This question originally appeared on Quora: What are some things that doctors know, but most people don’t? Answer by Joanna Bisgrove, family medicine physician.
I can’t cure your obesity by handing you a pill. I can guide you, give you information and tools on healthy eating and exercise, but ultimately you need to take responsibility for your health and lose the weight to stay healthy.
Likewise, I can’t wave a magic wand and make your pain go away. Many people hold the unrealistic belief that medications should make their pain disappear. Let me make this clear: that belief is unequivocally false. Take narcotics, for example, which are in the same family as heroin and therefore potentially addictive. Many patients become upset when their narcotics don’t take away their pain. What they don’t realize is that narcotics work by dulling the nervous system, which diminishes the pain temporarily. They do nothing about the source of the pain, and as soon as the medication wears off, the pain is back as bad as it was before.
There are other classes of pain medications which can help diminish the pain temporarily, and some which will help diminish the cause of the pain, making longer lasting pain relief. Ultimately, however, the goal of pain control is just that—control. We can’t make the pain go away, but we can help keep it from taking over your life. To do this usually requires what is known as a multi-disciplinary approach: pain control involves medications, changes in diet, various forms of exercise (yes, exercise), physical therapy, chiropractor in certain cases, massage, injections, and psychotherapy (how well you can mentally handle the pain actually determines how bad the pain will be—the worse your coping skills, the worse your pain). Most of these things need to occur simultaneously, which means the patient needs to be engaged at all times. The luxury of passively letting medicine cure all of your ills simply isn’t possible.
The most important thing that doctors know that most people don’t is the limits of what medicine can do.
Probably the most important limitation of medicine is that it cannot keep us forever young, nor can it prevent death. Death is unavoidable in life—we will all die someday. I recently read an article about how doctors die. Usually we die quietly, without much medical intervention. We have seen too many times families who, in the grips of fear, pray for a miracle and ask us to do “everything.” What families don’t understand is that often “everything” merely gives their extremely ill loved one a prolonged, tortured death. I’ve even read one doctor say that is akin to telling us “to do things we would never even do to a terrorist.”
So, when we ourselves are faced with a terminal illness, we know the limits of medicine and we know that we don’t want to die alone, in pain, in a hospital or nursing home. So, we opt for hospice or other comfort care measures and spend our last days with our families and loved ones. We know to tell our loved ones what we want, we know to put our wishes in writing, and we know to tell them it’s really okay to let us go when the time comes, so long as they are with us to see us off on the journey.
I spend much of my time educating my patients on how to take command of their own lives and their own deaths. I tell them my goals and philosophy—to keep them as healthy and active for as long as possible, then help them be in control of their care until their very last breath. I haven’t had a patient disagree with me on that, and when I phrase it that way, then they are open to how I plan to help them accomplish these goals.
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