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?

So You Want An Online Diagnosis?

Last week Doctor D sternly rebuked those who wanted him to answer illegal (diagnose-me-over-the-internet) questions.

Several commenters replied it was D's own fault for naming his blog "Ask An MD." I mean seriously, what answers could an MD possibly have worth reading if he can't discuss your bowel problems?

Oh, so THIS is what you wanted?

So "Ask An MD" is running a special this week only:

Doctor D will answer every single diagnosis or treatment question you ask in the comments of this post!

(Very important small-print disclaimer: None of Doctor D's answers will be correct or sensible in any way )

What good are bullshit diagnoses, you may ask?

The Weight of Perfection

One of the greatest stresses in a doctor's life is having to be correct all the time. Of course, we aren't always correct, but people always expect us to be correct. This leads to a lot of stress in a docs life.

The avalanche of questions started early:

When Young D was a Pre-medical student in college people started asking him questions that were totally beyond his abilities. "Hey D, I get this weird feeling in my stomach, but sometimes it isn't there. What is that?"

Ah, to be young and free of the heavy responsibilities of doctoring!

D would just smile, shrug, and say, "Probably either metastatic cancer or gas."

Young D became legendary for his smart-ass diagnoses, and a good time was had by all.

But then Medical School began and the game of diagnosis became one of life and death. A wrong guess could hurt someone—badly. People kept throwing unanswerable questions at him, but the weight of his profession had crushed D's carefree attitude. He began giving evasive responses and advising people see their own doctor.

D has been practicing medicine for a while now. It is heavy stuff to talk to people every day about the ways that their own bodies can cause misery or kill them.

Doctor D actually doesn't like talking about suffering and death. He would rather open your mind and make you smile. So D started this blog answering people's questions about the odd quirks of the medical profession. For D this blog is a lighthearted way to process the hard and nasty stuff he has to see every day at work.

But work found Doctor D in his secret online hide out. He should have expected it—answering questions about doctors brought patients, and patients have questions about diseases they want to ask doctors.

Unfortunately, I can't answer diagnosis or treatment questions, no matter how desperate you are. I have to admit: I don't even want to try. I miss sleep at night over the guesses I make in my real job. Trying to do the same thing on-line would lead poor Doctor D to have a nervous breakdown.

But Doctor D won't abandon you poor folks so desperate for answers. He can't diagnose you but he can offer you the next best thing: Utter Nonsense!

"Nonsense Therapy is all-natural and involves no harsh chemicals!"

Therapeutic Misinformation

Do you doubt the healing power of ridiculous bullshit?

Doctor D learned this lesson as a young doctor. He had been working for months with a patient who was miserable from one of those frustrating mystery illnesses. She was in the office crying and listing her symptoms. Finally Doctor D shrugged and grinned, "All I have left to offer you is racehorse therapy. We take a rifle and put you out of your misery!"

At first Doctor D was petrified. He had let one of his pre-med smartass comments loose on a real person with real suffering! Then the patient smiled—the first smile he’d seen from her in months. Then she laughed, and D laughed with her. They had a good hearty laugh and the patient hugged him as she left the office.

Things were different after that. We talked and laughed a lot. We never found a diagnosis for her, but we ridiculed the disease mercilessly. It made us both feel better.

Nonsensical bullshit from a doctor can have a wonderful therapeutic effect!

Ask any middle-schooler and they will confirm it: The human body is funny! The human body is silly! The human body is gross! The human body is ridiculous! The human body is a low-down Judas that will eventually screw you over then kill you!

The only sensible thing to do is to mock our bodies on a regular basis.

So send Doctor D your symptoms and he shall mock them fiercely! He shall diagnose you with improbable and silly things! He shall loose his inner child to laugh at your bodily functions! He shall suggest ridiculous and painful treatments!

Not a single one of you shall get any useful medical information from Doctor D’s snarky replies... but you still know you want to send D your symptoms!

Therapeutic Misinformation:

Just like Chiropractics!

It feels so good,
you won’t even care that it’s total bullshit!

All questions will be personally answered by the doctor. So send in those aches, tingles, throbs, swellings, and vaginal discharges!

Now, Doctor D is a busy man, and he doesn’t check his email 8 times a day like more dedicated medbloggers. (Grumpy you're embarrassing the rest of us with your annoying dedication!)

Be patient, and the doctor will be in to misinform you and mock your symptoms shortly!

What Are My Chances, Doc?

As you may recall from the last post, if Doctor D suspects you might be facing a lethal illness he'll let you know straight up. He brings it up gently, pointing out that any doctor's guess has a lot of uncertainty.

You do, of course, have the right to ask, "How certain are you, doc?"

But here's the secret: MDs hate answering this because we often don't know how certain we are. I'm usually pretty good at predicting what will kill a patient. How good? Results may vary...

In a few diseases there is solid data: 80% of people diagnosed with pancreatic cancer will be dead one year later. Usually, however, the situation is too complex and there isn't any research data to answer the question. Then Doctor D whips out a gut guess.

I once had patient with curable but advanced colon cancer develop urosepsis and then have a heart attack from the septic shock. His family wanted a percentage for his chances. I made one up, "Maybe a 40% chance of surviving the next 24 hours." He survived and went home.

As I said, I'm not perfect.

Percentage numbers don't really mean that much when I'm guessing, but people just like something that sounds mathematical rather than “almost certainly dying” “could die” or “maybe dying but probably not.”

Predicting death is a risky business. Doctor D once had to dodge a fist when D told a dude his dad probably wouldn't make it. (Fortunately crying people can't pull off a good sucker punch!) Doctors also don't like mentioning death because most people don't like to discuss about their own mortality. We vaguely acknowledge we all die sometime, but you don't expect "sometime" anytime soon. Then Doctor D sits you down and says, “Now might be your time.” It's never an easy talk, and it's almost always based on an educated guess.

Doctor D still thinks it is worth letting you know, even if his estimations aren't perfect. Most patients want to prepare themselves and their families if death is a real possibility. I only withhold such information if a patient told me ahead of time they don't want hear any discussion of death.

What do you think? Do you want your doctor to tell you your chances? Even if it is only an educated guess?

Some old MDs never mention the word “death” because “they don't want to take away hope.” Obviously, Doctor D takes the opposite approach. Which would you prefer? For yourself? For your family?

Recognizing Death

A reader with a bad illness writes:

I would prefer that my doctors give me any bad news straight up. I'm not confident they will. No one is saying anything definitive. I've asked two of them about my prognosis. One said, "I can't tell you that." I don't really think anyone knows, but I wonder if they just don't want to tell me bad news?

Predicting the end of life is very difficult even for the most knowledgeable doctor. People with certain conditions are obviously closer to their death, but estimating how and when a person will die is extraordinarily difficult. With some illnesses (like common cancers) we can say what percentage of people will be dead in a year, but a percentage from a study doesn't tell you with certainty how long one individual will live. And most life-ending situations don't have good percentage studies. Still, experienced doctors become pretty good at recognizing when a person's body is declining and fighting a war that it won't win.

One thing that frustrates Doctor D is that MDs often talk amongst themselves about a person's prognosis without frankly mentioning it to the patient. They discuss the disease process in such techno-medical jargon that you don't recognize they are saying you will probably die. The confusion is intentional. They don't want you to hear the word "die" because they are often afraid to discuss with you it themselves.

Death is hard to discuss. No one likes to give bad news. You are telling a person about the end of their life. It is a heavy conversation. Since all they have to offer are educated guesses, doctors often busy themselves and the patient with the technicalities of treatments and tests—until the end is obvious and undeniable. Only then do we frankly discus dying. By then, death is sometimes so close patients have almost no time to prepare themselves and their families.

Your doctor is technically correct. A doctor cannot tell you exactly how and when you will die. But your doc may have a good guess as to where things are headed.

Give your doctor permission to guess. Let the doc know you won't be angry if they cannot win against the disease. Only then are you likely to get a straightforward estimate.

Doctor D has a policy of not hiding his guesses from patients. If I think a person may have a life-ending illness I won't keep it a secret. I point out that I am not certain, but I need to let them know my suspicions. It is hard to discuss someone's mortality, but I believe it is one of the most important duties of a physician with a patient facing a potentially fatal illness.

Of course the next question everyone asks is "What are my chances?" and "How long do I have?" These are also difficult questions to answer, so I will save them for a later post.

All of us will eventually die, but today you have your life and the lives of those around you to be thankful for. So today forget about shopping and tell someone that you love them. See you next week!