Lately, I get the feeling that I’m doing something wrong.  I’m supposed to form a partnership with my patients.  My patients are supposed to be the working partner and I’m supposed to be the consulting partner.

My job as the consulting partner is to offer sagely medical advice to the boss (working partner).  As a consultant, I’m supposed to help in the making of key decisions, find the appropriate tools to help make the boss healthy and happy, and instruct the boss in how to implement those tools should he decide to follow my advice.

As the boss and working partner, my patient is supposed to weigh his options, institute those procedures and treatments as prescribed and to keep me updated on how he is doing.  His job should also entail reviewing key health decisions with me prior to making changes in his overall healthcare.

Lately, my patients have been making unilateral decisions.  In other words, they have not been consulting with me, their doc, prior to changing or stopping their medications or other treatments.  While it is well within their rights to institute or stop any medical intervention on their own, it is often wiser to utilize the services of a trained consultant/doc.

This latest trend toward patient autonomy baffles me.  Yes, the Internet is full of information and advice; however, the Internet’s info and advice is uncensored, impersonal, and biased.  Much of what the Internet claims is gospel is really the carefully disguised marketing of junk.  The legitimate, scientific data that can be gleaned from the Internet often exists in a vacuum.

Case in point.  When researching Actos, a medication used to control diabetes, the Internet will inform you that recent studies suggest that the use of Actos may be associated with a rare form of bladder cancer.  While the operative words are “may be” and “rare,” the only thing my patient sees is “cancer!”  Rather than coming in to discuss this new finding with her doc, my patient stops her Actos.  Three months later, her blood sugar is out of control.  Her kidney function is now abnormal and her primary disease, diabetes, is having its way with her.

The Internet failed to inform my patient that Actos was instrumental in the control of her diabetes.  The Internet failed to inform my patient of the benefits of being on Actos.  The internet did not know my patient.  It did not take into account her individual needs or the damage done by invoking the fear of “cancer!”  As a consultant, my job is to take all of those factors into account.  My job is to “care” for the individual.  The Internet is “careless” (without care) by its very nature.

So, what am I doing wrong?  I’m in the office 5-6 days a week.  When I’m not in the office, I’m on call.  I don’t leave the office until every last one of my messages is dealt with.  I write this column daily, teaching people to be self-empowered.  Maybe that’s the problem.

Perhaps the problem is that people underestimate the risk of being empowered and making unilateral medical decisions.  Stopping the wrong medication can lead to heart attack, stroke, or even death.  Stopping other medications can lead to uncomfortable or dangerous withdrawal symptoms.  Deciding not to do critical tests can cost you your life or diminish the quality of the life you have.

Yes, the patient is the boss.  Most successful bosses have trusted consultants who help them stay ahead of the game.  Form a partnership with your doc.  Use him or her as trusted consultants before making any healthcare decisions.  The life you save may be your own.

Stewart Segal is a family physician who blogs at Livewellthy.org.

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