Posted by Thomas Repas, DO, FACP, FACE, CDE January 8, 2009 10:45 AM
Most people would not dream of directing a cardiologist how to perform cardiopulmonary resuscitation during a cardiac arrest. They also would not come in to see the surgeon with a specific outline on how to do the procedure. Most would decline to have their surgery done in the same way and with the same techniques as in the 1970s. Despite this, many intelligent, otherwise reasonable people have no hesitation trying to “teach” me about the thyroid. Many of these same people also request to have their thyroid disorder managed similar to how we did decades ago.
Why is this?
There are several reasons. For one, despite the advances made in technology, scientific knowledge and outcomes over recent decades, modern medicine has failed many patients from a humanistic perspective. It is not too much to expect for questions to be answered and treatment options explained. Everyone desires to be listened to and heard. There is nothing more discouraging than when one’s symptoms are ignored. I have witnessed this myself when I and family members have been patients. It is extremely frustrating. Not surprisingly, some pursue alternative options.
Some believe in a more natural approach towards health. Their goal is to minimize the synthetic, processed and man-made. I actually understand this philosophy very well. My family and I grow a large portion of our vegetables organically. We enjoy the sense of connection with the land and the seasons. We take pride in knowing that we participated in the sustainable production of our food. If someone presented to us a well-crafted, scientifically valid argument as to why there is no benefit to organic vs. conventional gardening, we would smile, nod and keep doing what we are doing. We garden organically as much on philosophical grounds as any other reason.
For me to argue for patients to change someone’s belief system based on science is equivalent to attempting to convince them to change their religion or political party on the same grounds. It would be futile as well as absolutely inappropriate.
Health care is different, however, because there is the potential for harm as well as benefit. I am obliged to inform my patients about the positive as well as negative potential consequences of one option over another. This is true no matter if we are discussing alternative vs. more mainstream therapies. However, I realize that I am only one advisor among many. My duty is to provide the most accurate information possible. Patients are free to choose for themselves how they would like to proceed.
Finally, last week I saw a woman who had been on desiccated thyroid for decades. I explained that we now prefer levothyroxine instead of desiccated thyroid. I also quickly pointed out that her thyroid-stimulating hormone has been perfect, between 0.7 mIU/L and 1.0 mIU/L over the last several years. She had no symptoms; it was difficult for me to argue with success. After discussing and asking her what she wanted to do, she left my office still on desiccated thyroid.
Comment by Tom Repas DO FACP FACE CDE — June 12, 2009 12:24 PM
Hello all – I continue to read the comments posted on this and related threads.
I appreciate everyone sharing their insights and experiences. I haven’t responded to every single posted comment because the sheer volume makes it impossible.
I also get the impression that no matter what else I might add, it would be futile and encourage only further attacks.
I confess to purposely choosing a subject which many are passionate about — and which many of my peers avoid discussing at all.
However, if we take our respective positions, dig our heels in and never talk to those with differing opinions, how will medical care ever progress and improve?
Rather than avoiding talking about such topics, I usually prefer to meet them head on and encourage — not discourage — conversation. I’ll do that even if I know that everyone does not agree with me. I could have written about something or taken a position that everyone agrees with — but that would have been too easy.
Several endocrinologist colleagues have told me I’m crazy for writing about such a sensitive issue and in a way that I know would be sure to make me a target.
They are probably correct — but then I’ve never been known to be one who takes the easiest route, simply because is it easy. Don’t forget, I run ultramarathons in my spare time because marathons are “too easy.”
We might not agree on many things but I appreciate everyone sharing their thoughts, opinions and experiences. It actually has helped me in discussing this issue with patients in my own practice.
You have been heard — loud and clear.
Thank you all again for commenting.
(Please DO NOT accuse me of being patronizing — I sincerely do appreciate your comments, even if they differ from my own).