On the medical power
Doctors as patients
The case of prostate adenomectomy.
The BRITISH MEDICAL JOURNAL BMJ 2003;326: (14 June) gave the floor to the patient, namely to Christopher Reeve and to doctors who speak about their own case.
Major societal trends over past 60 years (Patrick Pietroni)
Loss of deference towards figures in authority
Knowledge explosion through popular books, media and internet
Rise of consumerism and focus on patients as customers
Rise in litigation and downfall of doctors as heroic figures
Rise of managerialism that challenges professionnal hegemony
As I completely share these opinions I made a paper at the 3rd World Congress on Men's Health in Vienna (2003, october) on the subject of prostatic adenomectomies.
PROSTATE ADENOMECTOMIES : A NEED FOR RECONSTRUCTIVE SURGERY
A true cultural revolution is currently developping : patients demand more and more to give their appreciation on medical care. World celebrities like Christopher Reeve draw attention and famous medical revues like British Medical Journal take up the challenge.
First of all, physicians and doctors who are patients themselves dare questioning ancient principles.
As an urological surgeon who has successfully undergone an open adenomectomy of the prostate I wish to emphasize the too often hidden insufficiencies of adenomectomies in the state of the art, for open as well as cystoscopic procedures.
Simply removing benign adenomatous tumor does not restore the normal status. After the best done operation still remain physiological anomalies :
- absolute loss of ejaculation and fertility
- variable loss of mictional control
- variable persistence of urgency
Experimenting for techniques of recontruction of the prostatic capsule and the bladder neck , at the moment of operation or later, would probably seem more appealing in the field of clinical and surgical research if men who detain the medical power were older and subjects themselves to this kind of incommodities.
At least this question should be a matter of discussion in men's health congresses i.e. in view of personal health and scientific knowledge not in view of state money cost.
Christopher REEVE said :
"A good doctor will really take the time to develop a personal relationship with a patient and think creatively to come up with the best possible treatment, rather than just following the protocols set by insurance companies or the administration of the hospital. They need to be independent thinkers who are full of compassion.
"A good patient should learn everything he can about his illness or disability and be willing to try reasonable recommendations and meet challenges that are posed by doctors or patients. A good patient needs to maintain self discipline, so that he can harness his own willpower and the ability of the mind to affect the body to help the doctors who are trying to use to medicine to affect a cure."
"What I don't like are celebrities who haven't really taken time to study an issue and, in that way, become a liability rather than an asset"
Dr. Stephen Hempling said to H. Gaze about his own illness and his relationship with colleagues :
( BMJ 2003;326:1323-1324 (14 June), doi:10.1136/bmj.326.7402.1323 )
"Some doctors have an immediate reaction of 'I am sorry for you,' and then, 'You're not bad are you—I'd never have guessed.' To me, this sounds as if the only way medics can deal with a disabled doctor is by seeing him or her as hardly disabled at all.
"Us doctors... are never the same as a patient; we never have the same problems, and we never do things straightforwardly. We tend to shrug things off and just get on with it, and that is another thing in the pigeonhole."