Aug 10, 2011

The Greatest Medical Myth

A reader asked her specialist a question that befuddled him, so she wrote Doctor D this question:

How is a doctor allowed to mess around with body parts he doesn't understand?
If doctors were required to understand everything we touched we wouldn’t be able to touch you at all!

The human body is still a deep mystery. Doctors understand more than most people, but what we know is still a vague approximation. Just because our educated guesses often work out well doesn’t mean we have any idea what’s actually going on.

The Myth of Physician Omniscience:

It is a popular myth that doctors know exactly what your body is doing. The myth assumes the human body is a machine that is even understandable in the first place. Doctors learn a ton of stuff in medical school so they must understand everything the body does or can do, right? TV medical dramas have reenforced this myth without you even realizing it. If you fart or have a rash a doctor should be able to explain exactly why your body is doing that.

"Nope, nothing about your body could ever surprise me!"

I hate to kill your Santa Claus, but MD’s don’t understand with any real depth what is going on in your body most of the time.

We are still be useful, but we don’t always know what’s going on behind the scenes anymore than you need to understand the internal combustion in order to press the gas pedal. Human bodies are exponentially more complex and varied than engines so when what we do doesn’t work, we can be at a loss to know why, although we can often make up some bullshit that sounds convincing.


Doctor D has tried to disabuse people of this impossible myth, but nobody’s listening.

Patients either don’t believe me, “How nice of you to be so humble, doc, but I know you know what’s going on,” or they assume the lack of knowledge is some default in my training, “Okay Dr. D if you’re incompetent then refer me to someone who does understand!”

People just refuse to believe that there could be things that no doctor understands. The body is just too complex! Every human body is different and is constantly interacting with your mind, soul, other humans, and the environment. Not only is there a lot we don’t know. There is a lot that will always be impossible to know.

So, why is the myth of Physician Omniscience so deeply ingrained? When a wrong idea won’t budge it’s usually because it satisfies a deep psychological need.

No Thanks, We Prefer Myth To Reality!

Being ill is terrifying. When your body begins to betray you it is natural to want to know why. Patients need to believe that somewhere out there is a doctor who understands this. In their imagination patients replace doctors’ vague, tentative understanding with a mythic understanding that is complete and without doubt. “It’s okay that I feel out of control, because my doctor is on top of it!” This is why mystery illnesses are so unsettling. It feels like like being in speeding car with no one at the wheel.

"Don't worry! Doctor Zeus has this under control."

Doctors are also responsible for this myth. We perpetrate this falsehood for 2 reasons:
  • First, we want you to trust us. It takes a lot of trust for you to ingest the chemicals we give you or let us cut you open. We fear that if you knew how little we understand the bodies we work on you wouldn’t let us near you.
  • Secondly, we lie to ourselves. Medicine works. This is a good thing, but it allows us to mislead ourselves about how deeply we actually understand what’s going on. It also takes a lot of self-confidence to take on the care an ill person. Imagining we have god-like knowledge of the body helps us banish self-doubt. Unfortunately, banishing self-doubt is a double-edged sword: It can give us the confidence we need to pull of some incredible healing, and it can blind us to the humility and insight needed to acknowledge when we don’t understand.

One thing you can take as gospel: If any physician tells you they totally understand your body they are either lying or deluded.

How To Live Without The Myth

This is good and bad news for you. The good news is that having and MD doesn’t make your doctor the final authority on you. Understanding this can allow you and your doc to have frank discussions on what we do and don’t know about your body. The bad news, of course, is that full understanding of your body is impossible.

But realizing that the body is a fearful and wonderful thing isn’t such a bad discovery. Appreciate your body for the mystery it is!

Doctor D always loves to read your thoughts in the comments.

Do you think that Dr. D is over-stating the uncertainty of medical science?

Patients and Heathcare People: How has this Myth affected you?


Anonymous said...

Well said. Loving the Age of Mythology pic too, by the way.

ToasterPastry said...

Sorry, where I live, I'm not treated like a God. Maybe this was a popular belief in Doctor D's time or in Doctor D's practice on some remote island, but this myth doesn't hold true today. In fact, maybe it's time to post a blog stating that MYTH: ALL DOCTORS ARE IDIOTS WHO CARE MORE ABOUT MONEY THAN ABOUT YOUR HEALTH. This seems to be the popular belief among patients in my office who seem to know more than they should. I waste more clinic time debating with patients their web-based falsehoods than I actually do treating the patient. Of course, I don't know everything. I regularly tell people I don't know, but provide a hypothesis. I also tell patients that if this doesn't work, please call me. Unfortunately, this distrust of physicians has played directly into a multi-billion dollar alternative health industry. Chelation therapy? Doesn't work. Vitamin E? Expensive piss. Fish oil? Blind placebo-controlled study says it doesn't work. Midwives? Sure, until something goes horribly wrong. Sometimes you gotta put your trust in a person that will help you through a health crisis, rather than fighting them every step of the way.

Doctor D said...

I think I'm younger than you, ToasterPastry. We're both far removed from the time in which the world revered MD's as gods.

I think what you're describing is the direct effect of the same myth. "The body must be totally knowable, therefore if I discover you don't know everything you must be full of shit!"

This attitude still assumes that somebody understands the body fully. "If it isn't my MD then it must be my yoga instructor or an internet supplement guru."

What I would love to see is patients recognize is that uncertainty is a part of every interaction with the body, but that acknowledging this uncertainty can actually make an MD more useful, not less.

PS: A Midwife delivered my son and I think they are great. A midwife with good OB backup isn't snakeoil.

Helen said...

I hear a lot of "we don't knows" from my electrophysiologists. This was new to me at first, having been used to dealing with my rheumatologist and what is a pretty textbook case of RA. At first, all the uncertainty threw me off. I wanted straight answers, and doctors who knew everything.

Now, though, I've really come to value their honesty. If anything, it makes our relationship feel like more of a team effort. I may not get easy answers, but I do get a team of doctors who are dedicated to providing the best care they can with a body of knowledge that continues the grow.

family eldercare austin tx said...

I believe there can be a happy medium... patients need to trust their doctors but also realize that they are really just people too.

Anonymous said...

This seems to be the popular belief among patients in my office who seem to know more than they should.

I suppose it would be best if we never questioned or did our own homework on our bodies and left the pill tossing to you.

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Anonymous said...

I understand your what you are saying about the Myth of Physician Omniscience. I don't think anyone expects doctors to always have a solution. What bothers me is how easy they give up. I've had medical problems of unknown origin for 2 years. I've been to several doctors. Each one does a test or two, then just says I don't know, or that I'm suffering from anxiety (of course I'm suffering from anxiety, but the anxiety is secondary - its the fact that I can't get anyone to dig in and spend more than a few minutes on a problem that has taken from me a highly active fully functioning adult to a shell of a man). They don't go beyond spending more then the 5-10 minutes during my visit thinking about the issue. I get the comment like "we can't solve all medical problems". I would be fine with that if they actually put some effort into it. They never have any questions for me. They never refer me to anyone else. They never say something so simple as "I will do my best to help you with your problem". I get 1 of 2 responses: I don't know what is wrong, here try this drug, or we can do an MRI. It is just insane and shameful how little effort doctors put in to helping patients. And when they come up dry with ideas, shame on the patient for making a suggestion. All I can say is that my experience is that doctors are a strange bunch. I'm an engineer - maybe there is something different about the professions, but when I can't figure something out, I talk to one of my collegues. We put our heads together and solve the problem. I've yet to hear a doctor say something like, "Let me toss this around with some of my collegues - maybe they'll have some ideas". I do a lot of troubleshooting in my job. When people come to me with problems I ask a lot of questions, then I double check that the answers I get are consistent with the facts, and I dig and dig and dig until I resolve the problem. The answer is always in the details or someone making a mistake. Doctors for reasons that are beyond comprehension, evidently don't think like that. They want the answer to hit them over the head. If the answer were obvious, I would not be going to a doctor. They're supposed to know more than me, and have the tools and fortitude to dig in. Yet, they don't do it. I typically know more than the doctors I visit. I've received so much misinformation from doctors that it is a disgrace!

Anonymous said...

I echo Anonymous 3/8/13 directly above. When I come in with a difficult problem, and have researched the issue (from very respectable online sources), what I want from the doctor is the humility to admit what they don't know, and hopefully some intelligent discussion based on what they DO know, and then a willingness to take some action.

Instead, what happens more often is:
* Shrugged shoulders ("sorry!")
* Suspicion
* "No, ____ doesn't work" (most MDs are extremely quick to discount things that aren't long-established practices, no matter if they make logical sense to try, or not)
* "Gobbledygook" (like Anonymous, I've once or twice heard some pretty uninformed and illogical things, spoken with confidence)

Of course, the situation is even worse than Doctor D described in this post: as a general rule, most MDs don't even think diagnostically. Instead they mostly rely on common symptom clusters. This doesn't constitute ANY understanding of how the human body works! A technician teamed with a computer could arguably be trained to do the same thing.

And I think this is why Anonymous sees MDs needing the answer to hit them over the head -- because if it doesn't, they simply don't know how to arrive there, as bizarre as that sounds. It's like they just weren't trained to think that way.

I agree with ToasterPastry's statement, to a point, that MDs' unavoidable lack of omniscience feeds some of the darker sides of the alternative industry. But just as much, it's Mainstream Med's insistence on sitting on their rear ends, as well as their arrogance.

And, a lot of the alternative industry is not wrong -- but it can be very hard to get an MD to admit that. You simply need to do your homework, and learn to discern, no matter who the information is coming from (including your MD).

Sometimes you see MDs that are exceptions to this -- those with humility, knowledge, and/or a willingness to discuss and help. My thanks go out to them -- we need more of them. And my thanks to Doctor D for trying to bridge the gap between doctors and patients!

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