Don't Shoot the Messenger

I thought I lost a patient a few weeks ago. No, he didn’t die, but after his office visit, I had the distinct impression that he might not come back. My job is to take care of my patients’ health. But sometimes I’m just the messenger. I report lab results to them, explain diagnostic studies, or interpret what a consultant has to say.

This patient is in his late 50’s and his first visit was just over four years ago. At that time he was already on a dozen medications for diabetes, high blood pressure, high cholesterol, insomnia, arthritis, reflux, and allergies. His “numbers” were actually quite good, with his diabetes, cholesterol, and blood pressure under adequate control.

He weighed 236 pounds.

I would regularly encourage him to lose weight, explaining that diabetes, hypertension, and elevated lipids could be controlled with weight loss. Losing weight would also take the stress off his painful lower back.

Then in 2008 he saw a specialist for abdominal pain and kidney cancer was discovered. He had his kidney removed without any complications. His weight after surgery was up to 244. I had often suggested Weight Watcher’s because I feel the program can be quite successful in motivated patients, but he said he just didn’t have time for it. He was too busy traveling around the state.

Considering all his ailments, his “numbers” remained good.

He came in for his routine visit and to review recently drawn lab work. Having only one kidney, his renal function studies were a bit higher than normal, as were his triglycerides. His blood pressure was also a little higher than normal. He was still on over a half dozen medications. His weight was 249 pounds.

I explained that I didn’t want to add any more medications, and that losing weight was the key to improving his health. He immediately became defensive, “You just don’t understand, I’m caring for a sick family member, I have to drive all around and just grab food wherever I can.” I explained that he was about the same weight as he was four years ago, so if he would just eat 250 calories less a day, he would theoretically lose two pounds a month, and two years from now he would be about 200 pounds. I told him not to eat the top of the bun on the quick burger that he grabbed, that was 100 calories. “Well, I’m driving; I have to hold onto it with something.” I told him that not only shouldn’t he be eating while driving, he should also avoid the dangerous habit of talking on the phone while driving.

At that point I sensed the visit needed to conclude. I told him I’d see him in a couple of months and he went up to the front desk. I told my staff a few minutes later that I didn’t think he’d be coming back. They said that he told them, “Dr. Lubin doesn’t listen to me; he doesn’t bond any more with me.” I’m not sure what else I could have told him. Should I have assumed my Dr. House personality, screaming at him while waving a cane? Would he then have listened and followed my recommendations? Maybe, but I couldn’t really do that, even if I felt like it.

Sometimes you may not like what you hear from your doctor, and you may ignore what he tells you, but please, please, don’t shoot the messenger.

PS -- He came back.