In a world full of drug ads and online advice, 'Talk to your doctor' is more than a cliché

I wish I had a nickel (well, maybe a quarter — thanks, student loans) for every time I’ve read or heard the words “Talk to your doctor” on advertisements for medications, supplements, and medical equipment; tucked at the bottoms of blogs or health news articles by non-doctor authors; or as recommendations by my patients’ acupuncturists, chiropractors, and therapists. In a world where nurse practitioners are increasingly taking on tasks formerly restricted to doctors, an awful lot of people still want you to talk to your doctor. 

What does “Talk to your doctor” (TTYD) mean? Essentially, it’s a legal and ethical security blanket. Only people with medical licenses can prescribe medication or provide care. Pharmaceutical companies can’t directly instruct TV viewers to take Enbrel; that would be prescribing. Instead, they provide tantalizing images of handsome silver-haired men flying kites and grinning, while the voice-over says, “Ask your doctor if Medicine X is right for you.” Most dietary supplement labels state “take X milligrams per day or as directed by your doctor.” Mommy blogs or disease-specific blogs can’t prescribe either, so they all contain the disclaimer to talk to your doctor. Even we physicians, when writing about a disease, have to include a disclaimer: “The information presented is not intended to treat, prevent, or cure any disease — talk to your doctor.

Logically, that’s a bit inane. Of course the information presented is intended to treat or prevent a disease. I won’t write about diabetes screening for kicks; I’ll write about it because someone might act on the information and keep their toes from being amputated in 20 years. But I don’t have that person’s chart, and that’s why I have to keep it vague — no two diabetics are alike, and that’s why we have doctors, not robots. So far.

But TTYD is nerve-racking in another way; it vastly increases the theoretical swath of information that we doctors are responsible for. Most doctors, especially primary care doctors, are so physically and mentally exhausted by the end of a workday that the idea of reading beyond the most conventional medical literature seems laughable. Flipping weakly through a couple of research studies or the table of contents of JAMA has to suffice on most days. But the next morning could bring an 80-year-old patient wielding a bag of 30 different prescription medications and herbal supplements. The responsibility for the outcome of that pill mixology is fairly intimidating. I certainly didn’t learn about ashwaghanda in medical school, and there’s a bewildering barrage of new medications released on a monthly basis, all with new quirks and side effects. 

But here’s a secret: We actually like it when patients TTYD. (We vastly prefer it to typing on the constantly crashing Dell with the illogical electronic medical records software.) We prefer it to patients wondering to themselves if their new medications are making them sleepy or if they really need that surgery after all. TTYD works when both doctors and patients are informed; when patients bring resources with them and pre-research arcane supplements (pointing to a name in your homeopathic handbook is a lot more helpful than “it was something Latin-sounding”). And it helps when doctors anticipate and study products and situations that might bring a patient in. Dr. Google or WebMD can only take patients so far, and when doctors talk to patients about the use of new methods or drugs, everyone benefits from the knowledge.

[Photo by Valery Kenski via Flickr.]