence of entitlement to some sort of deference in some situation or other.  Maybe this is frustration over a lack of agency in your life speaking?  At any rate, the world doesn't really work that way.  Nor should it necessarily do so. 

I work all the time with a variety of people who have nowhere near my level of education.  But that doesn't mean that they don't sometimes know things that I don't.  When I'm working with landscaping contractors, or HVAC technicians, or IT contractors I ask them questions, make suggestions, and tell them what I, the customer for their services, need done.  I also listen to what they say and am prepared to defer to their expertise in some situations.  It's the same with staff members that I supervise.  I'm the educated library professional and the official boss.  They're the people who work most directly with the public.  They see stuff that I don't, and I have to listen to them and take that into account when making policy and forming judgements.  There's one staff member in particular who is very poorly educated and not at all well-spoken.  She nonetheless has an ability to observe things that I may miss, and I've learned always to listen to her when she has something to bring up. 

Our particular academic skills and education are just one piece of what it takes to run society.  We're only one little part of society.  We need to remember that in our day-to-day lives. 

[Wahoo Redux]

So sorry to hear about your troubles.

As someone who has cared for two elderly parents, one of whom died of cancer and another who contracted but survived COVID, and an elderly MIL with very many health complications, be very polite but assertive with your doctor.  I imagine you will be on the phone with the nurse; be assertive, explain and don't be put off.  Put other considerations aside (who cares if they think you are PhD-sooty?  It's their job.  They have liabilities) and firmly press your health issues.  Modern healthcare is a traffic jam, anyway, best get on this.

Honestly, your doctor would want to know.

Hope all goes well.

[Caracal]

Trying to do your own research on medical things can get academics in trouble. The problem is that differential diagnosis and treatment superficially seems like it works in the way other research does, but it really has its own rules.

In this case, it doesn't really seem like you would be second guessing your doctor. Presumably she prescribed the steroid treatment because it is less invasive and often fixes the problem. She wasn't making a judgement about whether it would work, she was playing the percentages. If you go back and report no improvement, that doesn't mean she screwed up, and she's not likely to view it that way. It just might mean that since option A wasn't effective, it's time to go to option B. Or who knows, maybe sometimes a second shot does the trick.

You can obviously ask questions and make sure you understand her reasoning, but there's no reason to feel defensive about it.

[apl68]

Trying to do your own research on medical things can get academics in trouble. The problem is that differential diagnosis and treatment superficially seems like it works in the way other research does, but it really has its own rules.

In this case, it doesn't really seem like you would be second guessing your doctor. Presumably she prescribed the steroid treatment because it is less invasive and often fixes the problem. She wasn't making a judgement about whether it would work, she was playing the percentages. If you go back and report no improvement, that doesn't mean she screwed up, and she's not likely to view it that way. It just might mean that since option A wasn't effective, it's time to go to option B. Or who knows, maybe sometimes a second shot does the trick.

You can obviously ask questions and make sure you understand her reasoning, but there's no reason to feel defensive about it.

Yes.  Nobody's trying to dismiss your concerns, or telling you not to speak to the doctor about them.  Just try not to come across as defensive.

[AmLitHist]

Kay, wishing you all the best.  I'm dealing with diabetic eye problems myself, though much less scary for now (cataracts).  Don't be scared to talk with your eye doctors; as others have said, they're there to help and would rather know if something isn't working sooner, rather than later.  Good luck to you!

[Vkw10]

You are providing feedback on treatment, which is your job as a patient. Your doctor will have questions, which you'll answer, so your doctor can propose next steps. Your degree isn't relevant here; your experience with your body is. Call and report that shot isn't helping this time, that's a fact your doctor needs to know.

Give doctor facts about how you responded to treatment this time and give her a chance to address those facts. Afterward, you could mention that you've read about laser treatment on [CDC, Mayo Clinic, American Diabbetes Assn, other reliable] website and wondered if you might be a good candidate for it. That's an invitation to discuss option that acknowledges your doctor has to consider multiple factors in recommending treatment.

[kaysixteen]

Random responses, in no particular order:

1) thanks very much to all answerers
2) several of ye, nonetheless, misunderstood me, and I will take responsibility for this.   I am emphatically not going all PhD on her- I am afraid of her.   Like it or not.   She is older than I am, a top-credentialed expert, and speaks with a distinguished European accent.  And she is a woman, and I am sadly cognizant of the possibility that latent male chauvinism may impact how I react to her, so I have worked overtime over the years to try to countersuggest myself and override any such.  This practice is also extremely busy, and we are bang-bang in and out of there all the time, and this is even worse whenever, as has happened maybe 3-4 times over the years, I have to go in for emergency appointments.
3) That said, I do know I have to be more assertive in dealing with this not insignificant health issue-- indeed, this is the first time any such treatments I have received have not shown immediate and clear efficacy, and this particular eye has had almost no treatment of any kind in the past .  For the first time I have actually developed some fear for the long-time future of my sight.   Diseases evolve, and this one changed really quickly in this case, and, whether or not it is stabilized quickly and for the at least mid term, I need to discuss with her, and with my PCP, what changes to my overall diabetes management will doubtless be needed here.
4) I have not had any laser in this eye for at least 7 years, but I have had it, and much more extensively in the other eye.   Which I suspect is why the doc did not want to do it as a first recourse here, because, like it or not, it is much more painful than the quick in and out injection (done of course after the eye has been thoroughly numbed up), and when I have had her do laser treatments in the past, I was not a particularly happy camper.   I probably won't be one again, either, but it does appear to be necessary.

[mleok]

Not sure why you think your PhD is in any way relevant to this, particularly since it's not in a field that has anything to do with your treatment.

[Ruralguy]

I think that was a distractor....mentioned twice that he wasn't going to make it relevant, which I assume meant that he wasn't going to be arrogant about it?  Anyway, it's a giant distractor since indeed it had nothing to do with anything else?

[OneMoreYear]

Kay, I'm sorry to hear you are dealing with this. 
I agree with Vkw10 that this is not necessarily about second guessing your physician (she proposed a treatment (the shot) and you tried it). It's about giving her feedback about the efficacy of the treatment she provided. If she's in any way a good physician, she'll want to know how you responded to the treatment, and, if it didn't work, she'll want you to let her know, so she can propose a change in your treatment plan. I do hope you are able to contact her office to express your concerns and that you are able to get an appointment soon.

[kaysixteen]

You make a good point, actually, that I need to qualify, something I have been thinking on:  she did not 'propose' the shot treatment, she decided it, essentially presented it as a fait accompli.   I was expecting, given the severity of the bleeding incident, to get the laser treatment, and wanted it, because of its permanence, but when she just said 'let's do the laser', I acquiesced without saying word one.   I  am wondering whether I should have made my preference known, or indeed, whether it would have been my place to say so.   Recall those sadly ubiquitous American tv commercials for various prescription meds, saying 'ask your doctor about Miraculo Med'.... it would never occur to me to do that, as a doc knows what I have and knows what meds I should be taking, so 'asking' about some med you saw on the idiot box ain't nothin' like asking the server at Applebee's whether the fajitas are good...

[lightning]

Your degree has nothing to do with it.

You're a patient for whom a treatment plan hasn't worked.

Just call, let the service know the status of your situation calmly and objectively.

They know stuff, too. Like, preferred treatments might become ineffective after a time, there may be something else going on which is why the shot didn't "take," whatever.

It's a conversation, not a competition.

You both have the same goal in mind: to restore health, generally, to your system.

Your MD always prefers to hear earlier rather than later about a treatment result because trying the next thing on the list is more likely to work if complications from a delayed assessment haven't set in.

But--meant kindly--Get over yourself and just call.

M.

Seconded.  Tell your doctor that the treatment isn't working and ask some questions about why and what else might be possible.  And listen carefully to her answers to those questions. 

Very good advice from M. and API.

As much as we would like to demand that the medical profession is 100% spot-on, the medical arts simply have not gotten there, yet, and there are no better options for medical treatment than going to someone with an MD and their staff. I get what you are feeling though, kay16. For the kind of money that MDs make, we expect more.

[Caracal]

You make a good point, actually, that I need to qualify, something I have been thinking on:  she did not 'propose' the shot treatment, she decided it, essentially presented it as a fait accompli.   I was expecting, given the severity of the bleeding incident, to get the laser treatment, and wanted it, because of its permanence, but when she just said 'let's do the laser', I acquiesced without saying word one.   I  am wondering whether I should have made my preference known, or indeed, whether it would have been my place to say so.   Recall those sadly ubiquitous American tv commercials for various prescription meds, saying 'ask your doctor about Miraculo Med'.... it would never occur to me to do that, as a doc knows what I have and knows what meds I should be taking, so 'asking' about some med you saw on the idiot box ain't nothin' like asking the server at Applebee's whether the fajitas are good...

There's a whole culture now around being in charge of your medical care. There are some good things about that model, but it doesn't work for everyone and it doesn't have to. Your doctor presumably has lots of experience dealing with this condition. If that experience made her think that the less invasive quick treatment is the best thing to try first, there's no reason she necessarily needs to walk you through all the other options.

It makes me really anxious when doctors defer too much to me about next steps. I don't want to be presented with the option of getting a test or having a treatment unless the medical professional thinks it is indicated. Obviously there are times when a decision is going to depend on my preferences about pain or discomfort or inconvenience, but even in those cases I really want doctors to give me the options in those terms, not ones that require me to make the medical decisions. "We could try this treatment, which is less invasive. Waiting won't make anything worse, but we could also just go to the minor surgery. That has a pretty high success rate but the recovery is a pain, so its mostly about how much this is effecting your quality of life now and how you'd weigh those factors."

Doctors are also just people. It might well have been that she had a bunch of appointments that day, was running behind, did a perfectly good job with the medical decision making, but forgot to explain it to you or give you an opening to ask questions. Sometimes after I have a student meeting, I realize I ran through things too quickly and didn't give the student enough time and space to raise any concerns they might have. I'm sure doctors have the same thing happen to them.