Decision to change doctor lies with you

Qn. “I have visited a physician for a long time but I feel I need to switch to another just for a change. My friend, however, insists that it is safer to stick to one doctor than deal with many different ones. Is this factual or just psychological?”

In this question, you have raised at least three different issues, each of which merit a full coverage in an article such as ours. The first matter relates to the whole question of when one seeks a second opinion. The next relates to the value of medical opinions rendered by well-meaning but ignorant lay friends and relatives and the third, and perhaps most important is the matter of “when are matters real, and when are they just psychological”.

The latter is of critical importance because it sits at the very core of the practice of medicine.

In the olden days, any person who went to a doctor with a complaint whose cause could not be found was dismissed as suffering from “psychological” diseases, which by extension implied that such a person was suffering from an imaginary and possibly self-inflicted condition.

This state of ignorance by the medical profession led to the invention of words or terms to try to explain this situation. Some of the words used to mean that the patient had an imaginary condition were simple while others were high sounding and intended to confuse the suffering patient.

In their coffee rooms, doctors would talk of cases of a neurotic patient, while others were labeled as hysterical and others as having hypochondriasis. More diagnosis included a supratentorial condition or even neurasthenia. All portrayed the ignorance of the medical profession.

Armed with these diagnostic categories, which today mean almost nothing beyond being statements of ignorance, Insurance companies developed policies.

Section 46 of the Mental Health Act 1989 states: “(1) Every person in Kenya shall, be entitled, if he wishes, to insurance providing for his treatment as a person suffering from mental disorder and no insurance company shall make any insurance policy providing insurance against sickness, which excludes or restricts the treatment of persons suffering from mental disorder: (2) An insurance company which makes any insurance policy which expressly excludes or puts restrictions on the treatment of any person suffering from mental disorder shall be guilty of an offence”.

Many insurers operating in Kenya today are in manifest breach of this section of the law, thanks to the ignorance of the doctors who also treat mental health conditions as imaginary, and mostly self-imposed.

The truth is that the pain and suffering that persons with depression go through is often so severe that many millions of people with this condition take their own lives.

It is also true that up to 35 per cent of persons who suffer from diabetes are depressed. When one has both, the outcome of the diabetes is poorer than if on only suffered from one of the conditions.

Depressed people get heart attacks more frequently than those without depression. Heart attacks lead to depression! Depressed mothers are unable to look after their children properly. Their children have lower weights, have lower rates of immunisation, die more often from infectious diseases and in all have poorer outcomes than the children of non depressed mothers.

These are the real facts about what you might be calling “psychological factors, perhaps implying imaginary factors”.

With recent technology such as functional MRI scanning, doctors have demonstrated that many of the conditions that were said to be psychological 30 years ago, in reality do have an anatomical or biological basis.

This now brings us to the first and second issue that you raise in your question. As to whether you should change to another physician or not is a matter that only you and your family can make.

This will to a large extent depend on the confidence your present physician is able to inspire in you. Does he for example explain to you and the family what the problem is, what caused it and how to plan to deal with it? If he is unable or unwilling to answer these questions, then another opinion might be helpful.

I am sure your friend means well when he tells you to deal with only one doctor but as you have seen from the foregoing, the practice of medicine is changing rapidly and your doctor may or may not be keeping up with new knowledge!