BLOG: Past due

BySaleh Aldasouqi, MD, FACE, ECNU

I am writing this post with mixed emotions; or, in other words, with uncertain emotions. Anxiety, hope, fear. Big deal? No big deal?

As an introduction, back in 2009 I turned 50. At the time, I used to maintain annual physical exams with my wonderful primary care provider. At that visit, he said: “You now need a colonoscopy screening.”

Colonoscopy?

“No way,” I said to myself.

I am not sure how the conversation went on, but it could be something like this.

“Can we defer to next year?” I suggested/requested.

“It is up to you,” the PCP responded.

Well, I am the patient, and so it is my decision. But I am also a doctor. So, I am the doctor-patient.

Does this “hybrid” status make for a better or worse patient? A more compliant or adherent patient because he/she knows medicine very well, or a less compliant patient, because he/she has seen it all, and so it is not a big deal, or he/she is immune to illness?

Before delving further into the main topic for this post, let me pay respect to the author who coined the terminology that I just used: “Hybrid.” The concept was eloquently used by Rana Awdish, MD, in her recently-released book “In Shock: My Journey from Death to Recovery and the Redemptive Power of Hope” (Kindle Edition, accessed on July 31, 2018. Available on: www.amazon.com/gp/product/B06XWFRPKB/ref=dbs_a_def_rwt_hsch_vapi_taft_p1_i0).

Awdish told the story of her own illness when she almost died when she had a very severe case of HELLP syndrome due to placental abruption. She was a fellow at the time. So, she was both a doctor and a patient. She described her status as the “hybrid physician-patient.”

So, here I was at my annual physical exam: The “hybrid doctor-patient.”

My PCP respected my request.

Next year: Same case scenario. Same dialogue.

And next year and next year, until this last annual physical exam, last month. I am also embarrassed herein to report that this last one was not the annual physical exam. It was the physical exam visit 3 years after the prior physical exam visit.

I also have a friend who is a gastroenterologist. He, too, has been bugging me to surrender to colonoscopy.

It was not only my PCP and my gastroenterology friend, who have been bugging me about the colonoscopy, but also my wife and, some of my patients. A couple of years ago, a patient of mine told me that I should not decline colonoscopy any more. She shared the story of a family friend — also a “hybrid doctor-patient” — who declined colonoscopy until he was in his late 50’s. When he finally surrendered, he was found to have metastatic colon cancer.

So, in summary, I have declined colonoscopy, and now it is 9 years past due.

Why have I been non-compliant?

It is complicated, and I will elaborate on this in a future post.

Story short: In this last annual exam visit, my PCP said: “How about Cologuard?”

“What is that?” I asked.

“It is a new DNA test for colon cancer screening,” he replied.

“It is a home test,” he elaborated.

“Wonderful,” I said with a big smile,

I did the test last week.

It came back positive. My PCP called me with the result. This time, I said, “Please refer me for colonoscopy.”

So, now I am not sure if I am scared, anxious, or hopeful. Perhaps a combination of all?

I will write again after the colonoscopy, which has been way past due.