My son and I have been discussing this, together, for a while, so we agreed to both publish the concept on each of our websites. His will be under www.USHeadache.org.

Lessons gleaned from the Patient Provider Paradox (TM) can be applied to many relationships where there is an “Expert” or professional advisor and a client (aka customer). This could also be called the Expert Paradox(TM) or the Advisor Paradox(TM). So, what is a paradox and what is so paradoxical, here? A paradox in this situation is that there are contradictory features and qualities in the relationship between the patient and the provider, or the expert and the client or advisor and client, or even an advisor and person receiving the advice. So, this can apply to many situations, even a family member with your absolute best interest at heart. In no way is this article suggesting that the providers, experts, advisors do not have your best interest in mind. It is merely to point out the asymmetry in the relationship, and how you need to keep that in mind.

Perhaps an illustration is in order. You go to the doctor. For whatever period of time you have experienced the condition that you are now seeing the doctor about. you have felt every aspect of it, lived it first-hand, and in real-time. Perhaps, that has been for the past 3 days, or perhaps it has been for the past 30 years. Now, the doctor walks into the room. He will spend 5-15 minutes with you, sometimes longer, but a short time, nonetheless. You are going to do your best to articulate what you have been experiencing for the past 3 days or 30 years in the few minutes that you have with the doctor. And, the doctor, is going to diagnose you. You have all the information. You have done your best to confer that to him or her. But, you have an abundance of time with the condition, and an abundance of time to research the condition. The research factor can be a double-edged sword, but it can be a more important factor in the Internet Age.

The Provider has the expertise. But, they only have a tiny amount of time to listen to you and think about you. So, you already have the makings of a paradox. However, on top of all that, he or she decides your diagnosis, determines your treatment and moves on to the next patient. If they got it all right, then that is great. If they did not get it right, it won’t make that big of a difference in their day. However, for you, the patient, if they get it right, that is wonderful, perhaps, at times, even life-changing. But, if they get it wrong, that can mean a range of repercussions. It can mean you will continue to be ill. It can mean a repeat trip to the doctor. It can mean years of confusion as to why you are not getting better. Or, it could lead to utter devastation.

OK. So what? We’ve just dissected some unique features about the relationship between healthcare providers and patients. There is nothing we can really do about that, right? The answer is yes and no. That is the nature of the relationship. However, being aware of these dynamics, both patients and providers can help protect patients from traps that they might fall into, if they were otherwise unaware.

I will share a personal example to illustrate. I have been a Chronic Migrainer (my preferred way to spell it) for at least 30 years. Early on, I was misdiagnosed multiple times by multiple providers, both military and civilian. I carried the information that those providers told me, as if they were true for years, even as they appeared to conflict with my personal observations. In the military, I was told that I was not drinking enough water. So, over years I was drinking so much water that I felt bloated and miserable. As I looked around at my fellow soldiers, I noticed that I was drinking way more water than anyone else. My first thought was not, “I have been misdiagnosed.” Instead, I thought, “I must need a lot more water than other people.”  There were many other little things along the way that appeared to conflict with my the diagnosis that I had not been drinking enough water. I carried that misinformation with me for years, and it delayed me from seeking and getting a correct diagnosis. Had I not attended a “lunch and learn” about Migraine in early 2002, where I self-diagnosed during the doctor’s presentation, it is unclear how long I would have carried the misdiagnosis and misinformation with me, or when I would have finally gotten a correct diagnosis.

What can we glean from my situation? First, I want to point out the obvious. The only person who was paying a price for the times that I was misdiagnosed was me. None of the military nor civilian providers who misdiagnosed me ever incurred any discomfort for my misdiagnosis. So, we have asymmetry of outcome or asymmetry of impact. I suffered long-term repercussions from those misdiagnoses. Second, I carried the incorrect information that they told me as truth for many years. That was like getting bad directions on a long journey in unfamiliar territory. How long and how far do you go, before you realize you received bad directions? You can be way off course by the time you finally figure that out, especially when the original directions were from a trusted source, a medical provider.

So, through the cycle of the relationship, you have this paradox, because you, the patient, have lived with the condition. You are living with the condition. And, you will have to live with the outcome of your treatment after treatment decisions are made and treatment is administered to you. The provider has not had the condition, does not have the condition and does not have to live with the treatment decisions applied to you, hence, the paradox. Even if they have the same condition as you, they don’t have your condition. Only you have your condition.

Likewise, we have similar relationships with other experts and advisors. We often treat them with similar deference. I am not suggesting that we should not exercise deference to experts in certain fields, from whom we seek their advice and assistance, lawyers, brokers, pastors and the like. However, we should not subordinate our own judgement, nor set our own judgement aside. A truly excellent provider or expert advisor will educate you in their area of expertise, as it relates to your issue, and encourage you to participate in the decision-making process with them. In partnering with you in that way, when you encounter conflicting information, you should revisit the decisions made and consider revisiting the expert with that information, if necessary, especially for something as serious as a persistent medical concern.

I want to close with one final thought. One thing that I have noticed during the Covid-19 Pandemic is that people will say, “Just do what the experts say.” However, even with public policy matters and for us as individuals, I would, once again, recommend against subordinating your own judgement to the so-called experts. Certainly, they have provided some broad structural knowledge that has been helpful, and was spot-on accurate. The need to “Flatten the Curve” was spot-on correct. Social Distancing, bingo! They got that right, too. However, recommending we not wear masks was a mistake that any engineer could tell was a mistake. Any filtration is better than no filtration, whether you have N95 or something less.

At Pathfinders Foundation, we always encourage people to think for themselves. When we practice thinking, over time, we get better and better at it. Using experts, even doctors, is no different. Most good, quality doctors welcome patients who are thoughtful about your relationship with them and understand the pressure that they are under to diagnose you in just a few minutes with just a handful of clues. You can help that process by being thoughtful, by doing research ahead of time and being prepared to make your time together as productive and effective as feasible. Your relationship with healthcare providers and other expert advisors should be that of a partnership, and not treated as merely transactional. They are not there for you to dump all your symptoms in their lap, and barf up a diagnosis and prescription, on cue. Your life is too important to treat these relationships that way. If you approach these relationships the way I have discussed here, I believe it will position you to get the best outcomes for you, and avoid, to the extent feasible, serious pitfalls in the process.