I clearly hit a nerve on this piece.  So yes, doctors can be sanctimonious, self-aggrandizing and incompetent all at the same time.  And yes, medicine is not rocket science.  Some of it is very difficult, some is remarkably simple (other than the volume of material).  Some of us are quite mediocre.  However, many physicians are excellent, well read, well practiced and deserve to be treated with absolute trust and respect.

However, I’m not trying to say that doctors shouldn’t listen to what patients have to say.  But I’m saying that we are held to a standard of expertise, and if we’re held to that standard, we ought to be considered experts.  If we aren’t, then we should simply offer a menu in every hospital and doctor’s office, and let patients choose the therapy, medication or surgery they think is best; with the caveat that they cannot sue us for errors.  If you know best, you get to be accountable.

When someone with an odd or obscure disease comes to me, and has information to tell me about themselves or their child, I listen.  I want to know.  I’d be foolish not to. The same with difficult complaints, or persistent symptoms so-far undiagnosed.  We all should listen.  But when someone suggests to me that their idea, however bizarre, however unlikely, deserves my full consideration,and deserves to be refuted by evidence-based studies every time, then I have to respectfully disagree on the basis that I am a physician, and human illness is what I studied and what I understand.

If an engineer suggested something to me as a client that seemed outlandish and bizarre, I might step back and ask.  But I wouldn’t presume to know engineering the way he or she did.  I think that field of knowledge is far too expansive for me to insinuate myself into it.

Admittedly, we all have a body, whereas not all of us have an engineering project in the works.  We do know our bodies, and should insist on the best for them.

But what one reader glibly ridicules as the ‘BS of a huge pool of invaluable experience’ is really quite important.  Some diagnoses and prescription practices do become rote, because one recognizes them as routine.  But the ability to recognize and treat illness and injury requires a great deal of experience.  In my specialty, expertise is defined as requiring something like 50,000 patients or 7 years in practice.  That’s a lot of people.  And knowing how someone looks when they’re about to have a cardiac arrest, or when a child is suffering from appendicitis, these things don’t come by rote, or by reading double-blinded, placebo controlled studies. They come by touching and talking to people, over and over again.

And if someone would like me to cite studies to everyone before doing anything, rest assured, wait times will really go up and patient happiness will really go down.  And most of the very good, very sick people I see won’t understand what those studies mean anyway.  Furthermore, studies are mutable and subject to error, misinterpretation and the Hawthorne Effect. Studies are also subject to
industrial manipulation and political bias.  If we rely only on ‘studies’ or consensus, and ignore self-evident truth and experience, we won’t practice good medicine.  Both are necessary.

So, I maintain that doctors must be kind, and wise, and listen to their patients’ genuine complaints.  But doctors must also be wary, and remember that they are held to a high standard by people who generally expect them to give them solid answers without too much waffling.  I’m going to have to act like the doctor; confident when I can be, and smart enough to look further when I can’t.

That’s what is expected of me!

Ed

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