Be warned…whinge ahead! One of the things I’m asked most often by naturopaths is about my experiences & interactions with doctors regarding shared care of patients. The question typically arises because they’ve been on the receiving end of less than ideal situations. We’ve probably all been there at some point. My usual optimism tells me that if we keep building the bridge by ensuring our communication is professional, accurate, respectful and always in the patients best interests, eventually we’ll bring the detractors around and those who make it clear they’ll never come around reveal themselves to be ill-equipped for shared care. Over this last week I’ve had a nasty reminder of the latter!
Here’s the scenario: I recently started seeing a female patient in her late 50s who has had unresolving diarrhoea for 3 months. Multiple trips to the GP and investigations revealed no explanation, however, the diarrhoea was severe, unprecedented and deeply concerning to my patient. After much discussion I organised a CDSA for her, the results of which confirmed extensive infection with Dientamoeba fragilis. This parasite is a well-known established cause of diarrhoea and its eradication is associated with resolution of these issues. There were also high levels of two gram negative bacteria which can be commensals (non-pathogenic, not infrequently found in human GIT), however, their population should be kept in check: Klebsiella pneumonia & Citrobacter freundii. As both of these bacteria are notorious for developing antibiotic resistance I did what I thought was best and communicated the findings of these results (plus copies) as well as a review paper from a mainstream scientific journal on Dientamoeba fragilis to her doctor in case we needed to pursue medical treatment of the parasite. Now this is where the drama begins. Did I mention this patient also suffers from anxiety? Upon receiving my communication, her doctor wildly informs her that Klebsiella pneumonia is lethal! Potentially true if found in your respiratory system, however, absolutely not in the GIT. He says has no idea about what I’m talking about (true!), with the suggestion that I don’t either & refuses to treat her. Understandably, I receive frantic calls from a very upset patient concerned about the lethal bit! What do you say? Here’s what I said: Unfortunately this GP has simply demonstrated his ignorance about GIT microflora. K. pneumonia is nasty in other parts of your body but quite common in the gut. I can send you some information about this to reassure you. In the meantime let’s get you in to see someone who actually knows something about GIT pathogens.
A week later after the same patient sees the GP I referred her to (who received the same referral letter and information) I receive an email from him saying essentially: Thanks for sending this patient and the information. According to the Centre for Digestive Diseases I think we can treat the parasite if necessary without risking resistance with the gram negative bacteria, however, right now she seems to be doing really well on the herbal anti-microbials you’ve prescribed so let’s delay any medical intervention unless really necessary. I’ll see her again in 3 weeks and keep you posted.
Let’s just recap…this is a regular GP with the same training as her original one the difference is he has an open mind and takes the time to keep abreast of new information in order to offer his patients the best care. In the space of one week and two GPs I’ve gone from ‘mad fish-slapping dangerous naturopath’ to a welcome & respected contributor in patient care. A good reminder that if you’ve done your best in terms of establishing good communication with doctors and other carers and they seem unable to respond in a way that has the patients best interests at heart…find another doctor! Ok – I’m done now 🙂