Monday, September 17, 2007

Do We Really Know What Makes Us Healthy? No! So What Can Couples Do?

This past Sunday’s New York Times had a very meaty article that was both disturbing and comforting – “Do We Really Know What Makes Us Healthy?” The main premise is that epidemiological studies can be so fraught with bias, assumptions of correlations, incorrect correlations, and short-term vision that it becomes almost impossible to know what studies to believe. And therefore, it becomes very difficult to know what advice to follow. The long, sad story of HRT (hormone replacement therapy)– initially a cure for aging for women and ultimately thought to be a precursor to increased risks of heart disease, stroke, blood clots, breast cancer and perhaps even dementia --- is a brilliant example of well-intentioned research gone wrong in the end.

But how is one to know what to trust when it comes to medical advice? The author, Gary Taubes, writes, “All of this suggests that the best advice is to keep in mind the law of unintended consequences.”

For a couple holding hands and wandering through the snaky corridors of medical information, it is so easy to get lost. Especially if the health condition crosses the boundaries of several medical disciplines (like chronic pain, back pain, diabetes, fibromyalgia, headaches, and more), the couple is likely to hear not only more information than is comprehensible, but information that may be contradictory.

In seeking help for my chronic pain, one physical therapist who specialized in pelvic pain told me never to bend backwards, while a myo-fascial physical therapist told me never to bend forwards. Vertical or horizontal were the only positions left – neither one tolerable for too long.

While it is disturbing to hear that we can’t really know what medical advice to trust, it is also comforting to realize that this failing returns a good chunk of responsibility for decision making to the patient and the partner. We can feel empowered to voice our concerns and bring our intuition back into the treatment room.

A STORY:

I waited three months for a follow up appointment with the chief of neurology at a renowned hospital. He had me put on a gown and told me to lie on my stomach. Richard was seated in a chair nearby. As I was automatically moving into place I asked him what kind of exam was he going to do. He replied that he was going to do an epidural to test my spinal fluid for signs of infection, since that was one of the few test left undone. I sat bolt upright and started asking questions about the procedure, its risks, and the likely outcome given my medical history. His responses made the test seem much less appetizing. But here I was gowned and ready. And here he was, credentialed and authoritative. How dare I resist!

Luckily, Richard was there. And this is a grand advantage of going through the medical maze with a partner. Richard was able to hold up the stop sign and voice what I had been feeling but was too stressed in the moment to say – “It sounds like we have some doubts about the procedure and aren’t ready to go through with it today.” I could breathe again.

His intervention also opened up a line of questions I didn’t have the perspective to consider. I now place these questions among the top ten to always be asked:

  • What will happen if we wait a week? Two months? Six months? A year?
  • Are there any alternative ways of getting the same information?
  • What symptoms should we be on the look-out for that would indicate that we should have the procedure done right away?

Making medical decisions is one of the arenas where couples can collaborate brilliantly and use the wonderful advantage of having a listening/sounding board immediately at hand. Even if the relationship is strained and torn by heated issues, couples can try to declare an emotional moratorium in order to work together and bring their combined intellect to bear on treatment decisions.

Ultimately, the decision to take the meds or go through the procedure is the patients; and the patient must rely on his/her trust in the doctor weighed alongside of his/her own research and intuition. The partner can be the voice of gentle challenge to the doctor and to the patient, and can infuse the equation with her/her own research and intuition. This is a situation where two loving heads can truly be better than one frightened, overloaded one.

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