How do I make a medical decision? Part I

Be sure to visit Medical Decision Making Part II at Medical Decision Making Part II

A weekday supplement to the Denver Post featured Bob Moore of Bob's Red Mill on its cover this past spring.  If you don't know who Bob is, you must not be into the rising nuts, seeds, and stone-ground, gluten-free flour scene.  Bob's Red Mill is an Oregon-based company which has been stone milling whole grains, seeds, and nuts for nearly 50 years.  After just one look at his picture on every Red Mill product, you'll agree with me this octogenarian not only looks a decade or more younger than he really is, but he could easily be dubbed the "Gerber Baby" equivalent for the geriatric set so round-cheeked, pink, and glowing is he.


So when Bob extols the virtues of flaxseed in this article--"One of the healthiest foods on Earth! You should have a tablespoon of that every single morning of your life. I do."--no surprise that I pulled the sack of unused flaxseed off my shelf and started doing just that, ground up a tablespoonful that very day and every day since into my morning bowl of nuts and seeds. A no-brainer decision this one; flaxseed is cheap, and a search on pubmed.gov for 'flaxseed and health' yields 407 results, whereas 'flaxseed and dangers' returns none. Be sure to grind it before you eat it, warns Andrew Weil, or it will come out the other end unchanged and undigested.  But I digress, the health benefits of flaxseed can wait for another day, another post.


I wish all medical decisions were so simple and straight forward.  Alas, more often than not, they are complicated by emotions, belief systems, current medical evidence, conventional wisdom, Wikipedia, your doctor's latest patient, and your sister-in-law's cousin's experience last fall.  Since I semi-retired last fall, I have been particularly impressed by the power of an established partnership between patient and physician.  When I fill-in for clinics short on docs, all patients I see are as new to me as I am to them. Whether I am talking them out of an antibiotic prescription ("...but Dr. M. always gives me antibiotics, I will get terribly sick if I don't start them now") or urging them to change their usual meds ("Your blood pressure is not at goal, and has been unacceptably high for months"), when they fold their arms across their chests and regard me through lowered brows, I know we're going nowhere without that element of trust.


Fortunately, most decisions are not urgent, and most can wait for another day, another doc, an Internet search.  Those that are have an element of duress where haste trumps trust as the deciding factor. The young man doubled over in pain whom I bundled into an ambulance last week for a quick ride to the nearest hospital for an emergency appendectomy will probably neither remember my face much less my name.  Other times, finances over relationships determine decisions as in the day I told a man, thin as a rail with anemia and an enlarged spleen, that he needed evaluation for cancer. My inability to speak his language did not influence his decision-making process but a lack of insurance delayed follow-up by nearly two months.


So far, we're only talking information-gathering here--who or what is your trusted source. Are you fortunate enough to be partnered with a doc you've known for years? Perhaps it's a Santa-Claus-look-alike grist mill operator, or a vascular surgeon young enough to be your grandson who's just out of one of the nation's top fellowship programs.  Are you having trouble even defining your problem prior to researching solutions? 


What are your go-to sources for medical facts?  I'd love to hear from you.