Complications -- Atul Gawande

In another forum post, I mentioned that I had just finished the book "Complications" by Atul Gawande. Dr. Gawande is a general surgeon at Mass General, and a writer (medical columnist for the New Yorker, I believe). I really enjoyed this book, which covers some of his time as a surgical resident. The name "Complications" sort of refers to the grey areas (not just ethically, but also medically -- things are rarely "black and white") that doctors face.

I found one passage rather striking, and I'd like to excerpt it here (the book was written in 2002):

"Little more than a decade ago, doctors made the decisions; patients did what they were told. Doctors did not consult patients about their desires and priorities, and routinely withheld information -- sometimes crucial information, such as what drugs they were on, what treatments they were being given, and what their diagnosis was. Patients were even forbidden to look at their own medical records: it wasn't their property, doctors said. They were regarded as children: too fragile and simple-minded to handle the truth, let alone make decisions. And they suffered for it. People were put on machines, given drugs, and subjected to operations they would not have chosen. And the missed out on treatments that they might have preferred."

Dr. Gawande goes on to explain that one of the reasons for this dramatic shift in how decisions are made in medicine was a 1984 book called "The Silent World of Doctor and Patient", by a Yale doctor and ethicist named Jay Katz.

I've been one to often complain about "old school" doctors -- this passage sort of make things clearer to me. My best example would be my primary care doctor telling me I needed to take a walk after lunch to handle the excessive afternoon sleepiness I was suffering, or he would ask me about stress when I told him that I would wake often at night and wouldn't be able to get back to sleep.

Something happened just this week -- about a year ago, I was hospitalized over a weekend for reasons unrelated to OSA, but on ER admission in the morning, they noted low O2 saturation. I didn't hear anything else about it, that weekend or otherwise.

Well, I just got my hospital records this last week, and was quite surprised to find mention that I was probably suffering from obstructive sleep apnea and that I should be referred for a sleep study. I didn't hear it mentioned to me at all that weekend, and my primary care doctor never got the report, and it wasn't until about five months later, when I expressed some frustration with him about my sleep issues, before I was finally referred.

If that's not an indication that I need to be in charge of my own therapy (and fully informed), I don't know what is. I have a new primary care doctor now, too.

Guy