A Rant for a Sunday Afternoon

I'm lying in bed with the flu, today, and feeling kind of grumpy. My wife is feeling stir-crazy because we haven't gotten out of the house, but in truth all of the energy I have is going into typing. Walking upstairs from the TV to my bed is about all of the "out-and-about" I can handle today. I was perusing cpaptalk.com (as is my wont) and I just wrote a version of this in response to something on the site, and felt like expounding some more on the point...

The discussion in question was about doctors as authority figures, not to be questioned. One user had a doctor who made a statement decrying a feature of treatment designed for COMFORT as having no therapeutic benefit. My opinion is that comfort is almost as important as efficacy, because without comfort, there is a higher probability of non-compliance with directions, and without proper compliance, the most effective treatment in the world will have no good result. (You can buy the best, most effective exercise equipment in the world, but if you never USE it, it’s never going to have any effect on your flabby buttocks.) Comfort features are VERY important, and for a doctor (and supposed specialist in his field) to pooh-pooh them as marketing gimmicks indicates no real interest in his patient’s well-being.

But the part that really galled me was that the quote by this doctor went on to cite his various degrees and certificates and insist that one should not "question authority". In my opinion, (some *) doctors need to get it through their heads that they are NOT in positions of authority. They are in positions of expertise, which is different. Who do they think pays their salary? They work for us, not the other way around. When I go to a doctor, I’m there to consult upon his expertise, not paying him (or her) to be some sort of dominatrix. I’m not into that.

Similarly, when I go to a car repair facility, I ask the mechanic what is wrong, but if he comes back and tells me that my car needs new brakes when the problem is that it won’t start, there’s no reason at all why I should just do what he says. I paid him for a consultation on his expertise, I’m free to accept or reject what I get from him, as easily as I am free to accept or reject an apple I purchase, when I get home and find it not particularly tasty. I paid for it, it’s mine to do with as I wish.

My opinion is that true experts in a field do not get defensive about being questioned. If you REALLY know your stuff, you have no reason to feel threatened by someone questioning something you say. We’re all human, we all make mistakes occasionally or jump to conclusions before we know all of the facts. I’m considered an "expert" on the Oracle database within my company, but that doesn’t mean that it’s a direct or personal attack any time someone suggests that my way of doing something may not be always right. Because it isn’t always right. As the "expert", it’s right more often than it’s wrong (at least, I hope so, or what are they paying me for?), but I’m not infallible. I’m not a god among men.

The problem began, in my opinion, when the medical establishment decided to start naming everything with complex Latin names, with the intent of keeping their art mysterious and unknowable by the masses. When coming out of the doctor’s office after having sustained an injury, are you more likely to panic if he tells you that you have a "bruise" or a "subcutaneous hematoma"? They’re the same thing, but for quite a number of years, the medical establishment urged the use of the second over the first.

It was this level of "we’re just regular people, we couldn’t POSSIBLY understand the subtle complexities of the physician’s art" which allowed some of the travesties which are now public knowledge to be foist, in secret, upon the populace. Illicit tests of LSD on patients who thought they were being prescribed other medications. Intentional infliction of syphilis on men of the lower classes to see how long they would live without treatment. Doctor-supervised tests of the effects on soldiers of exposure to nuclear bombs (from a distance, of course, we know the immediate effects of an up-close nuclear bomb).

When we allow any part of society to be elevated to the rank of "god among men", we forget that all men (and women) make mistakes, and we forget that power corrupts. I’m sure many of the doctors involved in some of these illicit experiments felt that they were helping humanity. By inflicting trouble upon the few, data could be gained which would allow treatment of the many. This level of detachment is only possible when you feel honestly superior to your unwitting test subject. Who among us would not be HORRIFIED at the intentional infliction of various painful conditions upon test subjects, with the intention of trying one or more treatments on some, and leaving others as "control groups", if those test subjects were humans instead of rats and monkeys and other "sub human" populations?

The problem has gotten better. Ready availability of information on the internet to research drugs which have been prescribed for us has helped to make it better. Public outcry when some of the experiments like the ones I listed above were discovered has helped to make it better. Breaking of the doctor’s code (so that a non-doctor such as myself knows what a "subcutaneous hematoma" is) has helped to make it better.

But we still need to be vigilant, and we need to be active participants in our own health care, and if we are not, we are putting power into the hands of someone who, at best, will use it benignly, and with normal human potential for error. At worst, someone who may care more about his money or her prestige or his research or her paper than they actually care whether you get any better.


(* My own doctor, Mark Splaine, is wonderful in this regard, and so I do not wish to paint all doctors with one brush. I find Dr. Splaine to be as open about what he DOESN’T know as about what he does, and to be perfectly open to my being a PARTNER in my heath care, not a customer or servant. Good doctors do exist, I’m not even certain they’re rare. But as in any field, the bad apples can cast a pall over the rest, unfair as that is.)

Copyright (c) March 5, 2005 by Liam Johnson. http://www.liamjohnson.net