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.

Mythbusting

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?

How Should I Thank My Doctor?

Believe it or not, this is the most common question that Doctor D gets in his email!

I must admit I hadn't posted a response yet because the answer seemed kind of obvious: Your parents taught you how to say "thank you" when you were a baby. It should be fairly straightforward at this stage of your life. If you are grateful to your doctor tell him or her "thanks" and doc will have a better day because of you.

But as more "How do I thank my doctor?" emails poured in I had to rethink situation. I'd been thinking from the doctor side of the equation, but from the patient perspective expressing gratitude may be more daunting.

Doctors are intimidating. We hold life and death in our hands with a god-like power! Our lives are always exciting and sexy, as anyone who watches prime-time doctor dramas can tell you. MDs are so intelligent and knowledgeable that we cannot help but act like jerks to our inferiors! We are so universally admired and appreciated that your expression of thanks had better be impressive or we will scoff at you.

As a physician, Doctor D can personally assure you that all of that is BS! We only put up that ridiculous front because it helps us handle a stressful and scary job where people expect the world of us. Trust me, doctors are normal people: we always love it when people thank us for a job well done.

I had the son of a patient find me the other day, "Doctor D, I just wanted to thank you for saving mom's life." Did I save his mom? Maybe. I just did what any doctor would have done in the situation. But thanks to his gratitude Doctor D was had a spring in his step for the rest of the day. Everybody likes to be thanked.

So if you want to thank a doctor, go for it! Say it, write it in a card, bake cookies, whatever. Trust me, your doctor will be thrilled any way you say it.

Since everyone seems to want detailed strategies Doctor D will start a series of several posts on dos and don'ts of doctor-thanking so all my readers can tap into the intricacies of thanking MDs!

You're welcome!

Did you ever try to thank a doctor and have it just flop terribly or complicate your doctor-patient relationship? Doctor D always loves to hear your stories in the comments!

Part 2: How NOT To Thank A Doctor

Part 3: Delayed Gratitude

Part 4: Thank the Doctor, Not the Chart

Part 5: Why Are Cheap Gifts The Best?

Part 6: Spreading the Love

Nurses VS. Residents

Question from a reader:

What is the relationship supposed to be between nurses and residents in a large teaching hospital? During a lengthy stay for a surgery, I noticed a tension between these two groups, especially between junior residents and highly experienced nurses. Perhaps it is inevitable?

It wasn't that long ago that Doctor D was a resident in a teaching hospital and he can still recollect old days of being a young doc fresh out of med school and working beside experienced nurses...

The rules of medicine say that the doctor should call the shots, but this can be problematic when a new doc with no experience is giving orders to nurses who have been taking care of patients for years. There will always be some tension. It's like a captain just out of military academy taking command of a group of battle-hardened veterans. The captain may have an officer's rank and a head full of military theory, but the foot soldiers are the only ones who know what it's like to get shot at.

Ideally, this tension will make the team better. The young doctor learns a lot from working with experienced nurses, and the fresh ideas from the newly-educated residents improves the care the nurses give.

Unfortunately people who should be working together sometimes go to fighting amongst themselves. When inflated egos of new doctors or experienced nurses cause trouble and it is patients who can get hurt. Any doctor who doesn't listen to experienced nurses is headed for disaster, and any nurses who abuse new doctors are harming both patient care and medical education. Once the battle gets going, however, it is hard for either side to back down.

The best strategy is to start out on friendly terms and work to stay there. When Doctor D started residency the first advice his attending gave him was, "Be good to the nurses and you'll do well."

Mutual respect and open-communication works best for everyone, including patients. I can tell you it is hard to be nice when an older nurse is giving you shit just for being young. I'm sure nurses can attest that it's equally difficult to refrain from kicking the ass of a cocky resident with a big god-complex and zero inexperience. I have found, however, that if I bite my tongue and act respectful the obnoxious behavior of insecure nurses and doctors usually subsides to a tolerable level.

If you are a patient in a hospital where the tension between residents and nurses has broken into open warfare this is a bad sign. I would advise you appeal to a higher power to intervene, such as an attending physician or head of nursing. Don't take sides--trust me you don't want a part of that battle. Just tell them that you as a patient are worried by the animosity. Usually the responsible authorities can sort out who needs to have "come to Jesus" talk so that both sides can calm down and start playing nice together.

Have you ever witnessed (or been a part of) an interesting Nurse VS. Resident conflict? How was it resolved? I would love to hear your stories in the comments.

Who Determines Quality Of Life?

This is an interesting question Doctor D found in a discussion going on at the Serenity Now Hospital blog.

Quality of Life is the concept that medical care should focus not just on the number of days our patients live but the amount of meaningful and fulfilling health within those days. Patients will often sacrifice length of life for improved quality of life. Some patients also decide that in the face of a life-threatening illness they will not have further treatment once their quality of life falls below a certain level.

Reflecting on quality of life helps doctors recognize the humanity of their patients. It helps us realize that that longer life isn't always better. At its best, quality of life allows the patient to decide how they approach illness and disability, while the doctors respectfully relinquish control to the patient's wishes.

Doctor D believes that quality of life cannot be determined apart from the patient's personal values and preferences. Many doctors, however, make quality of life judgements about their patients. Often physicians embrace the concept of quality of life without acknowledging that it is a personal decision that belongs to the patient not them.

On the post "Compassionate Death?" Doc Sensitive relates the story of an attending that decided not to treat an elderly man with dementia due to the attending's belief the man had no quality of life. The attending allowed the patient to die comfortably and untreated without ever trying to find out the old man's desires or contact the man's family. Doc Sensitive wonders if this was the right way to handle this patient?

The discussion after the post is also interesting. (Doctor D threw his 2 cents worth into the conversation too--It's the 3rd comment down.)

What do you think? Would you be comfortable with a doctor making a quality of life decision for you if you couldn't speak for yourself? Do you think Doctors are the right people to be making quality of life decisions? Do accounts like this make you more likely to get a living will or discuss your wishes with your family?

Doctor D will be back soon with more answers to your questions.

Overcoming Doctorphobia

An e-mail to Doctor D:

"I am absolutely TERRIFIED of doctors... I have avoided doctors like the plague... how do I get around my fear of doctors?"

Doctorphobia is a common but curable condition. It can start with your first shots as a child. Throw in an uncomfortable exam of a body orifice, add a few run-ins with jerk doctors while you are wearing nothing but a paper gown, and you can end up with a full-blown phobia of anyone in a white coat.

If you had any idea what a bunch of nerdly social misfits we doctors really are you would be more likely to laugh than tremble. Unfortunately doctors, like dogs, can smell fear and often exploit it. When nervous greenhorn medical students first realize that patients are terrified of them they should respond with compassion. But when they realize being feared makes them feel special and powerful the “god complex” begins.

Here are some techniques for taking the fear out of your doctor visits:

• The Honest Approach: You wouldn't believe how many patients have started their visit with Doctor D by saying, “I hate doctors. They scare the shit out of me!” This reminds Doctor D that he should be friendly and calm. Honestly confronting them with this truth should induce your doctor to respect you. If a doctor is mean right after you admit Doctorphobia then you can move on—you don't need that jerk.

• Remember that doctors are scared too: What your mom told you about snakes in the woods is also true of doctors: “They are more frightened of you than you are of them.” Medicine is an anxiety-producing business, and doctors are nervous most of the time. We are responsible for the life and health of our patients, and most of what we do is based on educated-guesses. We live in constant fear of screwing up. It's enough to give anyone an ulcer. We hide our anxiety well, but you can rest assured that the scary doctor is often more nervous than you. Like middle-school boys, the doctors who strut and yell are usually most insecure. Any doctor that intentionally tries to scare you is more worthy of your pity than trepidation.
  

• Remember that you are the boss: Economically speaking, your doctor works for you. You pay them for a service and if they don't work out you take your business elsewhere. No, this doesn't mean you can order a boat-load of narcotics Michael Jackson-style, but it does mean you should feel more empowered in your doctor-patient relationships. You can always fire your doctor.

• Change doctors: Some people love no-nonsense, semi-abusive doctors, but aggressive docs are not good for people with Doctorphobia. Consider moving to a doctor with a different doctoring style. “Buddy” and “Parent” doctors are usually more gentle (although they do have their problems).

• Picture your doctor naked: This is a time-tested method for overcoming anxiety. Doctors are about the only strangers who can legitimately ask you to disrobe, so you should have no qualms about turning the tables on them in your mind. No doctor can be scary in their whitey-tighties. (Warning: This technique may be too distracting if your doctor is as handsome as Doctor D.)

Any readers have other tips for beating Doctorphobia?

Why Are Doctors Such Jerks?

Let's start with a question I know that you have been wanting to ask:

Why are so many doctors jerks?

Excellent question! As any nurse will tell you, doctors are notoriously difficult to work with. We doctors have a much higher percentage of jerks among us than the general population. Even Doctor D (on very rare occasions) has been known to be downright ornery towards patients. There is a epidemic of condescending, difficult, foul-tempered doctors, and you the patient are the one who suffers!

Some doctors have been jerks their whole lives. Maybe they weren't hugged enough as babies. These docs just love having a position of power so they can make others feel small. Such natural-born jerks can be found in any profession, and just one of them (especially as a customer service representative) can make anyone's day miserable. Such doctors will never change. It is best to avoid them whenever possible (unless you need surgery).

But the relatively few natural-born jerks in the world just aren't enough to explain the over-abundance of jerk doctors. This only leaves one explanation: many doctors become jerks by becoming doctors.

The number one reason everyone says they want to go to medical school is "to help people." Believe it or not, we were all once innocent wide-eyed young medical students who really cared about you.

Then they fed us through the decade long meat-grinder of training involving sleep deprivation, endless memorization, calling patients by their diseases, and getting yelled at regularly by our jerk-doctor teachers. At first we hated those other jerk-doctors, then we felt sorry for them. We worked till we were dead tired, and then got told heathcare is cutting back so we had to do the same work twice as fast next time. Patients expect us to work miracles after watching too much TV, and don't see any reason for dieting or quitting smoking since our purpose in life is to cure everything. Despite our good intentions people keep destroying themselves with bad habits, and nice people keep dying, and everyone is angry we can't turn them back into twenty-year-olds. Add to that lawyers promising irritated patients that they can hit the jackpot, if they just sue jerk doctors--It is enough to turn even the nicest medical students into misanthropic bastards.

As a patient that just wants to get your check-up none of this is your fault, but you are going to bear the brunt of this. Your best bet is to look at your doctor, and try to imagine him/her as the kindly, altruistic, and terrified student that showed up on that first day of medical school. Somewhere in your doctor lurks that annoying humanitarian impulse that doesn't die easy.

Look your doctor straight in the eye and say, "Doc, I really appreciate you taking care of me." Only say this and nothing else! Under no circumstances then ask for something or launch into a list of every odd symptom you had in the last year. Just say something nice and leave. A jerk-doctor hasn't seen human kindness and generosity in years might just feel a warm spark of caring in his/her cold heart. Doctors have a bad habit of forgetting we work on real people. Suddenly you become a real person and not just a patient. Trust me, doctors actually care about real people. You just have to remind your doctor that real people exist.

Who knows, your doctor might even be nice to the nurses after seeing you?

Any Questions?