The Problem with Doctors

A rant, yes, this post is a rant, but a much needed one!

First and foremost, Doctors are not omniscient; they are not omnipotent; they are not all wise; they do not often agree with one another; they are often wrong, and yet, they are indispensible for our physical well-being (from a human perspective); they can discern things about our bodies not seen to the common eye or discernable to the common mind; they understand human suffering, and they know how to alleviate it (in many cases); and together, the advances of doctors and medicine, inter alia,  is one of the prime contributing factors to our growing life expectancies and burgeoning (out of control?) population. Nonetheless, the way many doctors treat patients reveals a god-complex.

I am not trying to be perjorative, or even call doctors power hungry, though few doctors may deserve the designation. Rather, doctors do their best, in light of their extensive education and vast experience (in treating patients), to diagnose and treat individuals in pain and disease. And they expect that their suggestions be the final word. (Yes, getting second opinions is okay, and doctors do consult with one another, but they each give their final diagnoses with unquestionable confidence.) Those unwillinging to question, or ignorant (taken in a postitive sense) of alternatives, take the doctor at their word, fill prescriptions, take medicine, get surgeries, etc, etc, as if the doctor’s word was straight from God, or a god.

Let’s understand how medicine works (from the perspective of a patient and parent, not a professional). Ultimately, as I see it, medicine is dependent solely on observable evidence. The more collective observation of certain symptoms, the more certain the diagnosis. Doctor’s, I presume, are educated on the collective observation of human anatomy and how the human organism reacts to outside agents. Then, they are given intense hands-on experience, in the environment of a community of doctors, where they test out their skills at diagnosis and treatment. Upon determination of their professional and technical acumen, then they are turned loose to apply their growing knowledge and experience on the general public.

Thus, when a patient, such as myself, goes to the doctor with a fever, cough, runny nose, she can easily diagnose me as having a common cold. I trust her education and experience so I follow her prognosis for treatment. The more I see this same doctor, the more accustomed she becomes to my body’s reactions to ailments and illnesses and she is increasingly capable of diagnosing or recommending diagnosis for most of my problems. Unfortunately, if I switch doctors, even given the written records of diagnosis and treatment, there is a loss of observable evidence in my case. This is why specialists often disagree with primary care physicians, though this discontinuity may also be attributed to the specialists greater knowledge and experience of more particular situations in other patients. However, even this situation is exponentially complicated if I rarely go to the doctor, do not have written records, or am constantly switching physicians. This doesn’t make my situation impossible, but ultimate health care is less likely. Nonetheless, the doctor, fully aware of these barriers, in most cases, will give an authoritative diagnosis while lacking some, or all, of the volume of prior collective wisdom in my idiosyncratic situation. What am I to do? I’ll probably trust the specialist, or get a second opinion if they seem way off the wall. But if the specialist looks at my case and says, “You have no problem worthy of my attention,” whereas my primary care physician was convinced I needed it, does that not lower the authority of the primary care physician in my eyes. Yeah, I shouldn’t expect them to have intimate knowledge of a field outside of their own expertise, but if I’m sent to a specialists for appendicitis, and he finds out I had the flu, then why didn’t my primary care physician catch this, who is well capable of diagnosing and treating the symptoms of the flu (especially since she probably sees an exponentially greater number of flu cases than the specialist). This would lower my trust in my primary care physician, and I should seriously consider finding another.

But, when I change doctors, as I claimed earlier, there is a loss, even if minimal, of collective wisdom concerning my body and its reactions to outside agents. Furthermore, my original doctor will continue to diagnose and treat others, though in my mind, her expertise and ability is called into question. Of course, mistreating one person one time is a small percentage in light of thousands of diagnoses over hundreds of patients. But here is my point–doctors, in humility, should recognize the weaknesses inherent in treating any patient. There is not absolute knowledge of any one person by another person, whether a doctor or not. It may be undeniable that a person has a broken arm that needs to be reset, but there are certain uncertainties in other medical situations that are hidden from the average Joe.  Good doctors disclose as much information as possible to the patient, others leave most things unsaid. A doctor should realize that there are situations in which the patient should have input on the treatment and even the diagnosis. As such, the doctors word is not final. I am not saying every situation. In a very, very (I should add another very here) high percentage of situations, the doctor is right on. But in others, even among specialists there is disagreement, and, thus, ambiguity. The field of medicine needs to be careful to recognize this fact (because with any field based on observable evidence, it is limited only to what can be, or has been, observed; something may come along that changes a whole paradigm). This is a call for medical humility.

Finally, a call for medical wisdom. This is in direct response to a situation I experienced yesterday with my daughter. In the morning, my daughter was not eating as usual, but she was otherwise fine. So my wife took her to the playground in the afternoon. While playing, quite uncharacteristically for my daughter, she fell from the playset about 4 feet hitting her head and landing hard on her stomach. After this time, she was wimpering and crying in my wife’s arms, asking to go home. After going home, she laid down immediately to sleep. My wife scheduled an appointment with the Pediatrician and took her one hour later. The pediatricians office, which is a co-op of sorts of pediatricians and RN’s, allowed my daughter to see someone we have never seen (this happens quite often at this prominent pediatricians office in Wake Forest). My daughter had a fever of 103. My wife told the doctor the whole situation (here is a very real problem–doctors are tempted to treat the story rather than the person!!!!). As such, they poked and prodded my daughter’s stomach while she lay there wimpering. Because she was crying and unresponsive, they felt she may have appendicitis or a stomach injury and recommended we go to the hospital emergency room. So we did. However, after several simple tests (that required no equipment or secret knowledge that, in my opinion, should have been carefully carried out by the pediatricians office), they easily and quickly ruled out appendicitis or a stomach injury. They did X-rays, not of her abdomen, but her chest to rule out pneumonia. Finally, they tested her for the flu, which she had. Finally, we spoke with Dr. Saad who implied distrust of our pediatrician because of the co-op model. I had the feeling, the whole time we were at the hospital, that the staff and doctors were really wondering why we were even there. This is why I am calling for medical wisdom. The co-op model may be efficient for the doctors and lead to higher profits (since our particular office has several local offices and numerous doctors and staff over a large patient body), but it is unwise in treating patients. There is no continuity between doctors, and even though all of our medical records are in that office and only doctors from that office see our children, there is a major breakdown of collective medical wisdom towards my children. As such, my wife and I are considering finding ‘one’ pediatrician who can give primary care to our children.

Always remember to ask questions of the doctor–always, always ask why. I personally refrain from giving the “story” of what happened until they have presonally observed at least some of the symptoms. I know this violates the system of triage, but I think it also removes bias from the diagnosis (bias towards the story). Also, the doctor should be able to tie together for you why a certain treatment matches certain symptoms. The doctor may feel you don’t trust them, but so be it. Doctors, as I argue for medical humility, should not assume this trust, especially in complex situations–they should earn it. If they recommend seeing a specialist or going to the hospital or getting surgery, they have to, they must, answer why. You musk ask them why. They may, as in the case of my daughter, neglect to fully investigate the symptoms. If they can’t answer why sufficiently, then you have evidence they haven’t done all that they could. (Note, though, that an answer of “I don’t know” may be good reason to see a specialist.)

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