Updated May 11, 2013.
Mary Shomon: I can understand all that. What I, and many of my readers have trouble with, is when the doctor's seem haughty or obstinate.
The Shames: Oh, that's a much bigger issue. Health care in general is long overdue for a needed paradigm-shift in doctor-patient relationships. It needs to become more of a co-equal and mutually-sharing partnership for learning and healing. Many doctors are trained to think that an omniscient demeanor is most reassuring to the patient.
In some cases this is true, perhaps mostly with older patients, who have been indoctrinated to believe the doctor is infallible. We believe, instead, that our job is to educate and motivate, rather than dictate. The doctor should be open-minded, willing to try a variety of different medicines, and to help the patients decide which one is really working best for them.
We consider that part of our role as caregiver is to empower and honor the individuals who seek our knowledge, wisdom, and support in safeguarding their health. It is well documented that patients' beliefs play an integral role in healing. It is also well documented that an empowered patient does much better than one who simply follows orders.
We strongly consider that what the patients believe to be good, or not good, for them is of utmost value in planning our approach. If a patient has had negative experiences with certain medications, we respect their concerns and experiences. We encourage health care consumers to be sure to articulate feelings and beliefs about treatment.
If your health provider is not interested in hearing your feelings or beliefs, you may then definitely want to consider getting another opinion.
Mary Shomon: Can you sum this all up into a "nuts and bolts" recommendation list for patients?
The Shames: Absolutely. Here is when a thyroid patient should start thinking about getting a second opinion:
- If your doctor does not explain your lab results or provide the actual numbers (this is especially true if you ask for results and cannot get them at all)
- If your doctor or office representative will not return your phone calls
- If your doctor says that all of this must be in your head, or be stress-related or PMS or menopause related (of course it's all related, but thyroid often needs to be considered as a primary cause)
- When your doctor says a particular symptom you've seen on this website "couldn't possibly be due to low thyroid" (red flag)
- When you've been on the same treatment for years and are still not feeling your old self, but your doctor is unwilling to change anything
- If you are lucky enough to have a cooperative doctor, but he or she has been trying things that don't seem to be working, or are making you worse (your doctor may need some help to find just the find tweaking for you)
The Shames: Here's what we've found is most helpful.
- It is best is to let your primary doctor know that you would consider attending to the second opinion suggestions as a "temporary" trial of something new. If it doesn't work, you'll be content to continue working with your doctor perhaps in another direction, or at the very least, going back to what you had been doing before.
- Tell your primary doctor that you are willing to take full responsibility for any adverse outcome in trying out a second-opinion suggestion. In fact, you are willing to sign such a statement in the chart (this relieves a lot of pressure for the doctor, and puts you in the drivers' seat).
- Let your primary doctor know that you understand that optimal thyroid management is a very individualized and sometimes "hit and miss" situation, that you are perfectly willing to engage in, and that - in fact - you consider it good medical care to engage this way because you are suffering with an "intractable" and perhaps unnecessary disability in your life (that medical lingo will get more of your doctor's attention than simply saying "I don't like feeling tired".)