Create fear to achieve compliance

The good physician treats the disease; the great physician treats the patient who has the disease. 

~ Sir William Osler

This week, my husband had a follow-up appointment with a neurologist at the hospital that managed his last stroke.

The doctor was happy to hear how functional and healthy Dave had been feeling since the strokes. 

We were grateful for the time and attention the doctor took to listen, assess, and advise. He was a nice guy who showed genuine interest. 

Unfortunately, he resorted to using a paternalistic approach to patient care.

Creating fear to achieve compliance

Just as with the electrophysiologist who told my husband to "just take the friggen pill and go live your life, the neurologist shared anecdotal stories to create fear to ensure compliance with the prescribed anticoagulant (a more current blood thinner). 

He showed us the scar tissue appearing in the left and right hemispheres of Dave's brain from a scan done a day after the second clot. He said unless my husband took the medication daily as prescribed, within a decade, he'd be vulnerable to another stroke that he was unlikely to survive. He shared stories about a local billionaire and a bank CEO who had just suffered such events.

When my husband shared his belief in neuroplasticity, or the brain's ability to rewire itself for improved function, the doctor acknowledged that it is possible. 

Having carefully read the Catholic hospital's vision, mission statement, and core values, I felt empowered to advocate on behalf of my husband. I shared observations and asked questions that might help reveal potential underlying causes of his suffering. 

That's when the doctor admitted that conventional medicine does not yet have the tools to personalize care. He hopes that AI will facilitate a more patient-centred approach. 

I explained why a disease care model that manages symptoms with a one-size-fits-all approach that often prescribes drugs for life does not resonate with our core values. He understood.

Sensing a hint of helplessness, I felt compassion for him. We thanked him for his time and consideration and my husband assured him he would continue to take the drug.

On our way out to the car, we encountered and exchanged best wishes with at least a half-dozen priests. I wondered about the significance of that.