"Let Your Backbone Slide"

This is how I felt recently when I needed to stand up and advocate for myself. I felt a bit spineless,  also I love the Meastro Fresh West song, “Let your backbone Slide”. It reminded we of my middle school field trips and the “ski trip“ of a lifetime. On that ski trip, I needed to find a bit of courage to ski down the mountain after having had a bit of a crash the day before. I was nervous and shaken and I didn’t want to make a fool of myself. This was a similar feeling that I had the other day. I needed to find a bit of courage to speak with my physician about going in for some sputum testing. I had been experiencing some breakthrough symptoms, which I should not have been but with cold and flu season promptly upon us. I knew that the pesky cold that had been going around the office was now upon me and so was this annoying cough.

Science vs. Inconvenience

I love that my physician is attentive and always sides with science but sometimes this can be a huge inconvenience. I like to think that I have a good understanding of the science and decisions making process however, I needed a reminder on the importance of proper diagnosis and maintaining good control. So what did this mean? This meant that I was requested to come in for sputum testing. Generally, this is not a problem but now I have a new job and my commute times can be a 2 hour drive in traffic for a 20-ish minute sputum induction, not to mention the challenges of arranging time off to be out of the office. Especially being the new employee, time off is generally frowned upon. It gets to be a bit more challenging. This cough was becoming problematic but because I generally felt fine and since I had a sputum induction fairly recently and that there was evidence for medication changes or immediate concerns, it was deemed most likely viral. I needed to address the concerns that I was happy to be an active participant in my own care, however I was going to need ask for a “How Might We address my symptom concerns with a different diagnostic or can you help me understand when it would be most beneficial to have this diagnostic?”. I knew that this was going to be a touchy subject for my physician, as this is their gold standard, however, if I want to keep my day job and be able to afford my health care, I was going to need to have an open discussion about the constraints that patients face. The challenge is this test is available in limited centers across the country, so it is actually the closest location to me.1

The time came, I still wasn’t feeling so hot and I was going to need to address my constraints and concerns. Since the request was once again for a sputum induction. I had the opportunity to dialogue with my physician about my concerns and also the realities of having to take a half day off of work, drive 2 hours one way for a 20 minute test and that I was going to need to need to make the most responsible decisions about being able to follow through with the requests. I approached this by having an honest and open discussion with my doctor when I received the request. Firstly, I made time and asked for their time to have this discussion so it wasn't viewed as being non-compliant or being confrontational. Did you know that many patients face this reaction from their physicians? I expressed my concerns, was respectful and expressed that I valued us working as a “team”. It is important that the outcome may not change but the outcome was less important than being heard and looking at alternate solutions. I am proud that I stuck up for myself and earned bonus points for addressing the issue. It is true that physicians are not mind readers and they are not always tuned in to what patients may be going through.

What sticky topics have you had to approach with your physician? How did you handle these? How do you balance taking time off for test? I would love to hear some of your solutions.

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