Episode 4 Transcript
Coming up on "Life (Part 2)," the doctor-patient relationship. It's a complex dance, but we'll break down the steps. And later, he was the perfect husband on "Sex and the City," but when Evan Handler barely survived leukemia, he was anything but the perfect patient. Plus, he wrote for "The Dick Van Dyke Show" and "Kate and Allie," which qualifies Bill Persky as the expert on how to age with good humor, all coming up on "Life (Part 2)."
Major funding for "Life (Part 2)" was provided by The Atlantic Philanthropies--engaging many to improve the lives of and achieve health and economic security for older adults. And by MetLife Foundation-- celebrating the wisdom, talent and experience of older adults. MetLife Foundation proudly supports "Life (Part 2)."
[bass, & plucked strings play in playful rhythm; bright in tone]
Welcome to "Life (Part 2)," I'm Robert Lipsyte, and I have a medical fantasy in which I call a meeting of all of my doctors, which currently includes a primary care physician, an ophthalmologist, urologist, oncologist, gastroenterologist, cardiologist, neurosurgeon, dentist, dermatologist, audiologist, osteopath and podiatrist, all of whom I have seen recently, but never as a group.
When I've got them together, I will ask them the 3 key questions. These questions are critical to this nation's healthcare crisis as well as my own.
1. Will you get past your partisanship to talk to each other, so you can treat me as a whole person?
2. will you feel my pain to assuage it?
And 3. Are your hands clean?
Now, that last one is not a metaphorical question. It's hard to ask the healthcare provider who is about to touch your body, "Did you wash your hands?" And that's because most patients are not comfortable enough in the medical environment to ask it in a friendly, non-challenging way. And they're afraid of causing antagonism. We need to be made equal partners in the system so we can talk freely. We need to be calm and assertive as patients, and that's difficult when you feel scared, rushed, and powerless.
The heart of true healthcare reform is about the doctor and the patient finding their way together toward compassionate care. Actually just thinking about all this gives me so much stress I'm going to add a psychiatrist to my fantasy medical staff meeting. But the good news is that I'm sitting with 3 panelists who offer us all a lot of help.
Dr. Michael D. Brennan, an endocrinologist is Professor of Medicine and Chair of the Program in Professionalism and Bioethics at the Mayo Clinic in Rochester, Minnesota, where presidents and kings seek medical care when they're seriously ill.
Dan Shapiro knows medicine from both sides of the sickbed. As a psychologist, he is a frequent therapist to physicians, but he is also a cancer survivor. Dan is Professor of Medical Humanism and Chair of the Department of Humanities at Penn State College of Medicine. His books include, "Mom's Marijuana," which documents his struggle with Hodgkin's disease. When Dr. Esther M. Sternberg felt herself falling prey to the effects of stress, she recognized something that the medical community was missing. Stress can make you sick, and believing can make you well. Her latest book is...
Welcome all of you to "Life (Part 2)." And in our ongoing diagnosis of the medical industrial complex, let's start with you Dan, what's wrong with doctors? Why do so many of them have a hard time seeming to be human with patients?
I think we've got a really difficult system that they're functioning in right now.
About 50% to 60% of primary care doctors describe themselves as being emotionally exhausted a lot of the time. And you can see why. They're seeing 25 to 30, maybe even 35 patients a day. These are very quick interactions. They have to, in very short order, address a patient's problem, come up with a solution, and then do something about it. And there's just this ongoing cascade of people in need and in crisis. And we, as a system, particularly in our medical training programs, haven't really prepared young docs very well for that kind of lifelong term.
Coming out of your kind of rough medical experience in your early 20's, how did that inform the way you deal with doctors now in telling them what they need to do for people like you?
I think I have a sense of what patients are looking for when they come to see them. So that I can help with a legitimate voice say to a young physician, as a patient coming in to get needs from you, I want you to look me right in the eyes and tell me what you think is wrong, and I want you to have some kind of emotion and connect with me in that way.
Dr. Brennan, on the other side, of course, is this needy patient coming at you.
What's wrong with patients?
Oh I think that the patients actually are quite fearful oftentimes of the medical interview with the physician. I think there are ways that they can actually overcome this. It however, should be a relationship between patient and physician. And I think if you look at the really mature clinician, they are the ones who can direct the conversation in such a way that patients feel comfortable. But patients can be very helpful in that regard also, in preparing, for example, for the visit. Because oftentimes, so much of the time is actually spent dealing with things that could have been determined before the patient even came into the office. You want me to come with a list.
Exactly, and the list should include first of all, what are my medications, what is the dose, how frequently do I take them, how long have I been taking them, have I experienced any side effects? The list should include, do I have allergies? And what were the symptoms of the allergy? And also for the patient to have reflected, perhaps, on some of the symptoms so that when the patient goes into the office, you're able to get to the real heart of the matter. I think it's good to have a relative to come with you, particularly for elderly patients. That person maybe can take notes, can add to the conversation, can actually share some observations that the patient may either not know about or is reticent to speak about it.
Let's not cut the difference, Dr. Sternberg, in what very often is a stressful and toxic relationship on both sides. What happens when a person is stressed, is the stress response, those stress centers in the brain take over and prevent you from really hearing.
It's not that they're not listening on purpose. So when a patient walks into the hospital, they're already anxious, they're already anxious about their illness. They're coming into a strange, very intimidating environment. We've, in recent years, forgotten the importance of that doctor-patient relationship, that ultimate belief that that doctor is going to help you heal.
So let's get back to the patient, though, I'm interested in the patient, because I don't even play a doctor on television. You're naked on tissue paper, and you feel rushed. How do we bring that pace down? How do we slow it down? Do you have any ideas for us?
First, we have to be willing to be aggressive sometimes. I think one of the real important issues from the patient's side is to prioritize, to not only come in with a list, but a real sense of what the most important thing to leave with is going to be. And without that, the physician is waiting to figure out what's the one thing that I need to do here?
Here's something that I've noticed and I've spent a lot of time in the country of illness. One of the things that I've noticed that when I go in dressed like this, and when I'm visiting a patient, particularly someone that I'm involved in as a caregiver, I always go dressed like this. First of all, they think I'm a doctor. (Dan) Or a lawyer! That's right, that's exactly right, they think I'm a lawyer or at least that I've gone to college with lawyers and can get one quickly. There's a kind of a class thing here because doctors, even if they were born poor, are instantly upper middle class people in our society. So they do respond to their class. I think it's double-edged though, because I think when physicians practice defensively, or worried, you're much more likely to get useless tests. And that can backfire.
You can be in a much more worried state than if they make a calculation, let me just do--this is not someone who's going to come after me if I get some minor thing wrong, he doesn't really need that test, I don't really need to order it. But if you're hyper-vigilant, you're going to get that extra test.
What happens when I sense that the doctor doesn't like me and maybe are there mechanisms to get another doctor?
I think that that is so unfortunate if that happens. But it can be prevented. I think for patients, when they go to see the doctor, and they have a feeling he or she gets it, they know why I'm here, they know what my concerns are, that opens up a whole great opportunity for partnership. And after that, so many good things can happen, but that is key, I think. I think the patients who physicians don't like fall into some very specific categories. They tend to be patients who have issues that don't resolve, they have issues that are vague and don't seem to fall cleanly into a category, and they're patients who don't participate in their own healthcare. In other words, wanting more medication instead of to lose weight, quit smoking, quit drinking, or whatever else they're engaged in. I think as patients we need to think about what behaviors we might need to change to be active participants and I think that goes a long way towards preventing some of these conflicts.
Now the other thing is, when you do want to change doctors, I had an experience some years ago about to go through a third round of surgery, and I really felt that there was something wishy-washy about my surgeon. I didn't want some guy who was going to pull out a bowie knife and use Jim Beam as his anesthesiologist, but I wanted that up jock, you know what I mean? And this guy was um-hmm, and it was so hard to get another doctor and it became a real political process within the system. Really great doctors aren't threatened in those situations.
My experience has been that really great doctors are much more willing to get on the phone and call for advice around the country, they're much more willing to let you explore options. I think if you're in a situation where a doc is starting to get really defensive and controllingand not wanting you to see anybody else, that's an absolute sign that you're doing the right thing.
When I was the mother of a patient, so when my daughter was sick when she was a child,
I used to upfront tell my pediatrician, "I'd rather that you think I'm a hysterical mother, than that I be wrong one time when she really did need care." And my doctor said, "That's fine, I don't think you're hysterical." Anything that you worry about. So I think that a patient should not...
You did have an advantage, you were a colleague.
But when you're in that situation, you go in as a person. I did not wear my doctor M.D.
on my forehead. And I think that we all, in our lives, we experience multiple, we're all patients at one time, family members of patients, we're professionals, we're doctors, and you're not all of those things all at once. And I get just as scared as any patient when I'm sick.
Have you been seriously ill?
Yes, when I had gone through this very stressful period in my life, I developed an inflammatory arthritis knee biopsies and this and that, and scans, so of course I know what it feels like to be scared.
Walk into a scary place and your stress response is triggered. So we have to do all that we can to build hospitals in such a way that that's diminished. And actually I did, when I visited the Mayo Clinic, I visited the new Gonda Building, which is amazing and is designed by healthcare designers, architects, who take into account all the physical aspects that will help calm, will help-- light, and soothing music and beautiful artwork all around, that as soon as the patient walks in, you feel a sense of calm. Then by the time you get to the doctor's office, you are in a state that is not quite as anxious, and perhaps that will facilitate this kind of interaction partnership in healing.
And on that commercial note... [laughter] Yes!
Thank you all so very much for joining us on "Life (Part 2)."
Before I knew Evan Handler as a featured actor in films and on Broadway and such TV hits as "Sex and the City," "Law and Order," "The West Wing," and "Californication," I was a fan of his doctor-bashing memoir... In his 20's Handler almost died from leukemia. To a great extent, he was saved by being the patient from hell. In his new book......Evan Handler charts his survival into life, part 2.
Evan Handler, welcome to the show.
Hey, thanks very much, glad to be with you.
Evan, you came through a horrific experience of leukemia, which I think statistically should have killed you, but only made you tougher.
Yeah, I was 24 years old, diagnosed with acute myeloid leukemia, which at the time was considered incurable and almost inevitably fairly rapidly fatal. And I managed to be one of the few from that era who survived. It's no longer categorized that way, although it's a very daunting diagnosis still. But it chewed up 4 to 5 years of my life for the most part, and I came out of it, altered by the experience, to say the least!
In one sense there was certain lessons for us, to be more assertive, to be tougher, and yet never with your fury. I think there are great lessons, yeah, I think there's an innate conflict.
Hospitals are places that are designed to deliver adequate medical care to great numbers of people at a time. They're not set up to deliver exceptional medical care to any one person ever. And if you need that exceptional medical care, you have a lot of battles ahead of you to try to make sure it's delivered. And I would have to say that I feel that there is an innate difficulty of 2 populations meeting in really acute care centers.
There are people who are freshly outraged that such a horrible thing could happen to them and their family, there are people, the medical workers, who see it happen to people every single day.
How do you get that population that sees it every day, to be adequately sympathetic and empathetic to the people who are newly horrified?
And I think the medical centers that do the best are the ones who manage to solve that puzzle in a good way.And to, without destroying themselves, really remain open and available to the horror that those newly diagnosed people are going through. But you weren't alone. Your fiancée was there, and your parents, who I gleaned from the book, being more old school, were not able to help you in this new consumerism.
There's a few things. One important thing is, I wasn't alone in terms of my support system, but I also wasn't the only person suffering there and in need, and my survival really took my putting my survival before everyone else's. I found it a him or her or me atmosphere because there were only so many resources to go around and I manipulated the system and cut lines and did whatever was necessary to be the one who got out. And that's just the way it was and the way I experienced it. And I'm open about that.
In terms of support, I had tremendous support. I was rarely left alone, if I needed companionship or protection, my parents did not come up to speedat the speed I would have liked them to, but still, they abandoned everything in their lives, and gave everything they were capable of, and did everything they could to learn as fast as they could. So I had a lot going for me, and I was also willing to step outside the bounds of maybe what polite society considers appropriate in a situation that was by no means polite society.
In "Time on Fire," you wrote that you were a person "impossible to please" and that's what got you through. And then in the new book, "It's Only Temporary," you're still a difficult person to please and in a sense, that got you through to what seems like a wonderful relationship now.
Yeah, you know, the irony of this new book and of the story is that it was a 20-year period after being declared cured of this supposedly incurable illness that I actually found consistent contentment and gratitude in the life that I knew I was lucky just to be living.
How have you acted upon those life lessons now? You're slowly moving up towards 50, you're kind of a tail-end Boomer, what's in your mind?
In my mind is the conflicts that used to exist so strongly in my life aren't there so strongly anymore. I have a much greater sense of ease about my existence on the planet, about, I suppose, the inevitability of our mortality, and a lot of these came from achieving things that were important to me. One has to do with career success and one has to do with finding a mate, and those are both things that I felt very deprived and cheated of when it seemed my life was going to end early, and now that I've been lucky enough to accomplish both, now the new conflicts have to do with feeling very calm and settled for having gotten those things and feeling like that means I could die a happier man and a sort of neurotic terror that feeling like I could die a happier man is more likely to let that happen sooner than when I was miserable and trying to stave it off.
You obviously can never be pleased.
[laughs] That's not true; I'm pleased every day of my life. Maybe I can never reduce anxiety to zero, but I can be very pleased.
Do you think that there's a difference in the way that you're treated now, that-- your surge in popularity?
Hm, I haven't really noticed that, no. I think there are certain doctors that treat me differently knowing what I've been through and knowing why it has shaped me into the one person that I am and who I have an appreciation for, of course you want to investigate this, of course you have some concern, and of course you don't want to spend an unnecessary amount of time feeling unwell right now. Then there are other doctors who don't respond as sympathetically and with as much sophistication and understanding and I just have to try to not spend a lot of time with them.
I think a doctor who meets someone after such a real true trauma, would be really well served to understand some of the psychology of that person, and there are some doctors,
I've found who do that, and those are the ones that I hold close.
Well, extending that to whether you go into car repair, or a major medical center, how do we as consumers, which ultimately we are, sick or well, how do we deal with it?
Well, I've long said, they change when the paying customers refuse to give the business to the places that aren't doing it in the ways that they want to receive it. And that's what it's always going to take. And from the other side of it, I have car mechanic issues right now in my life, and it's not easy to find a good one and it's not easy to keep from getting ripped off, even for me with all my experience.
So it's really a daily thing that everyone faces of, how do you arm yourself not to be taken advantage of in the world? It's just extraordinarily ironic to think that the same things exist when it's actually your life on the line.
Yeah, there is a difference between your car dying and you dying. There certainly is, yes. Unless you've got your priorities awfully mixed up.
Evan, thank you so much again...
(Evan) Sure thing.
...for being with "Life (Part 2)."
Bill Persky is a comedy veteran. His credits as writer, producer, and director include "The Dick Van Dyke Show," and "That Girl," as well as "Kate and Allie." But 8 decades on the planet, most of them in show business, take their toll, which means that when he's not writing, Bill Persky has another full-time job, producing and directing his own health.
Just when you thought you were getting ready to retire, you're about to start a whole new career as a maintenance man. It's America's fastest-growing industry of guys like me whose full-time job is taking care of themselves. And I have some tips for those of you who are about to enter the field.
Doctor visits are a big part of your new career, since there is now a specialist for each of your body's 289 moving parts, some of which will stop moving.
Here are a couple of suggestions that will help mentally if not physically.
Don't get upset until you've waited at least an hour-and-a-half after your appointment time, it's perfectly normal.
Get them to handle the insurance and get samples of any and all prescription drugs even if you're not taking them. You probably will and someone you know already is.
Because the average maintenance man is on at least two of the following, a stat in for cholesterol, something for arthritis, high or low blood pressure, eyes, digestion, and of course, prostate.
Throw in a couple of vitamins, occasional Viagra, and it's about 10 pills a day, all to be taken with a full glass of water. That makes 8 p.m. the end of the safety zone, when, not if, you have prostate problems.
Exercise is important, but don't waste time remembering how you used to be. This also pertains to sex. As your memory fades, and it will, two fellow maintenance men are needed to help you recall the dates, places and names that don't really matter but cause untold concern just because you can't remember them.
For the times when you wake at 3 a.m. and desperately need to remember the name of a bit player in a movie you didn't even like, and the other 2/3rds of your memory aren't available, running through the alphabet usually helps.
The second time through, you'll probably fall back to sleep. When you can't remember the alphabet, see one of the previously mentioned specialists.
Most important, when you enter this new phase of your life, be sure to maintain a sense of humor.
And that reminds me, it's time for my pills.
For now, that's it for "Life (Part 2)." I'm Robert Lipsyte, thanks for watching.
See you next time, older and better.
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Major funding for "Life (Part 2)" was provided by The Atlantic Philanthropies--engaging many to improve the lives of and achieve health and economic security for older adults. And by MetLife Foundation--celebrating the wisdom, talent, and experience of older adults. MetLife Foundation proudly supports "Life (Part 2)."
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