I wish hepatitis C patients and their physicians could talk more openly with each other. Here are two fantasy conversations I would have, one from the patient’s perspective; the other from the physician’s.  

Dear Doctor,
My life is in your hands. 
This worries me because _________ (fill in the blank)
  • You don’t spend much time with me
  • You don’t make eye contact with me 
  • You dismiss my fears
  • You don’t seem to recall what you said at our last visit 
  • I have a hard time getting an appointment with you
  • Your office doesn’t call me back with test results 
  • You rolled your eyes when I told you I used herbs
  • You don’t seem to take my concerns seriously
  • I want hepatitis C treatment, but you don’t support this
  • You want me to undergo hepatitis C treatment, but the side effects scare me
This is what I want you to know: _________ (fill in the blank)
  • I am scared
  • Living with hepatitis C is hard
  • Hepatitis C has made it hard for me to think
  • I am tired all of the time
  • I am afraid I might die
  • I am worried I will infect my family
Your Patient

Dear Patient,
Sometimes I get scared thinking that I am responsible for the health and safety of others. This is even more frightening now because bureaucrats dictate how much time I get to spend with patients. When I went to medical school, I imagined that I’d have enough time to be with patients, but I am under intense pressure to see more patients. Sometimes I don’t have time to eat, and by the end of the day, it may appear that I am not focused on you. I am sorry; it is not my intention. 

As for your life being in my hands, it isn’t. Your life is also in your hands. When you don’t take care of yourself, and want me to fix you, I am at a loss. It would help if you would meet me halfway, by getting enough sleep, and some exercise, and by eating a healthier diet. 

Sometimes I forget that you are scared. If you tell me your concerns right up front, I’ll do my best to address those. In the meantime, you can help by learning how to manage stress. Having an illness is stressful, but worrying about it just makes matters worse. Find ways to manage your anxiety, and your life will improve immensely.   

If I don’t recall what I said at your last visit, remind me. I make mistakes. I’ll try not to get defensive. As for rolling my eyes over your herb use, I apologize. Sometimes I am not open-minded. It was condescending, and thank you for pointing this out. I will try to take your concerns more seriously.

Thank you for letting me know about the limitations of my office staff. I will talk to them. Have you signed up for our email service? You can get test results, appointments, and email questions to me. 

As for you wanting hepatitis C treatment, I would love to treat you, but I know your insurance company will deny it. What you don’t know is that my staff and I have spent hours and hours trying to get insurance authorizations for hepatitis C treatment, and we are repeatedly getting denials. This is such a burden, because I don’t have enough staff to do this. I don’t get paid for this, and the sheer number of denials is depressing for patients, staff, and for me. I want to help save lives, and not watch bureaucrats take away hope from my patients. 

The other side of this is hearing that you are reluctant to undergo hepatitis C treatment because of the side effects. I’ve seen countless deaths from this disease, and now we have a relatively easy treatment that is curing most hepatitis C cases. Sometime I just want to shake you by the shoulders and ask you to consider all the horrors of hep C. Look at these side-by-side with treatment side effects, and ask, which looks worse: years of cirrhosis, liver cancer, death versus 12 weeks of temporary side effects?  

Yes, I imagine it is very frightening to feel tired, foggy, and unsure if you are going to make it. However, you aren’t powerless. Do you know how much better you’d be doing if you stopped drinking, or smoking, or maybe lost some weight? Yes, I struggle with my weight too, but I know it can be done. Get some help for this, and you might be able to change the way you feel. 

As for infecting others, that is a tough one. Of course, if you are cured of hep C, that issue will go away. But truly, if you are following some basic precautions, you are unlikely to spread hep C. 
Thank you for writing. Let’s keep talking,

Your Doctor

Wouldn’t it be wonderful if all doctors were like this? Here is a link to a video of one of my favorite physicians: Abraham Verghese’s Ted Talk