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Wednesday, July 16. 2014
Educated people often make doctors’ worst patients: anti-vaxxers, cancer treatment rejecters, herbal remedy enthusiasts. Why do otherwise brilliant minds ignore science and reject modern medicine?
Read the article. I think people tend to be skeptical because "the science" is always in flux so many would rather go with their relatively-uninformed judgement than with the expert judgement of the day which may be obsolete next year. Remember the big scare about hormone replacement? Remember when they claimed that broccoli was good for you? Etc. People do know that physicians are smart and well-educated, but they like to make their own decisions for better or worse.
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It's because smart people recognize that most doctors are over-data'ed to the point of being made stupid. For me, my signs, symptoms, and the benefit/risk of following doctor's orders don't add up. As they told me on the first day of medical school: don't talk to the nurse, question the patient's family, or read the chart; talk to the patient, who knows more about their condition than anyone.
talking to the patient to learn about them is not the same as the patient refusing your treatment because (s)he thinks she knows better than you how to treat her condition.
I've seen it a lot with my aunt (before she died). While not the smartest of the lot, she had the smarts and was always reading about medical things (without really understanding what she was reading, which is typical of intelligent people untrained in medical issues, they read a lot, don't understand it, but do draw conclusions. Main difference being intelligent people draw those conclusions thinking their intelligence enables them to understand everything equally, my aunt just picked what seemed like the most dramatic thing that fit what she thought her symptoms were and then claimed high and low she had that condition).
So these people go to the doctor not so much to get cured as to confirm for themselves that they were right in the first place. And many of them then end up falling for quacks and charlatans claiming to have "natural remedies" or "ancient knowledge suppressed by science" as a lot of them have a deep mistrust of anything scientific born out of their own ignorance of any and all scientific issues outside their small direct circle of knowledge.
I see this all the time. Patients seem to think that if they're "smart" in one area they know all about everything else. They are consistently more gullible than the average plumber. And you can't explain your rationale to them because they already know better than you. I often wonder why they're in my office. Also, they're very angry.
One reason people don't listen to their doctors is that most Americans are anti-intellectual, anti-elitist, and hate and fear truly smart people. Doctors are some of the smartest people in our society, and arouse the evil troll "smoosh them til they're dead" in every dumb jock or crooked business person who knows uneasily that they're a pretty dim bulb next to them. Those patients bluster and invent specious arguments or just ignore the doctor because they are humiliated at being stupider than him or her. So internet surfing and arguing with their MD is a way of trying to overcome a legitimate inferiority complex. Humiliating that the former geeks studying for Organic Chemistry are now in a position of diagnosing one, and granting or withholding life saving advice/treatment, etc.
In other words, some people (especially narcissists) are at best ambivalent about their doctors. The smarter their doctor, the dumber they (the patient) feel. It's not sensible, as better a living dog than a dead lion (as the Good Book tells us) and any sane person would rather feel dumber but be cured...
Another reason people ignore their doctors is precisely because they expect too much of "health care." People think they can overeat, smoke, drink alcoholically, drug, screw around, yadda yadda and still look like a God and live forever. It is deeply insulting to their narcissism and frankly terrifying when a lump or some awful pain sends them to the witch doctor. They want the wizard to banish the terrifying thing and make them whole RIGHT NOW, without any effort on their (the patient's) part. Anything short of a miracle cure is worthless. So when the doctor says that this particular medicine may help, that it will have a few side effects, but will make them feel a bit better, and that they are going to need to start coming in for regular visits and tests, they are branding a "Defective and Doomed" label on someone who wanted to be sent away restored to perfection. This leads to a lot of unhappy and argumentative patients.....
Also, the doctors who have this happen to them a lot MIGHT want to look at themselves. Sometimes patients do this when their doctor doesn't listen to them, and express sympathy BEFORE diagnosing and prescribing. Being arrogant and abrupt tends to make any patient mad, hurts feelings, and leads them to go off looking for other answers on the net or from friends, etc. Whereas being politely and compassionately listened to for even a couple of minutes can make all the difference in terms of someone being willing to follow medical advice. Most people come in quite desperate, and wanting the doctor to figure it out, help them, tell them what to do. If handled compassionately, and respectfully, most will appreciate being taken care of and being given some hope that their situation is not hopeless, that SOMETHING can be done (even if miracles can't be guaranteed).
But this doesn't happen all the time. Sick people aren't always polite or deferential, Intelligent people and free people don't doff their caps to ANYONE. Many patients nowadays feel that they don't matter at all to their doctors (this may or may not be true, but HMOs and MDs cramming more and more people into a days' appointments don't do much to make patients feel that an MD has given their case their full, considered attention. Whereas one's own health is of supreme importance to oneself.
There aren't always clearcut treatments or cures, and even halfway intelligent patients may be aware that there is considerable debate in the medical community about treatments. When it's one's own or a loved one's life at stake, one may develop a preference or pious hope that one or the other may work better. So much of healing involves faith, hope and the placebo effect, that doctors who ignore such feelings aren't helping mobilizing powerful forces that may help cure their patients. In other words, the patient or patient's relative may be being a jackass, and a knowitall jerk but that's their privilege: they're sick or terrified about someone they love who IS, and they're paying for the physician's wife's SubZero fridge, so the physician can just be diplomatic...
Patients are often forced to change doctors nowadays as they move or their jobs require them to go to different doctors when they put their employees on ever worse health insurance plans. Any physician who says "Don't you value your health, just pay for a good doctor" forgets that doctors and their families get better rates. Us plebes with large families or anyone who has several family members with chronic conditions ends up having rather circumscribed choices of physicians. Because you have to feed your family as well as pay the doctor. My point is, during the enforced shuffle from doctor to doctor, they may have received contradictory advice about the same condition from the previous barber surgeons, and may not have that blessed respect and gratitude for Marcus Welby's benevolence and superior wisdom that it's natural for a hardworking physician to want from a patient. They may have been badly treated, or callously neglected or overcharged, or severely hurt by a previous physician, or got great care and then been forced to switch to a jerk, and this tends to make people turn to the internet even if not to lawyers. Furthermore, if they have an intractable condition (for example, a depression that never remits) they will be totally skeptical of anything a new doctor suggests as nothing has worked before.
You have to earn the trust of your new patients before you can assume you have it. Think about how they have been treated before.
On the other hand, I often tell my flaky Gaia worshipping friends this story to remind them how lucky we are with even imperfect access to modern medicine. A relative was doing medical work in Nepal (or Tibet, I forget which) with a bunch of other idealistic young MDs. They all wanted to go there to learn about traditional medicine, about which all had read and had high hopes of bringing back to their supposedly "dehumanizing" hospital residencies and the like. The first day they looked outside the lice ridden hut they had all slept in, in sleeping bags. A line nearly a mile long of people. All ages, some had walked fifty miles or so, to see the Western doctors to get antibiotics that would save a life. They wanted nothing to do with traditional medicine, that had not been able to help the desperately sick people the young doctors now began handing out fairly basic stuff to (antibiotics, rehydration fluids, etc.). That wrought miracles.
I was admitted to the hospital for PE's. I had PE's 4 years earlier and they put me on coumadin. After a few year my doctor ran tests and thought perhaps my first PE's were just a quirk and there was no good medical reason to continue on coumadin. So when I got PE's (multiple, perhaps a dozen) the second time he was really worried and put me back on coumadin. But I'm laying in the hospital bed about to be discharged when my nurse came in and gave me her opinion; she wouldn't use coumadin and maybe I should consider some natural blood thinners. She had a general anti-big pharma rant. I was stunned that a professional in the medical field would be saying this. Smart and well educated doesn't always make a person right.
For a lot of common folk,, doctors are like plumbers,mechanics,lawyers,professors,and, workers in general some pretty good and some are not worth a poop,.makes for skeptical folk ,,as they should be.
An article full of errors.
Never mind that it’s the doctor who can cure you
That should be may be able to. Not can.
He made adult-level toys for the masses
Yup. Hand-held computers are just toys. With a judgment this poor, why should I trust anything else the author writes?
tumor was felt to be curable with immediate surgery
felt here is being used as weasel word to avoid clearly stating that the patient might have to undergo long, painful treatments which would be ultimately unsuccessful. I don’t pay my doctor to feel anymore than I pay my plumber or auto mechanic to feel.
There are fads in medicine as in everything else. One cannot simultaneously advocate being an informed, critical consumer of medicine and advocate trusting one’s doctor completely.
Was Jobs wrong? Yes. And guess what: even if he’d opted for surgery, it still might have been the wrong choice.
I have some sympathy with your criticism that the article paints Jobs's other choice as life-giving, when the reality was more uncertain.
OTOH, there is the pesky fact that he's dead, and that choice was going to leave him dead no matter what. So the other choice, even if it was a poor chance, was some chance.
I want a doc who comes across as working with me to solve a problem. If the doc seems compelled to establish a superior-subordinate relationship out of the box, I immediately suspect he/she/it is trying to cover up something. Same goes for plumbers, roofers, carpenters and auto mechanics.
We docs don't get a cheaper rate on medical care. How'd you figure that out?
We're not "working with you to solve a problem" because you don't know a damn thing about it. We don't know a fraction of what there is to know, but we still know far more than you. I expect you to be able to tell me your symptoms. Knowing something about your medical history and maybe having a clue about what medicines you take would be nice. Then it's my job to figure out what is the problem, and find a way to treat it. You don't "work with me" on that, any more than I "work with" my mechanic to tune my engine, or "work with" my accountant to do my taxes. Then I explain to you what I think is the problem, and the options to address it, and which I think is best. I will listen to you, treat you with respect, have compassion for you, and get to know the person you are, but I don't "work with you to solve a problem." As above, the rules of interaction between doc and patient are the same as any other interaction, with mechanic or accountant.
"Felt" is not a weasel word. Treatment may have worked, and maybe not, but the result of the patient's reliance on his own intelligence were not very impressive.