July 09, 2007

Medice, Cura Te Ipsum

OVER AT DR MAURICE Bernstein's Bioethics Discussion Blog, Dr Bernstein has revealed that -- at least according to Google -- physicians are the most hated professionals in American life. This has prompted Dr Bernstein to ask how doctors can improve things -- after all, in Dr Bernstein's unscientific experiment, more people apparently hate doctors than they do lawyers. No, really.

According to Dr Bernstein's informal survey, some 18,300 results came up when one entered "I hate doctors" into Google, compared to 10,100 results for "I hate lawyers," 994 results for "I hate politicians," and 684 results for "I hate insurance companies." Interestingly, Dr Bernstein did not enter "I hate reporters," although a quick search just now reveals 1,440 hits for that particular query, and "I hate journalists" brought up 1,760 hits, for a total of 3,200 hits. This makes journalists the fourth-most-hated profession in American life -- just behind being Peyton Manning, who recorded a total of 3,740 results. (In any event, it's all the broadcast boys' fault, and that's all I'm saying on that).

As for me personally, I generally like doctors. This is because their efforts over the past 31 years have managed to keep me alive against all odds, and in addition I have a pretty good quality of life as a result. Not only that, I like my GP and the various specialists I see for this and that. (I also generally like lawyers, but that's what happens when half your friends go into law). I even like my dentist, who is a cheerful and pleasant sort. (I am, God save me, seeing him on Tuesday).

But are there things doctors could do differently to change their image and improve their care? I think there are, and I think the expressions of dislike recorded for doctors may stem from a cultural clash between the old-school style of medicine and the modern day alienation so many Americans have towards established institutions.

Now, as I understand it, back in the old days people generally did what their doctors told them -- doctor's orders and all that. Plus, given the set-up of the health care system back in the day, doctors had more freedom to actually practice medicine than they do these days. There was not the culture of defensive medicine that sometimes results in patients undergoing myriad tests for no discernible reason other than they might have a malpractice lawyer on speed-dial. Nor were the costs of medicine such a big factor -- with the advent of modern medical technology, the cure for what ails you often proves quite expensive.

Those two modern developments haven't helped doctors, I don't think, but I also think doctors have become much more forceful in addressing preventive medicine issues. Herein may lie one of the problems. There are few things more annoying than going into the doctor's office and being scolded -- not advised, but scolded -- for X, Y and Z when the patient knows damn well he ought to quit X, Y and Z. There are a lot of things about medicine that aren't exactly rocket science and it is frustrating to get lectured about these facts.

For instance, here's one of the disappointments I had with my own medical care. A while back, I had gone in to see a nutritionist for tips on keeping my weight under control; I am a diabetic and sadly overweight, so the doctors were trying to keep tabs on that. The discussion of lunch came up -- I have an irregular work schedule and I'm not really able to pack a lunch, and sometimes my lunch choices are limited. Somehow we got on the discussion of Subway sandwiches, and I mentioned I sometimes got a foot-long roast-beef sub for lunch. I was advised to cut that down to the six-inch sub because the foot-long sub had too much bread.

Now, this might have proven an acceptable suggestion if I was 5-foot-6 and weighed 160 pounds, but I'm 6-foot-4 and weigh 240 pounds. On a daily basis, my body runs through about 3,000 calories even with my sedentary lifestyle; the Subway roast-beef sub has about 650 calories or something. Had I cut that in half, I knew full well that about 4 p.m. I would be starving and down at the vending machines eating something I really ought not. But the way the advice was dispensed seemed so unyielding that I just held my tongue and politely listened to various other advice, little of which I actually followed because it again seemed unrealistic to my own circumstances.

Contrast this with an appointment I had recently with a specialist I saw for my diabetes, who advised me my sugar levels were too high and that additional action needed taken. The doctor came in, sat down, explained my options and then his recommendation. He then gave me a choice of treatment options to follow; I concurred with his recommendation and started up taking insulin injections again.

The big difference here is that in the second case, the doctor treated me like I was a functioning adult, and that went a long way. I think doctors may too often know what's best for the patient without hearing out what exactly the patient has to say about the matter, and I think they may deliver that advice without considering what the patient's circumstances are. Combine that with the pressures of modern-day medicine -- the assembly-line feel of going in for an appointment, the paperwork headaches, the time-constrained visits -- and it can prove a bit frustrating for the patient, who is almost certainly giving up time away from work/family/activities to go in for an appointment he didn't want to endure anyway.

Posted by Benjamin Kepple at July 9, 2007 12:01 AM | TrackBack
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