I just hate it when patients shoot themselves in the foot. In my particular case, being a foot and ankle orthopedic surgeon, this might be closer to fact than fiction. What I am talking about here are the more low-key diagnostic and treatment decisions in general, but this concept rings true throughout medical decision-making as you will see.

Each and every one of us must be our own patient advocate, but too much of a good thing can be bad. There is no doubt that patients and/or their family will all too often unwittingly try very hard to force/dictate a poor outcome. This unhealthy influence can be wielded anywhere from a small medical problem all the way to a life threatening issue. You know these people, they are the controllers, micro managers, type A’s, etc., and they make up about 15% of my personal patients. Ask them and they usually have no clue that they are even doing this.

In fact, what they do think is that they are trying to facilitate their own care and safety. In most cases this couldn’t be further from the truth. With the Internet poring out massive amounts of medical knowledge, good and bad, we all feel more knowledgeable and EMPOWERED these days. OK, I know what your thinking, “Here is another doctor who does not like being told what to do.” You’re damn right I don’t like being told what to do when it is not in your best interest and you are asking me to place you directly in harms way.

A perfect and timely example of this wayward behavior is Michael Jackson. As a disclaimer, I like many, loved Michael Jackson’s body of work and I personally have nothing against Dr. Conrad Murray. Both men are at fault in this case. In the simplest form Mr. Jackson was totally inappropriate in his request. However, Dr. Murray was even more at fault to give in and comply with Mr. Jackson’s dangerous plea. Get it, Dangerous plea? Dr. Murray should have taken the higher road and fired Mr. Jackson as a patient or never taken him on as a patient in the first place.

I am willing to negotiate with patients within reason and as long as their request does not place them in harm’s way. Definitely there can be a give and take, but at the end of the day if you don’t like my recommendation, learned I might remind you,o f course, everyone is entitled to a second opinion, if they really think they want one. If Conrad Murray is an example, you are likely to find someone who will give you what you are looking for. I won’t.

I have a colleague in California and we are both part of small group of surgeons (a think tank, if you will) and every year he makes a statement that turns my stomach. When several of us discuss a standard and reasonable technique or an interesting, case he invariably says, “My patients would never let me do that.” Is this sort of thinking just a California thing?

A patient needs to know when to hold ’em, but more importantly your doctor needs to be your advocate and do the right thing, even if it means not giving in to what you want.