advice vs. permission

I've been thinking about this for quite some time, and I still don't get it.  Hopefully I can explain what I mean here.

Sometimes (a lot of times, actually) I see people post stuff like "My doctor doesn't allow his patients to take NSAIDS" or "My doctor lets us eat mac-n-cheese at two weeks post op" or "My doctor requires that we not drink for an hour after meals" or "My doctor doesn't allow snacks," and so on.  What I don't get is, how does a doctor "allow" a patient to do something?  Or how does a doctor "not let" a patient do something?

Doctors advise us about things we should or should not do, sure.  But how will a doctor prevent you from snacking or taking NSAIDS if you want to do those things?

Maybe it's a matter of how much power we give our doctors over us.  And maybe some people are comfortable giving their doctors a whole lot of power.  And I guess if that works for you, then there's probably no big problem with it.  The only problems I could see would be if your doctor's advice didn't work for you or if you decided to do something your doctor didn't "allow," you might be afraid to tell your doctor the truth about what you were eating or what vitamins you were taking or whatever because you didn't want to let him know you weren't "following the rules" and I think it's a bad thing when we are afraid to be honest with our doctors.

So how it is for you?  Does your doctor give you advice or does he or she tell you what you're allowed to do?

My surgeon does tell us what we are and are not "allowed" to do immediatelty after surgery... but they are things that can truly cause us physical harm, pain, etc. if we ignore her instructions (lifting restrictions, for example).

Beyond the immediate post-op period, however:
1) She has a fairly liber post-op eating plan, so when her plan suggests that you not eat, say, pineapple, until 3 months out, you know there is a legitimate reason to avoid it for a while (in theis case, the fibrous nature of ipineapple makes it very hard to digest).
2) She provides guidelines and "rules" for success, but she is very aware of the limited power she has over her patients. That is part of the reason that she discourages soda post-op, and strongly encourages moderation for those who DO choose to drink it, but does not "forbid" it (although she is pretty firm about ti being a really bad idea for the first 3 months while you are healing). She knows damn well that many of her patients are going to drink it no matter what she says, so rather than try to exert some mythical power that she knows she does NOT have, or trying to scare people into compliance with bogus threats of pouch stretching, she explains the negative aspects of drinking diet soda with the hope that her patients will make good choices once they understand the issues.

One of the reasons that I really like her is that she doesn't play games (I would kick any surgeon who would try to use scare tactics about pouch stretching to the curb in a New York minute, for example), and if you have sufficient medical/physiology knowledge to ask more detailed questions, she will give you more detailed answers.

Lora
(edited for typos)

 You are spot on with that comment.  My in-laws both went through Dr. Rita and have expressed the same thing.  Which is why I chose her, and very glad that I did.  

My after care program is pretty straight to the point, meaning a list of what I Can have and if it is not on the list then I am not supposed to eat it.  I follow it as closely as possible, but not because I fear the doctor.  I fear screwing this up.  Its been only 6 weeks and I second guess everything I put in my mouth.  It's hard sometimes because of what you mentioned (posts such as "my doctor lets me have mac and cheese" vs "my doctor said zero carbs").  Since there are so many schools of thought concerning what we should or should not eat, I find that this early out I just stick their plan.  Everything else is just confusing.  Great topic and not something I thought about before.  I wonder if vets treat doctors advise as rules or guidelines?

I have a different opinion of the eating plan I was given. I didn't necessarily want a list of foods I could or could not eat. I wanted to be taught HOW to eat. I am one whose eating plan said I could have mac and cheese at 2 wks out, my plan also said I could have potatoes and toast.  Great. So I CAN have those foods, but SHOULD I have those foods?

I would rather be educated on HOW to eat i.e. eating protein first, limiting carbs, how to chose foods based on nutritional content, etc. I have always been the kind of person who bristles at being told WHAT to do. I want to be given more information. Its not that I'm non-compliant or that I want to do my own thing. I just want to be educated about HOW to make MY OWN choices...

I will say my one real regret post op was that i ever tried toast.
Toast is my demon.

I had my surgery at Cleveland Clinic and prior to surgery I recieved a book, basically, a road map for surgery.  It has guidelines of do's and don'ts for before and after surgery, including a progression of diet. I was careful to follow it and suprisingly on my first post-op visit, my surgeon told me that he wanted me to progress to a regular diet as soon as possible which was against what my "guide" said.  At first I was excited, "yes, I get real food", then reality set in.  I have to listen to my body.  I have to be completely aware of every signal my body gives me, ie: slow down, chew more, don't eat that. 

For me, I trust MY body first. I'm a nurse and I know that intake and output are very important. I trust my NUT second, to help me figure out amounts and new ideas for foods that I hadn't thought of. My surgeon, well, I've only had one follow-up since surgery and I haven't had any other communication with him.   I refer to my book often and call my NUT if I have a question. In the end, I know what I can do to be successful and I know the things that will hinder my success.  The choices that I make, are the choices I will have to live with.

My doctor and nutritionist tells me what I am allowed or not allowed in terms of diet. But then in terms of things like vitamins, he's totally wishy washy. This is the guy who told me that I should NOT be drinking protein shakes at this point because they'll cause me to not lose all my weight. But then with the vites he tells me I can take iron, unless it bothers my stomach, then I don't have to. These are just examples, bu*****pifies the program that I'm in unfortunately.

I know now that I have to find a primary care doc who has experience with post-op patients and frankly just pay lip service to my surgeon... I feel sad saying that, but (I don't know if you remember my post a few days ago) I feel like my doc is full of s**t for all the cruddy advice he gives. Like several people told me, its our bodies, we have to do the research and listen to the docs, but do what is best for us.

I do have to say (I can see getting flamed for saying this) when I was earlier out and I needed advice here (because I knew I was getting bad advice from the doc/NUT) I was constantly told that I should ask my doc. Some posts were "this is what I do, but call your doc" and some were "follow your doc's plan, do what they tell you to do - they are the doc...". The latter posts were so unhelpful because I wasn't getting good advice from my docs... If I followed their advice 100% I'd be taking in 300 calories and 30 gram of protein a day. I tracked this for a few days, so I know this is what I was taking in. When people are told "do what your doctor says" it contributes to the feeling of powerlessness on the person's part and adds to the dependence on the doctor.

I'm a nurse and I still have trouble being assertive with my doc. I believe that this experience will change this. I know that I will have effects from my surgery for life and I need a doc who will be supportive of my health, not just ignore things until they become issues.

I agree with you that people need to be their own advocate and be partners with their doctors, as opposed to just doing what they're told. The sad truth is though, that many people may not have the freedom to change doctors if they aren't getting the support they need, because of insurance reasons, etc. I think that's why its so important we remain a supportive cohesive community here. No, we're not doctors, but those with experience can help a lot, maybe more...

I don't know if I answered your question, but I've been thinking a lot about this too, especially since my crummy follow-up appt....

You know, I think there are many reasons someone might tell you to ask your doc or do whatever your doc says.

Some people may just think doctors know everything.

Some people that know doctors don't know everything may feel uncomfortable giving people medical advice since they are not doctors.  I usually tell people "the ASMBS says you need X amount of this vitamin" or something like that.  I'm not giving my opinion, I'm presenting factual information from a reliable source.  Now, sometimes I don't have a reliable source, I'm just basing something on my own experience or what I've heard other people say.  And then I'm likely to say something like "This is what I would do" instead of "this is what you should do."

I wish we had a like button! I've always gotten great advice from your posts and I can tell you that I appreciate beyond measure how you say things and how you present the information that you do.