But doctor, what are the possibilities?

Biases, decision-making and patient care. Why doctors can’t tell you all the information or unbiased opinions. Ask your doctor for more information.

Each ailment has its own palet of therapeutic options. Often doctors discuss the most medically and culturally accepted option, the one that most patients would choose. However, you might not be like most patients. With time pressure, sometimes not all options are explained well enough and as a consequence patients could make suboptimal choices.

Everyone has their own way of thinking, so information and choices should be tailored per patient. You might think that doctors shouldn’t tailor information, but the reality is that with time pressure not every option can be explained in detail; why should the doctor waste time on explaining irrelevant therapeutic options? Bad choices can be caused by multitude of factors: time pressure, biases and assumptions from the doctor, but also biases and assumptions from the patient.

Interestingly, culture also plays a large role. For example, in some countries, life prolongation is often preferred over quality of life. Louis Theroux made a thought-provoking documentary called “Life on the Edge” (Louis Theroux’s LA Stories episode season 1, episode 2). He illuminated how, for better or worse, the American culture of “fighting till the bitter end” has permeated clinical practice. He showed several situations in which doctors have pushed the life-extending option to the patient. In one case the patient chose to have another cycle of chemotherapy, making him extremely weak in his last days on earth. In the end, the patient died without any life extension benefit. I’m definitely not criticizing American culture nor American doctors, these types of situations can happen in any country and depends on a multitude of factors. One study investigated end-of-life practices in European intensive care units (ICUs). Remarkably, the withdrawal of life-sustaining treatment differed across the doctor’s religion, for example Protestant Christian physicians withdrew life-sustaining treatment in 44% of cases as opposed to 16% of Jewish physicians [1]. Another study surveyed 535 doctors from Sweden, Germany and Russia surrounding end-of-life treatment decisions [2]. They found that Swedish physicians chose fewer life-prolonging interventions as compared with the Russian and the German doctors. The authors concluded:

“The lack of compliance with patient wishes among a substantial number of doctors points to the necessity of emphasising ethical aspects both in medical education and clinical practice. The inconsistency in the treatment decisions of doctors from different countries calls for social consensus in this matter.”

Unfortunately, it’s going to be almost impossible to create a “social consensus”, simply because beliefs and ethics varies across different religions, countries and continents. Instead of waiting for this social consensus to happen, I’d want to give you the power to make fully informed decisions. Rather than accepting the doctor’s advice head-on, you may want to consider asking about the pro’s and con’s of each relevant therapeutic option. In short, you may want to ask the doctor: “But doctor, what are the possibilities?”


1.         Sprung, C.L., et al., End-of-life practices in European intensive care units: the Ethicus Study. JAMA, 2003. 290(6): p. 790-7.

2.         Richter, J., M. Eisemann, and E. Zgonnikova, Doctors’ authoritarianism in end-of-life treatment decisions. A comparison between Russia, Sweden and Germany. J Med Ethics, 2001. 27(3): p. 186-91.

Photo by Javier Allegue Barros on Unsplash



I set up a substack newsletter. I’m really excited to write more about how “HOW TO (NOT) BE A BETTER PATIENT”. This will be a biweekly newsletter. Check it out here if you like this topic.

My blog at www.manivenkatesan.com will be about more wide-ranging topics, kind of like a personal diary. Get in touch with me if you have special requests about specific topics to cover. Write to you next time!


My first week as a medical student in the hospital

I wrote this post a long time back (February 2021), but resisted uploading it (grrr the resistance…). That said, I want to write a bit more about my journey in the hospital. Every week I end up in the craziest situations, so writing about it will be a good way to process what happened.

Witnessing a poor lady getting the diagnosis incurable pancreatic cancer, getting shouted at by a delirious patient, and performing a rectal examination were amongst the many adventures during the first week as a medical student in the hospital. As a medical student at Erasmus Medical Center in Rotterdam in The Netherlands, I’ve received 3 years of training on how the human body works. As a medical student you are taught which symptoms are linked to specific diseases, how to extract relevant information from a patient and how to perform physical examination. Nevertheless, when the time finally came to enter the hospital in my 4th year as a medical student, fear and doubt entered my mind.

I was sent to a faraway hospital in the south of The Netherlands. Since it’s a 1.5-hour drive from Rotterdam, I fortunately got allocated a room next to the hospital for 10 weeks. My first clinical rotation is in the internal medicine department. Every week I’m linked to a different doctor and tag along with them. Whenever a new patient is referred by their respective GP, I am allowed to first see them. I question them about the problem, perform the physical examination, discuss my findings with the specialist in the absence of the patient and finally the patient is called in to get the specialist’s opinion. One of the most intense consultations of the week included telling a patient in her 60s that she has got incurable pancreatic cancer (just to be clear, I simply sat beside the medical oncologist who gave the news). Seeing all the frail people in their 60s, 70s and 80s approaching the end of their lives is a strong reminder that time is limited. Even though I easily get carried away by all the minutia, this is a good moment to take some time to look back at my journey and acknowledge no one lives forever. Whether you’re 80 years old, 50 years old, 29 years old (like me) or just born, I’m sorry to say but time is running out. One-third of our lives is gone because of sleeping, what you do with the remaining two-thirds is up to you. We’ve got to spend our time consciously, because we don’t know what tomorrow will bring us. For the most us (including me), the problem isn’t that we don’t have enough, the problem is too often we don’t spend it well…

How to secure a PhD

Every now and then people ask me how to get a PhD. If I’ve got enough time I usually repeat a riddle of tips and tricks that I myself have used and many of them stem from discussions with a dear friend. In addition to my rant I’d like to create this post as an extra resource that others can use. Here, I’ll give you top tips about how to secure the PhD position you want.

Why even bring up this topic?

Students are drilled with assignments and exams during their bachelor and masters studies and rush into doing a PhD. A PhD is a long-term commitment. Some people even marry more than once in their life, however almost no one does a second PhD, so take a step back to reflect and choose your PhD wisely.

Scientists like to use the scientific method when making decisions in their science projects.


However, when it comes to choosing your PhD, it often looks more like this.

Nugget of wisdom #1: you only get to do one PhD, Choose Wisely! Don’t just accept any offer. Your PhD determines the course of your career.

Step 1 decide whether a PhD is for you 

1.1 The goal is NOT:

  • to complete an assigned set of milestones
  • about the title

1.2 The goal IS:

  • to learn and follow ‘the scientific method’
  • to build a network
  • to develop significant and original research in your area of expertise

1.3 Pros of doing a PhD

  • Learning and applying the scientific method
  • Access to more prestigious jobs
  • Soft skills (time management skills, focus, patience, problem solving)
  • Friends & network
  • Explore different countries

1.4 Cons of doing a PhD

  • 3-6 years of focused work
  • Losing out on other job experiences
  • No easy way to opt out
  • Extreme stress and frustration
  • Can be a lonely experience
  • Mediocre pay / No big financial reward
  • Potentially stalling other aspects of life (buying a house, settling down, kids etc)

Nugget of wisdom #2: show off your work ethic during your internship, but don’t overfocus on your grades or your individual project and lose sight of connecting with others in the team. Also get to know and become a part of the team.

Step 2: Find a topic and think about the next few “variables”

2.1 Figure out what interests you

  • What do you read in your free time? It only makes sense to do a PhD in a topic that you are highly interested in, as it will take 3-5 years of your life delving in this topic.

2.2 Topic-based vs skill-based?

  • Do you want to do a topic-based vs skill-based PhD? In the former you tend to answer a specific question, whereas in the latter you tend to develop a specific method and are less interested in a specific question itself. Of course if you’re lucky enough and everything progresses very neatly you could develop a specific method to answer specific question.

2.3 Wet lab vs data science?

  • Nowadays data science PhDs are gaining momentum in the life sciences space, also there many opportunities outside of science and their transferable skills tend to make them more adaptable than wet PhD students.

2.4 Appreciated field vs unappreciated field / Hot topic.

  • You can imagine that it is harder to raise money for PIs to recruit PhD students in less well-funded fields.  Also if you manage to become PI in this field your fate might be the same.  Of course, this doesn’t mean of course that you shouldn’t go for what you are truly interested in, even though it is not well appreciated. Many groundbreaking research stems from niche fields that were initially not a popular field. 
  • To check whether a specific field is a hot topic or not, consider checking https://scholar.google.com/ and seeing how much research activity is ongoing in that field by seeing in what type of journals these papers are published and how many citations they receive. Also check out what is being  discussed in high impact reviews such as “Nature Reviews Journals” and “Trends Reviews Journals”.

2.5 What do you want to do after the PhD?

  • Also consider what you would like to do after the PhD.  if you want to work in industry, you might not even need to do a PhD. There might be opportunities for master students in industry. On the other side, some jobs require a PhD, so a PhD might increase the chance of eventually landing a higher paid job in industry.
  • Even once you found a topic for your PhD project, don’t be fully set on this, as the specifics might change in the first few months of the PhD. Many projects simply don’t work out and you will then need to adapt. So stay open to suggestions. 

Nugget of wisdom #3: Science is a small  playing field.

  • Don’t make any enemies as they might be future reviewers or lost collaborators. 

Step 3: Pick a place in the world

  • You can do a PhD in any country
  • It’s your chance to explore
  • It could be a potential gateway / getaway for life after the PhD


Nugget of wisdom #4: You’re more wanted than you think.

  • Do you have a manuscript (in progress)  that you were working on during your internship, then use it to your benefit
  • Many PIs are looking for initiative, enthusiasm and perseverance, so don’t overfocus on purely grades.

Step 4: Decide the correct PI

As a real estate agent would say it’s all about environment, environment, environment. 

4.1 University vs institute

  • In universities, PIs are usually burdened with more teaching duties whereas in institutes scientists tend to have more time to work on their science. Also research institutes tend to have more shared core facilities that might speed up your future research. 

4.2 Mentorship qualities and working style?

  • Try to identify what mentorship qualities and working style the PI and the lab members have. Ideally you want to be in a collaborative environment.

4.3 Rich PI vs poor PI?

  • Rich PIs have more money for experiments and tend to be closer to the forefront of science. 

4.4 Lab composition – PhD students vs post-doc ratio

  • Ideally you would want to have 1:1 or 1:2  PhD student to post-doc ratio so that there is plenty of help and mentorship for a starting PhD student.

4.5 Big lab vs small lab?

  • There are pros and cons to big labs and small Labs. Big labs can often move projects quicker and there is more expertise in a big lab,  however it is easier to get lost in a big lab and fall in between the cracks.
  • Small labs generally might have less momentum, however starting PIs tend to push their first few projects in their lab with more veracity as they rely on its success. So it could be worthwhile to join the lab of promising young PI.

4.6 Track record

  • Check the PI’s track record.  ideally you would like to work  for a boss who is respected in the field and has made several contributions resulting in a growing citation record.

4.7 Do your own field work

Gather the following data and analyse it:

  • Publications (last 2-3 years)
  • Lab website
  • Lab members
  • Ask for tips/advice from your mentor

Nugget of wisdom #5: Grades are of limited use

•Some PhD programmes require top 10-20th percentile

•However, the PI usually doesn’t care. And there might be other ways to get into the lab circumventing the official PhD entrance program. 


Step 5: Approach the PI

5.1 Get a good reference from your current PI (where you might be doing an internship)

5.2 Read about what the PI has published

• Read about what the PI has published and the field they work in: first read reviews —>  then perspectives —> and then specific research articles

5.3 Create your one A4 proposal

  • Your proposal should include:  background, research question, methods, future perspectives.
  • This will show your PI that you have a lot of initiative enthusiasm and perseverance to figure out what you want to work on and sets you apart from many other PhD candidates. 

5.4 Create a short 5 slide PowerPoint

•Email The PI with your attached one A4 proposal and short PowerPoint  and explain why you are the one the PI should choose as his or her next PhD student. Make sure to include the following:

  • Interest in their lab
  • Research experience (papers?)
  • Unique skill set
  • Current state of the field
  • Pitch for a project (attach the word document / attach the ppt)
  • Request for a zoom or F2F chat
  • Attach CV

Step 5: Prepare for a discussion/interview 


  • Think about how you can add value to their lab?
  • Make sure to show off your enthusiasm and positive energy, interrogative and deduction skills

I hope these 5 steps will help you in your journey to find the PhD program you want.

Frontiers of Science: Sreya Bhattacharya researching diabetes

Understanding diabetes and unravelling the latest developments in diabetes research

New feature series: “Frontiers of Science”

The fun of being a scientist is that you make cool friends who study cool stuff. Sreya Bhattacharya is definitely one of them. She’s doing her PhD trying to find new therapies to treat diabetes. More on her later. So, besides giving information on “how to (not) become a better patient”, I’ll be featuring cutting edge science projects done by friends and colleagues. Read until the end!

Introduction – what is diabetes?

In this disease the body has difficulty processing sugars. In the human body, sugars are taken up by cells and further processed to produce packets of energy, better known as ATP. ATP is the fuel that keeps different cellular processes running. In short, sugars are an important part of keeping the body running.

Sugar is taken up by cells through the action of a hormone called insulin. Insulin gives the instruction to cells all over your body to take up the sugar. Insulin is made by specific cells (so called beta cells) in the pancreas. In diabetes there’s a buildup of sugar in the blood. The cause of the buildup could be due to various reasons and relate to the type of diabetes.

There are 2 different types of diabetes:

Type 1 diabetes: around 10% of all diabetes cases. In this type, your own immune system attacks the insulin-producing cells in your pancreas (i.e. the beta cells). As a consequence, the pancreas can’t make enough insulin, eventually leading to a sugar buildup in the blood. Patients with type 1 diabetes need regular insulin injections to keep the blood sugars low.

●Type 2 diabetes:  Constitutes around 90% of all diabetes cases. In this type, the insulin is produced… , however the body becomes less sensitive to insulin. The body needs more and more insulin to reduce the blood sugar. Over time, the pancreas can’t keep up and stops making enough insulin to regulate the blood sugars. Patients with type 2 diabetes can take tablets (such as metformin) that increases the cells of the body to become more sensitive to insulin. If metformin can’t control blood sugars, doctors often prescribe medication (such as sulphonylurea derivatives) that pushes the pancreas to produce more insulin. After some time even this medication might not be enough, after which patients need insuline injections to control blood sugars. In the early stages of type 2 diabetes, patients often can still reduce the need for medication by eating healthy, avoiding alcohol and exercising more (in short working on their lifestyle).

The active participant

In this substack I’m trying to make a case for people to take charge of their own health and seeing doctors as ‘healthcare partners’ with whom they need to work together with in order to control their disease, rather than taking advice point blank without thinking about better alternatives. In short be the active participant rather the passive patient.

So if you’ve got diabetes (which is apparently a whopping 1 in 10 adults aged 20–79 years in 2021) or are trying to prevent diabetes (like what the rest of us are trying to do), try to:

·      generally understand how the disease works

·      Be an expert regarding how your body responds to different foods, exercises and stressors. Patients with diabetes should try to understand what medication to take, including the exact amount of insulin units to inject in different situations (according to the meal and the physical exertion).

·      what the risk factors are for developing this disease: For type 2 diabetes this is more clear, it includes factors such as being overweight, being less physically active, older age and being genetically predisposed .

·      figure out how lifestyle changes can affect the disease course: a healthy diet and exercise can have a great positive impact. However, consult your doctor how it affects your medication, for example patients who use insulin could be at risk of getting too low blood sugars when they suddenly decide to eat healthier or exercise more.

The passive patient

I regularly come across patients who don’t take their lifestyle and medication seriously. The problem with diabetes is that low and high blood sugars can often have little effect on a person’s complaints (subjective experience). However, in the long-term, chronic blood sugar dysregulation can create many problems in different organs such as: heart disease, chronic kidney disease, nerve damage, and other problems with feet, oral health, vision, hearing, and mental health. Sometimes people need amputations because their blood vessels are too damaged to provide enough blood to their feet. I’ve seen teenagers being in denial of their type 1 diabetes diagnosis. Often, they’re embarrassed to inject insulin at school, or are embarrassed to be the only one who can’t let themselves go with unhealthy snacks or meals. They subsequently experience problems with extremely high blood sugars. These patients shouldn’t be ridiculed or demonized, since diabetes is a horrible and tiring disease, demanding careful attention to medication, diet and exercise. Nevertheless, ignoring the disease doesn’t take away its nasty consequences. As friends, family, fellow-patients or healthcare workers, we’d ought to listen and find ways to understand their situation and stimulate better lifestyle choices.

Passive patients often have one or more of the following characteristics:

·       denying they’ve got diabetes

·       demanding a doctor solves their problem without taking responsibility of their own health

·       not really knowing when and how much anti-diabetic medicine to take

·       regularly making excuses to eat their comfort food or not to exercise

Featured diabetes researcher: Sreya Bhattacharya

What is your background?

I studied microbiology during my bachelors. It sparked my interest in biology and therefore I decided to do my masters in biomedical sciences. In the end I chose to study at King’s College in London. I met you in London of course and we stayed friends since then.  Eventually I got recruited to the Helmholtz Diabetes Center in Munich.

How did you get interested in your PhD topic?

I was always interested in diabetes. My master’s research was also about this topic. In London, I studied type 1 diabetes. Besides that, I’ve got close relatives who have diabetes. After my master’s I worked in a hospital lab in India investigating kidney complications in patients with diabetes. I studied SGLT2 inhibitors, a common class of new inhibitors that reduces glucose reabsorption in the kidney, enabling patients to pee out glucose, thus lowering there blood sugar levels. It was a really cool project, as I was trying to grow kidney cells from urine samples of diabetes patients. I worked with Dr. Sujoy Ghosh . It was super cool working with him.

What are you currently working on?

I work in a lab that focuses on diabetes and regeneration, specifically of beta cells and islets. My boss published a paper on a novel protein, INCEPTOR, which is a novel inhibitor of the insulin receptor (INSR) and IGF1 receptor (IGF1R) signaling in mouse beta cells. Knocking out this gene in mice caused more secretion of insulin and increased proliferation of beta cells with improved glucose tolerance. So, currently I’m trying to find novel ways to block INCEPTOR, which might be useful in patients with diabetes.

How do you envisage the future of diabetes treatments?

Firstly, lifestyle changes would remain important. The latest therapies are looking at dual therapy and triple agonist therapies specifically targeting the β-cells helping them regenerate. The future for type 1 diabetes might be stem cell replacement of the destroyed β-cells. For type 2 diabetes it’s targeted β-cells therapy to promote β-cell regeneration.

Who inspired you in science?

My earliest inspiration was reading about early female scientists like Marie Curie. There were so few of them and they weren’t getting the recognition they deserved. I felt so angry about how Rosalind Franklin’s contributions were ignored. Those were early inspiration, but now I see so many inspiring female scientists around me. The people who I learn the most from are those who are directly around me doing brilliant things. It’s amazing to see how much they care about their work and how passionate they are.

A new series: at the Frontiers of Science, showcasing inspiring scientist profiles

Share, learn and be inspired

The most exciting part of science is that the future is unpredictable. You don’t know what lies ahead and maybe you’ll be the one making the discovery. I guess that’s one of the drivers of many scientists going into the lab day in and day out, without getting paid overtime, but just doing it simply out of curiosity.

In this new series ‘Frontiers of Science’, I will be interviewing fellow scientists and ask them their origin story. Of course we’ll also get into the latest developments in their respective fields.

This Sunday I’ll publish the first scientist profile. My dear friend, PhD student Sreya Bhattacharya, working at the Institute of Diabetes and Regeneration Research (IDR) at the Helmholtz Diabetes Center Munich, will share her story. She’s a molecular biologist unravelling the inner workings of a novel receptor involved in insulin signaling. Stay tuned!

Stress and lifestyle, an unaddressed challenge in modern healthcare

Stressed out…?There’s a pill for that! Want to control your high blood sugar levels…There’s a pill for that!Can’t sleep…?There’s a pill for that!High blood pressure…?There’s a pill for that!

Stress and lifestyle as a cause of poor food choices and lack of exercise

Healthcare costs and associated costs for communities are growing at unsustainable speeds. Stress, lifestyle and calling in sick to work are major contributing factors. Unfortunately these factors are very difficult to address during the typical short doctor’s appointment. In medical school, doctors are taught to give lifestyle advice, but how effective is this really? Several studies suggest they’re not that effective… [1,2]

  • 1.         Kaner, E., et al., Effectiveness of screening and brief alcohol intervention in primary care (SIPS trial): pragmatic cluster randomised controlled trial. BMJ, 2013. 346: p. e8501.
  • 2.         Aittasalo, M., S. Miilunpalo, and J. Suni, The effectiveness of physical activity counseling in a work-site setting. A randomized, controlled trial. Patient Educ Couns, 2004. 55(2): p. 193-202.

If the doctor believes lifestyle advice isn’t being/ won’t be followed, they often provide an option in pill form… To be fair, regularly patients ask for the quick fix as well or eagerly accept the doctor’s offer… Sometimes these pills might be necessary, but in many cases they are certainly not…

Stressed out…? There’s a pill for that!

Want to control your high blood sugar levels…? There’s a pill for that!

Can’t sleep…? There’s a pill for that!

High blood pressure…? There’s a pill for that!

So how should doctors, and the society as a whole, deal with this problem? Perhaps we should try to address root causes, rather than relying on quick fix options. Many would think purely focusing on eating healthy and exercising would be the way to go. However, the danger is we aren’t addressing the root behavioural problem in this way. We’d need to dig deeper, asking ourselves why we aren’t eating healthier or moving more than we ought to. Many times this boils down to being unable to cope with ongoing stressors and having bad lifestyles.

Perhaps we should try to address root causes, rather than relying on quick fix options.

Too little time during a doctor’s visit

Stress and lifestyle are complex issues (perhaps too complex?) to address within a short doctor’s appointment. Ideally the healthcare professional would need more time to explore the underlying problems, to truly listen to the patient, to truly understand why they are living their life in a certain way. Often doctors give advice such as ‘just take it easy’ or ‘take some time off’, however I wonder whether this really would push the patient towards a healthier lifestyle or perhaps even hamper recovery. Work is very important, it provides people social interactions and a sense of purpose, so healthcare professionals should be (at the very least) careful to take that away.

Whenever a cardiologist sees a patient with chest pain, for which no medically objective cause can be found, there’s often no time to dig deeper. Patients are then sent back to the general practitioner (i.e. GP), even though the GP is swamped with their own appointments. These are interesting scenarios we should put more effort into addressing. If there’s too little time to address these complex issues, patients could theoretically get referred to mental healthcare providers, such as psychologists or psychiatrists. However, it’s not unusual that these mental health services have very long waiting times.

(Click the image for the BBC article)

Occupational medicine doctors, an untapped resource

A good portion of these stress and lifestyle issues could potentially be addressed by doctors who work as advisers to both the employer and employee on the relationship between work and health, so called “occupational medicine doctors or occupational physician”. In the Netherlands (where I’m currently being trained), the waiting list for occupational physicians is usually much shorter than for mental health services. Hospital specialist, GPs, employers and employees should seriously consider referring to or getting help from occupational physicians, either whilst waiting or instead of visiting the mental health provider. Obviously, consult your (occupational) physician first before opting out from a visit to a mental healthcare provider. Many employees are often unaware that they could pay a visit to their occupational medicine doctors. At least in the Netherlands (I’m not sure how this works in other parts of the world), companies are obliged to provide their employees access to occupational medicine doctors. So don’t hesitate to make use of this often untapped resource.

Many employees are often unaware that they could pay a visit to their occupational medicine doctors.

Stress and lifestyle: complex issues we need to address in and outside the doctor’s office

Again, stress and lifestyle are complex issues to address within a short doctor’s appointment. I’m not touting that a visit to the occupation medicine doctor will solve all problems, however it could be one of the many pieces to solve the puzzle. We ought to think more about solutions in and outside the doctor’s office to address how to deal with stress and a poor lifestyle.

We ought to think more about solutions in and outside the doctor’s office.

Don’t stay the passive patient, become an active participant!

Rather than merely being a passive patient, become an active participant and hop aboard the email list!

PS: Have you got any out of the box ideas or found any useful resources to address stress and lifestyle issues? Share them in the comment section!

Photo by Luis Villasmil on Unsplash

Let’s get rid of “patients”

I got into a discussion about the word “patient”. My colleague mentioned that the word has a negative connotation. She mentioned that the word makes us focus only on the disease rather than on the person as a whole. I was taken by surprise by this statement. It’s interesting how I’ve been using this word without truly realising how others might view it. It made me curious how others think about this issue…

The word derives from the Latin word “patiens”, meaning suffering or enduring. Julia Neuberger argued, in an article in the British Medical Journal, that

“The word “patient” conjures up a vision of quiet suffering, of someone lying patiently in a bed waiting for the doctor to come by and give of his or her skill, and of an unequal relationship between the user of healthcare services and the provider. The user is described simply as suffering, while the healthcare professional has a title, be it nurse or doctor, physiotherapist or phlebotomist.”  Deriving from this thought process she argued that, “The active patient is a contradiction in terms, and it is the assumption underlying the passivity that is the most dangerous. It is that the user of services will remain passive in sickness, allowing the healthcare professional to take the active part and tell the user what to do.”

I would agree that a passive user of health services is not the way to go in modern medicine. However, regardless of the etymology of the word, I’d find it a far stretch that the term patient would promote or provoke passiveness. For example, healthcare professionals usually don’t address the patient itself with this word, most often it’s used in communication with colleagues. This article received several rebuttals.

One of them was from Raymond Tallis who argued against changing the word “patient” into something else:

“Would change mean improvement? Even if there were a case for change, and a satisfactory alternative, would there be any reason for thinking that this would drive improvements in doctors’ attitudes and behaviour? Most linguistic reforms reflect rather than bring about changes in attitudes.”

I side with Tallis on the practical reasons for not changing the word patient, nevertheless for me this is not the main topic to be highlighted. Neuberger raises an important issue which can’t be overlooked, namely that the patient must be an active participant in their whole medical process. More importantly each person must be an active participant in their health before and after being diagnosed with a disease and being labelled as a patient. That’s what this newsletter is about after all. Being health conscious is not just about a moment in time or a period in your life, it’s a lifestyle. I would argue that being health conscious doesn’t stop when stepping into the doctor’s office. In most situations you will have options and hopefully you can decide the best treatment together with your doctor’s advice (i.e. shared-decision making), rather than being forced to choose something you don’t feel good about. I would like to urge you to stay engaged in your own medical pathway, try to understand what the pro’s and con’s are and ask questions if something isn’t clear. Try to be an active participant, rather than the passive patient.

Photo by Yaopey Yong on Unsplash

#8 How to be a better patient – Should I get a second opinion?

Your health is one of the most important things in the world. Even though healthcare professionals want the best for you, sometimes you might not agree with the recommendation of your doctor. What would you do if you’re in this situation?

You might want to consider getting a second opinion. This is the situation in which you would want to be seen by another doctor and find out whether the initial diagnosis and/or recommended treatment stays the same. Asking for a second opinion might be a right move in the following situations:

  • The patient-doctor relationship is irreparable
  • Your diagnosis and/or treatment plan is still unclear
  • You would like to explore other treatment options
  • You want more assurance about the initial recommendation
  • The treatment doesn’t have the wanted effect

As far as I’m aware, as a patient you have the right to choose a different doctor. Whenever you do request for a second opinion, ask you initial doctor to share the medical report (including the diagnosis and treatment plan) with you and the other doctor. I hope you don’t feel the need to ask for a second opinion, but sometimes it might be necessary…

Consider reading this interesting blog posts on the same topic: Navigating medical customer service – a reprise

Featured image credits: Photo by Possessed Photography on Unsplash

Note to myself: A growth mindset over a fixed mindset

The day we stop developing is the day we stop living. I believe that every day we are making a choice, whether we are aware of it or not, to choose to work on ourselves or to accept our own limitations. The future becomes far more exciting when we think about how we can use time to our benefit to compound learning and slowly but surely acquire new skills. This concept is explained in the book by Carol Dweck “Mindset”. People with a fixed mindset believe their current skillset and limitations are set and that it’s out of reach to improve. In contrast, people with a growth mindset understand that limitations are self-imposed and find ways to get better at something or acquire skills. In reality, no one has a pure fixed or pure growth mindset, we usually are a combination of both mindsets. Often we believe that we can’t improve in certain areas of life (for example perhaps giving presentations or socialising), whereas other areas seem more adept for improvement (perhaps something you enjoy doing, like playing games or cooking).

The beauty of living, is that we are presented with time in order to learn anything we want to. The difficulty of living though, is that we can’t learn everything at the same time, neither can we learn difficult skills immediately. Fortunately, if we consistently show up and put in the work, we can eventually compound skills. This all sounds very wishy washy, but this concept has been beautifully explained in the book “Atomic habits” by James Clear. If we aim to merely improve 1% every day, our growth becomes exponential and over a long period of time this can result in world-class performance.

Check out some nice blog posts for further reading:

Featured image credits: Photo by Mikel Parera on Unsplash

#7 How to be a better patient – Alternative treatments?

In modern day life so many aspects of the human experience is medicalised (meaning conditions and behaviours are labeled and treated as medical issues). The emphasis of medical training lays on how to solve problems through medical interventions (such as drugs or surgery). Quite often there’s a (commercial) treatment for your medical problem:

  • Are your blood sugar levels too high? Well, there’s a pill for that.
  • Are you feeling depressed? Well, there’s a pill for that.
  • Are you having trouble sleeping? Well, there’s a pill for that.
  • Are you feeling anxious? Well, there’s a pill for that.
  • Etc, etc.

Let me be clear: all these things are legitimate issues and need care. However modern medical treatments may not always be the only or the best option for your malady.

Whenever your doctor provides medical advice, when appropriate, request whether there are also other ways to resolve the problem. Take for example diabetes type 2, simply put, this is the disease in which your blood sugar levels become too high. Doctors can prescribe drugs such as metformin to lower blood sugar levels and sometimes they might not inform you that daily exercise and a healthy diet could have similar or additive effects. I’m definitely not advising you to ignore your doctor’s advice! Please do follow their advice, however also ask these extra question:

  • Is there something I could personally do on top or instead of the treatment you initially recommended?
  • Are there other treatment options available?

These questions force your doctor to list all the treatment options, instead of the “one-size-fits-all” recommendations. As a result, your doctor might be able to advise a less risky treatment or might be able to suggest lifestyle interventions in addition to the initially recommended treatment.

Disclaimer: All content and media on this website is created and published online for informational purposes only. It is not intended to be a substitute for professional medical advice and should not be relied on as health or personal advice.

Featured image credits: Photo by cottonbro

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