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?

Mystery Diseases (Diagnosing the Undiagnosable)

Lots of emails to Doctor D ask:

Why hasn't anyone figured out what's wrong with me?

This a common sentiment of patients whose doctors have yet to find a reason why they feel miserable. Patients with mystery symptoms tend to get lots of tests and shuffled to lots of specialists. More people than you might think are in this limbo of an illness without a diagnosis.

This is frustrating for everyone. Patients get irritated with their doctors: "If I just had a smart doctor like the ones on TV I would have been diagnosed by now." Doctors, who like having answers and hate looking foolish, get frustrated with patients and wonder if the weird symptoms are all in your head. We need to all take a collective deep breath.

We all want uncover the mystery diagnosis, but we have to acknowledge an unfortunate possibility:

We sometimes won't find a diagnosis.

There are diseases that are very common and ones that are very uncommon. It also stands to reason that there are diseases that may be so uncommon as to not yet be discovered. Some diseases may be so uncommon as to affect only one human being, which could be you. If this is the case you could never find a “diagnosis” per say, because a diagnosis groups you with other people with the same disease.

There is a point at which we say, "We've done a thorough work-up and found nothing. You may have to live with this." Doctor D hates saying this as much as any doctor, but at sometimes it needs to be said.

What is a disease?

Literally disease means dis-(without) ease. If you are visiting doctors because you have miserable symptoms you already know your body is without ease. You don’t need a multi-sylable medical term attached to your suffering to know that you suffer.

When doctors diagnose diseases, we look for particular patterns of symptoms and physical findings that are specific to known illnesses. It feels great for everyone when Doctor D can say with confidence, "You have _____."

But naming your disease doesn't cure anything. Having a diagnosis is useful because we can look at research from others who have had the same disease to know what treatments work and how we can expect the illness to progress. The rarer the disease the less other patients we have to get useful info from. We can just name your disease symptoms after you (John Doe Syndrome). It might feel satisfying to give it a name but it really doesn't help us make you feel better.

The Good News About Mystery Illnesses

People with mysterious symptoms get a lot of tests. A competent work-up has likely proven you don't have certain dangerous diseases. Doctor D has yet to see a patient with a mystery illness after a good work-up die. (I'm not saying it never happens, but it is exceedingly rare.)

Why? Even though the number of conditions that can cause discomfort are limitless, the mechanisms that can cause your heart to stop are fewer and generally well-known. Your large work-up has probably excluded most of the mechanisms that lead to premature death. A negative work-up can be a good thing.

Doctor D has often reassured frustrated patients about negative studies, "Trust me, you don't want the disease I was looking for."

The other good news: We don't always need a diagnosis to treat your symptoms.

Treatments do two things: postpone death and/or decrease suffering. A thorough work-up makes impending death unlikely, so we are left with easing the suffering. Doctors often treat symptoms even without knowing the underlying disease process. Whatever helps your symptoms and isn’t dangerous is a good treatment—whether it be Tylenol, or nice sunset, or an off-label use of a medicine.

Shifting Perspective

It can be liberating to realize that finding a diagnosis is not the be all end all. Lots of patients with mysterious symptoms get run through a gauntlet of tests and doctors and often feel pressure to advance to more uncomfortable and even dangerous testing to find an answer. Doctor D has actually found that patients often find it comforting to not to "have to find an answer."

Sifting the aim of care from finding a diagnosis to learning how to treat and live with your symptoms doesn't mean that we've given up. It just acknowledges that the ultimate goal is not diagnosing diseases, but helping you find ease and comfort.

What do you think? Do you have a mystery illness? Are you a doctor who works up patients with mystery illnesses? What do you think about acknowledging not all diseases will be diagnosed? As always Doctor D loves to hear your stories and perspectives.

Click here to read follow up post: What Is A Proper Work-up?