When should we go to the Doctor?

Of all the issues that I have dealt with recently, this is the toughest. Many of us who have worked hard and studied hard to find the best possible lifestyle believe that our habits, eating style, exercise, stress reduction, and family/community life help us to avoid using the health care system. I realize that there is a certain amount of bravado here. I do believe, however, and this belief has been reinforced by the physicians whose advice I respect, that leading a healthy lifestyle, especially an excellent eating style should keep us away from doctors and hospitals.

John McDougall, M.D. is especially forceful on the subject. See his newsletter article How to Choose a Primary Care Physician, if you must. He starts his article with this statement:

"Sick people visit doctors, take medications, and undergo surgeries—healthy people don’t. Your goal is to get as far away as possible from the medical and pharmaceutical businesses. The only way to safely accomplish these goals is to become and remain healthy. Genuine health comes from proper nutrition (a near vegetarian, low-fat diet), clean air and water, moderate activity, adequate sunshine, and a comfortable psychosocial environment. Unfortunately, even with the best intentions, and after the most sincere efforts to obey life’s basic rules, medical services may be required."

I admit to being "physician phobic," if there is such a condition. There is a serious downside to this condition. If a physician is required I may delay too long and make my condition much worse. My wife frequently accuses me of playing doctor on myself because rather than running off to the physician when I have symptoms, I diagnose and manage my condition myself before running off the the doc. I honestly do not know whether my tendency to go to the doctor as a last resort is good or bad.

I justify my behavior based upon my strong belief that most Americans are over treated and over medicated. I have been heavily influenced not only by Doctors McDougall and Fuhrman, but also these books, Overdosed America, by John Abramson and Overtreated: Why too much medicine is making us sicker and poorer by Shannon Brownlee. Nortin Hadler, M.D. has many interesting things to say on the subject in his book Worried Sick. The common theme is that Americans are too quick to seek professional care and that physicians are too quick to diagnose (often misdiagnose) and over prescribe. Dr. Hadler is especially forceful in pointing out that many so called illnesses can be "coped with" without medical intervention and that they will resolve on their own. He cites many orthopedic problems, such as low back pain, as prime examples. He uses the expression "medicalized." Every time we make the decision to go to the doctor we take the risk of being over treated and over drugged in addition to the potential benefit of being cured. He considers the decision to medicalize to be a very important decision that deserves lots of careful thought.

One might argue that we are always free to not take a doctor's advice, so why not go in and get checked out. I do not believe it is all that simple. Once I am in the doctor's office, I find it difficult to reject his advice. I have not followed doctor's orders on many occasions, but I find noncompliance to be quite stressful.

My recent urinary tract infection is a good case in point. A couple of weeks ago, I started having burning sensations and slight discomfort when urinating. I also was going to the bathroom much more frequently than normal and the sensation to urinate was quite urgent. I coped with this condition for several days without seeking medical attention. I logged onto the internet and did a search for foods that might irritate the bladder. I was eating lots of fruit, including citrus fruit, and thought his might be causing my symptoms. I sent a post to Dr. Fuhrman on his Ask the Doctor Forum open to website members. I described my symptoms and asked him whether I should try to avoid certain foods for a few days to see whether my symptoms would go away. I have great confidence in Dr. Fuhrman. I wish he practiced in Atlanta. He advised me to have my urine checked for an infection because foods do not normally irritate a normal bladder. I was in Sarasota, Florida at the time and found an immediate care center that tested my urine. I had a bladder infection was prescribed antibiotics. I wrote back to Dr. Fuhrman and asked him whether I should take the antibiotic. He said to try d-mannose and cranberry capsules for three days. If those non prescription remedies did not relieve my symptoms then to go on the antibiotics for three days. It turned out the combination of the d-mannose, cranberry and antibiotics eliminated the symptoms within about a week. If I had sought out medical care earlier, I could possibly avoided a few days of discomfort, but who knows? I was following Dr. Hadler's advice to try to cope before running of to be medicalized.

Crossing the boundary and going into the medical world is a huge decision for me. I don't want to be foolish, but I will hold firm to the guidance to try to avoid being treated unless absolutely necessary. Here are some guidelines I am following. These are not necessarily recommended for others?

• I don't do annual physicals. They are a waste of time and money for most of us.
• I only do routine medical screening when I am convinced that the risk/rewards are in my favor. The only routine screening on males that I think is useful is the Colonoscopy. The research shows that test to be potentially beneficial, even though there are risks. I have only had one Colonoscopy at age 61. The results were negative. I am considering whether to ever have another one done at some point. A Gastroenterologis friend suggests one every ten years for me. I will probably take her advice.
• I don't currently have a primary care physician (PCP). I am considering developing a relationship with a PCP, if I can find one who is nutrition-oriented and who is conservative about doing procedures and prescribing medications. A doctor like this is a "needle in a haystack", but I will keep looking because I do want to have a relationship with a good doctor in case I ever do become seriously ill.
• If I ever again suspect that I an infection, I will seek medical attention. I will evaluate the advice I get very carefully and probably seek out second opinions.
  
• If I have other symptoms of serious illness, significant loss of energy, bleeding, severe pains that don't go away within a day or two, I will seek medical attention.
  

Otherwise, I have a strong orientation to stay doctor and medication free as much. I realize that my reluctance to use doctors in the traditional way is controversial and, some would argue, risky. I consider the risk of being over treated the greater risk, in light of my healthy lifestyle. I could be wrong. It is possible that by avoiding most screening tests and the annual physical I am missing the possibility (remote possibility?) that some symptomless life threatening illness might be detected early.

Nevertheless, my current approach is that I will take prevention of serious illness into my own hands and leave the treatment of acute symptoms to trusted doctors.