Monday, September 10, 2007


Medical Adventures (A)

How I am Alive Thanks to Some Doctors and in Spite of Others

Starting today I will write over several days a critique of some medical practices. It is by no means a critique of the medical profession as a whole. I am alive today because of the advice, efforts, dedication, and high skills of several physicians. But choosing the right doctors and ignoring unsound advice was essential. I also want to counteract the tendency of some people to reject modern medicine altogether because of a negative experience with a particular practitioner. I am a strong believer in modern medical science even if I have lost respect for some of its practitioners. If an inept mechanic messes up the tuning of my car engine I will not reject the laws of thermodynamics; I will simply look for a competent mechanic. Of course, choosing doctors is more critical than choosing mechanics because you may not get a second chance. Because the human organism is so complex, even the best doctors make mistakes sometimes. What patients should be looking for is doctors who will do as well as the current state of medical science allows.

These writings are motivated by my medical problems during the winter of 2006-7. I am detailing that story in where I also present more extensive comments than I do on the blog.

My most severe problem with doctors has been the unwillingness of many of them to listen to the patient and their extreme self-confidence, if not arrogance. Of course, such attitude goes against the advice of Sir William Osler (a Canadian MD, one of the founders of Johns Hopkins School of Medicine) who said: "If you want to find what is wrong, ask the patient" and also "The greater the ignorance, the greater the dogmatism."

This attitude is troubling enough by itself, but it is often coupled with a tendency to make a diagnosis based on the most common cases. If you have symptom A, then the cause must be B because that is the case with, say, 60% of the people who exhibit symptom A. Too bad if you happen to be in the remaining 40% and your symptoms are caused by something other than B.

The situation becomes even worse if your symptoms have multiple causes (which was the case with me last winter). Superposition effects seem to be beyond the grasp of many physicians. When I tried to explain the issue to some of them, they looked baffled and even impatient; it was clear they thought I was wasting their time. The tragic side of this is that in older people several systems may start functioning below the optimal level but, because each system is still within "normal limits", the MD cannot find what is wrong.

Another bad practice is that whenever physicians are puzzled they claim that the patient's problems are in his/hers mind. (This was the initial diagnosis for me.) This is the modern equivalent of been ill because of "foul airs" or the "evil eye". Because of the frequency of such a diagnosis in older people we have the myth of the "elderly depression".

You may say that I demand too much from doctors because the human body is a far more complex mechanism than any technological device. Well, doctors cannot have it both ways. If they want sympathy from their patients for their tough job, they must also have sympathy for the patients who suffer from a tough to diagnose ailment.

I am not dealing with practices that are clearly unethical, such as doctors who order unnecessary (and often painful and expensive) procedures to make money. Or doctors who prescribe medication because of their links with the pharmaceutical industry. What I am trying to convey is that some doctors may be harmful even if they commit no ethics violations or even if they use their best judgment in the interest of the patient. The problem is that their best judgment may not be that good.

There is an excellent book dealing with the problems of medical diagnosis: How Doctors Think by Jerome Groopman, MD that came out while I was struggling with my own doctors. Two of the most memorable (for me) observations in the book are: (1) 15% of all diagnoses are wrong; and (2) doctors often attribute to psychological causes ailments that are unable to diagnose ("it is all in your mind", "you are too anxious", etc). They seem to fit with what I was experiencing.

(To be continued)

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