That's Right; Blame Me
Yet another "educational" throwaway in today's mail exhorts me once again to encourage, urge and recommend colorectal cancer screening to my eligible patients.
Once more, I am reminded of the criteria for colorectal cancer screening (basically everyone over age 50 and certain individuals under age 50 with risk factors like polyps or a family history of polyps or colorectal cancer), the options for colorectal cancer screening (fecal occult blood testing, flexible sigmoidoscopy, double contrast barium enema, colonoscopy, or some combination of these) and the reasons why colorectal cancer screening is a good idea ("In Pennsylvania, 8,000 residents will be diagnosed with colorectal cancer and 2,970 will die of the disease this year.")
I know this. I do this. I urge, plead, encourage and exhort patients on a daily basis to undergo appropriate screening tests for colorectal cancer, breast cancer, osteoporosis, cervical cancer and prostate cancer, not to mention my urgings, pleadings, encouragement and exhortations for appropriate patients to receive pneumococcal polysaccharide vaccine (Pneumovax for patients over 65), annual flu vaccine, and diphtheria/tetanus booster vaccination (10 year intervals; one dose now to be replaced with a new combination that includes acellular pertussis antigen.) In addition, I regularly urge, plead, encourage and exhort my patients to stop smoking and begin excercising, to get enough sleep and to reduce alcohol intake.
I do my damndest. Really I do.
And yet, in boldface type on the front page of this American Cancer Society sponsored pamphlet provided courtesy of the Pennsylvania Medical Society, it says right there:
...90 percent of the patients who have not had colorectal cancer screening report that they would undergo screening if their doctor recommended it.Cut me a fucking break!!
Think about how that kind of a survey is done. What do you expect a patient to say in response to a question like, "Would you undergo colorectal cancer screening if your doctor recommended it?"
"Hell no! Shove something up my butt? No way, Jose!"No, of course not. Isn't it far more likely to hear something along the lines of:
"But of course if my doctor recommended it, I'd do it. I have great respect for my doctors and I would always do whatever they say."If you're buying that, then you probably also believe that Stephen Colbert is a Republican.
I am sick and tired of having surveys shoved in my face saying that all I have to do is "recommend" something to my patients, as if the only reason screening guidelines fail is that I don't bother mentioning them. (The same thing holds for smoking cessation, by the way. "Surveys show" that -- according to patients -- the most important reason they stopped smoking was that their doctor told them to. Bullshit!! If that were true, none of my patients would smoke; I say something about it every time I see them.) I can recommend, urge, plead, encourage and exhort until I'm blue in the face, and not only will patients refuse to do what I suggest, they'll innocently refuse to remember I even said it when asked by a survey taker from the American Cancer Society.
I know it's my job to be adequately persuasive, and frankly, I'm damn good at it. But don't go telling me -- on the basis of patient reported surveys -- that I'm not trying hard enough.