Dismantling power dynamics in medicine

Here are 5 dos and don’ts.

Credit: Annie Spratt on Unsplash

A couple of years ago I interviewed a neurologist who specializes in headache medicine. We discussed how fed up a lot of specialists are with the very limited time they get with each patient, as dictated by insurance-related red tape and staying afloat amid the more-patients-than-providers conundrum. It was a stark reminder that patients aren’t the only ones who are unhappy about the current state of U.S. health care.

But something she told me about self-advocacy has stuck with me many moons and months later (which is honestly a feat with how muddy my memory is these days). When I asked how patients can make the most of their appointments, which over the years I have learned is an actual skill that can be honed, she said that when patients show up to appointments prepared — with written questions, detailed symptom trackers, medication logs, or research they stumbled across — it allows a medical provider to bypass general triage. Generic “How have you been feeling?” inquiries can be replaced with specific questions like, “How was your pain the week after you increased your dosage?” In other words, it’s the difference between a first date and a fifth date. It feels like collaboration rather than a dictatorship.

When I think about that interview, I keep coming back to how power dynamics present in medicine. As patients and caregivers, we are at the mercy of professionals and systems. The systems themselves we don’t have as much control over (le sigh), but the relationship and communication with our care teams puts the ball in our court more than a lot of patients even realize. One of my favorite sayings is, “You know your body best” when it comes to advocating for ourselves, but there’s another that comes to mind when I think about power dynamics: A singular doctor’s opinion is not the be-all, end-all of managing your health. Patients have rights (and responsibilities) in their own health experiences, even when it feels like medical providers are untouchable and always “right.”

So, if it’s helpful, here are a few things to keep in mind as you move forward with managing your health conditions — from one patient to another!

A few dos

1. Come prepared for your appointments. I wrote about this above, but it bears repeating — there is no such thing as being overprepared when it comes to making the most out of a 5-10 minute appointment. In fact, I often find that having a list of written questions keeps the provider in the room longer (it just happened to me during a recent audiology consult) because they feel beholden to a literal list vs. an abstract list that only resides in your head.

2. Try to start each appointment with an open mind. I am honestly the first person who needs to take this advice, so do with the following confession what you will. I admit to having a pretty sizeable chip on my shoulder that results in a lot of skepticism going into health care interactions, mostly rooted in my own experiences with medical PTSD. Sound familiar? If it does, here’s a collective reminder that we seek out medical professionals for a reason. We need help. We’re trying to feel better. We’re not able to do this on our own. We need a person or a team or a clinic that can be a knowledgeable lighthouse and guide us. When we start from a place of openness, the right-for-us providers will greet that openness with their own.

3. Always look into things on your own. There is a fine line between convincing ourselves via WebMD that we are dying, and taking the time to truly understand the pros and cons of certain medications, treatments, procedures, therapies, and surgeries. When people ask how I know “so much” about health, I usually say two things: One, I have decades of (unfortunate) lived experience; and two, I spend a significant amount of time reading studies, patient narratives, pharmaceutical fine print, and learning the vocabulary/mechanics/anatomy of different specialities. Having a more robust knowledge base has greatly benefited my ability to advocate for myself as well as those I love.

And a few don’ts

1. Don’t stick with a provider who consistently makes you feel worthless, brushed off, or judged. I’ve written about this topic before in my quick guide to getting a second opinion, but it bears repeating in this specific context. Power dynamics are not only stifling, but they become a self-limiting belief, too. Things like medical gaslighting make you feel like this is the treatment you deserve simply because someone holds a degree or two more than you. But I assure you that it is not — we all deserve better care.

2. Don’t feel you need to follow through with every single prescribed/suggested [insert treatment/med/procedure/diet here]. To be very clear, I am not recommending that you go rogue and pick and choose your care team’s recommendations as you see fit. Nope. But what I am saying is that you are allowed — and have the right — to say no if a course of treatment makes you uncomfortable or scared. Recent, real-life example for you: 13 years ago, I saw a pain anesthesiologist who recommended a cervical epidural between my C5/C6 joints because of a mild/moderate disc protrusion. At the time, I was overwhelmed with establishing a health care team after a move, and was experiencing zero symptoms from that part of my body… so I said no. Now, fast-forward to now, and you better believe I am runninggggg to get that epidural because that bulging disc is causing your girl a million and a half problems! At no point did I doubt the suggested treatment from an ethical or clinical standpoint, but it just wasn’t a good fit for my body and life circumstances at the time. Medical power dynamics engrains in us that we must follow through with every single suggestion or prescription or idea, when in reality those recommendations are being spun in a vacuum. They lack context, quality of life, and general day-to-day responsibilities.

Phew. I need a nap now. What tips did I miss, friends?

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