Some doctors have deep contempt for patients

[sarah darwins]

Then there are the intellectually highly-conservative evidence-based medicine types very impressed by their own credentials who think medicine is just pure science which can not be wrong as long as the majority of publications support an idea.

I do think that's a very significant number (and not inconsistent at all with having high ideals). I know doctors at consultant level who would fit this description — very genuine in their desire to do good but somehow, perhaps through their own personal success, convinced that the field in which they have excelled must, itself, be in all ways excellent, its practices almost beyond question.

At the risk of psychoanalysing them, their sense of self may be so bound up with their professional identity that they dare not be skeptical of their profession, lest in undermining it they undermine themselves. In fact, I zink for zees doctors ze medical profession has assumed ze role of ze mother, their professional bodies likewise ze father, and zey live with ze terror zat if they do not show enough love for ze mother und ze father zey will end up naked und alone und unloved ....

... too much?

 

[rosamary]

Do I have a deep contempt for Drs?

The answer to that is: 'Yes but I am trying to get this in perspective.'

I've had some bad experiences due to medical professionals being subjective in their approach to my symptoms (they were far too arrogant to actually LOOK for any signs during the time I am referring to). I don't have ME but another chronic disease.

But , although medical students are led to think of CFS as somatoform, I think the younger ones are becoming more clued up and make more attempt to accept that they don't know everything.

And let's face it, patients are more clued up nowadays. So it is possible that intelligent discussion can take place between adults during a consultation.

The big-headed breed are on the way out I think. (They'll always be a few.)

Anyway, although it goes against the grain for me to say this: I keep meeting some really good drs lately.

(There is only one that I would have liked to have punched over the last couple of years.)

 

[ukxmrv]

I think for some of them it is hard to admit that modern medicine doesn't know everything and cannot cure or treat everything.

So patients get split into 2 groups. The "medically sick" (or as they probably think of them the "worthy sick") which they think that can fix and the "mentally ill" (or the unworthy sick or malingerers or lifestyle failures) which are someone else's problem.

So they have contempt for the patients that they cannot fix. This is of course entirely unfair.

As more and more is known about mental illness (thinking of the recent work on depression etc) the two areas may be overlapping more and one day maybe depression will be treated with anti-virals and / or anti-inflammatories by conventional doctors.

That will leave the next lot of "unknown" diseases to become the focus for their contempt. Also anyone with medical problems that are currently considered lifestyle like obesity and diabetes.

 

[Valentijn]

So patients get split into 2 groups. The "medically sick" (or as they probably think of them the "worthy sick") which they think that can fix and the "mentally ill" (or the unworthy sick or malingerers or lifestyle failures) which are someone else's problem.

That was also my observation during the Nasty Nurses scandal, before the relevant blogs went private. The nurses had strong prejudicial attitudes toward FM patients, CFS patients, the mentally ill, addicts, and the obese. Elderly white people were automatically worthy of compassion, and little black girls, but not other "inner city" types.

The scary thing was that there were quite a few nurses (dozens) who were actively commenting on these blogs and in overt agreement with the vast variety of prejudices. They certainly weren't speaking out against any of them.

Maybe the stress of the job gets to them, and they justify cutting corners and the necessity of neglecting some patients by finding an excuse to dehumanize them.

 

[chipmunk1]

CFS patients, the obese.

i have known doctors that for some reason were very prejudiced against these two groups to the point of being obsessed with their perceived failures and lack of discipline. they almost seemed to love to talk about them. (all obese are depressed suggesting they overeat to self-medicate because they can not cope otherwise, they need to learn how to exercise, CFS people desperately want attention but one should not give them any, they're anxious ect.)

Not sure why these two groups are a target. Perhaps they view them as lazy and unlike doctors not hard working.

That was also my observation during the Nasty Nurses scandal, before the relevant blogs went private.

were the blogs archived @archive.org?

 

[SOC]

While we're at it....

I continue to be astonished at how poor the basic scientific training of doctors seems to be. They claim to be scientific, but they don't seem to understand fundamental concepts -- correlation is not causation, theories are not absolutes, current knowledge is always changing, you need evidence to back up your theories, simple statistics, just because we don't understand something doesn't mean it doesn't exist, rules of thumb are not fundamental principles, and so on, and so on, and so on.

My impression is that very, very few physicians have done independent research, even at the master's degree level. Maybe that's why so few seem to understand research, or have the ability to process the results of research. To get a doctorate in any other field, one has to do research. One has to think for oneself, not just suck in a lot of data and regurgitate it on call.

Medicine is still very much an art. To do it well takes more than just book learning. It's based on science, but it's not science in and of itself. There's still so much we don't know about human biology that practicing doctors have to do a lot of guessing and extrapolating beyond their data. Some do that well, others very badly. It's not their fault that the scientific data isn't there yet. They have to do the best they can with the information they have. My complaint is that they want to pretend they're all scientific, when really they're not. They're more like highly intelligent skilled artisans in a field based on science. Architects aren't scientists, either, but at least they know it.

 

[Keela Too]

While we're at it....

I continue to be astonished at how poor the basic scientific training of doctors seems to be.

Yes! It's remarkable how poor an understanding there is of these concepts generally, but one would expect doctors to at least understand statistics clearly. There was a report fairly recently that showed that many doctors have a poor understanding of statistical statements and what they mean. The correlation/causation thing was (if I remember right) what they most often misunderstood. Wish I was good at storing up links so I could back up that statement I've just made... but I can't.

 

[Valentijn]

were the blogs archived @archive.org?

I can't find anything ... it was at crasspollination.blogspot.com

It looks like she's moved onto twitter now, and I should probably add "homeless" to her list of Those To Hate.

 

[alex3619]

I do think that's a very significant number (and not inconsistent at all with having high ideals). I know doctors at consultant level who would fit this description — very genuine in their desire to do good but somehow, perhaps through their own personal success, convinced that the field in which they have excelled must, itself, be in all ways excellent, its practices almost beyond question.

At the risk of psychoanalysing them, their sense of self may be so bound up with their professional identity that they dare not be skeptical of their profession, lest in undermining it they undermine themselves. In fact, I zink for zees doctors ze medical profession has assumed ze role of ze mother, their professional bodies likewise ze father, and zey live with ze terror zat if they do not show enough love for ze mother und ze father zey will end up naked und alone und unloved ....

... too much?

My opinion on using satire is well known. There is no such thing as too much. See for example my blogs:

http://forums.phoenixrising.me/index.php?entries/evil-spirit-therapy-for-cfs-a-satirical-chant.732/

http://forums.phoenixrising.me/index.php?entries/supercalifragilisticexpialidocious.1162/

http://forums.phoenixrising.me/index.php?entries/wight-here-wight-now.1237/

http://forums.phoenixrising.me/index.php?entries/the-derision-and-tsunami-principles.1255/

 

[alex3619]

A problem in medicine is there is a clash between the science driven processes, the evidence driven processes, received dogma, and the authoritarian processes. The debate can be trapped in any one of these issues, though usually a combination. For example, claimed evidence based dogma backed by authoritarian support seem to be prevalent in some UK CFS/ME Oxford definition research.

 

[SDSue]

Many things are changing the face of medicine.

New graduates grew up with the internet and are more likely to use non-traditional sources for information. The older practitioner cut his/her teeth on journals, continuing ed, and drug reps for updates. In that system, doctors truly were the keepers of information. Not many patients made the trek to a medical library, but most will use the internet. The generation of doctors that resents patients for information-seeking is dying out.

At the same time information is exploding. We can't expect our doctors to know everything. What we should expect from primary care, however, is compassion, belief, and appropriate referrals, not antidepressants and a pat on the head.

As insurance and corporations take over medicine, the rewards of practicing medicine are dwindling. Hours are getting longer, more patients are being squeezed in, reimbursements are down, and it's all about the numbers. Doctors are burning out. Many are incented to keep referrals and testing down, whereas in some profit centers they'll test the hell out of you. Like it or not, medicine is a business, and chronic conditions are viewed as a drain on profits.

If the money is less and the stress is more, the incentives to enter medicine will change. Perhaps we'll get a breed of more compassionate physicians.

While there are many pompous doctors out there, I have to believe there are just as many who truly want to help us - they just don't always have the knowledge, time, or resources. They've also got a day packed with 40 more people who, just like us, want more time. We expect our doctors to skip lunch, stay late, research more, and always smile. We expect them to be superhuman, then bash them when they're not. As human beings, they can't emotionally or physically do it all, every day, for the duration of a 30 year career. (I'm not excusing the arses, but I am defending the ones who are trying their best.)

Insert "doctor" every time Stewie calls his mother. We'd burn out too.

 

[SOC]

We expect our doctors to skip lunch, stay late, research more, and always smile. We expect them to be superhuman, then bash them when they're not.

I certainly don't expect them to skip lunch, stay late, and so on... at least no more so than the average professional in any other field. Doctors have stress, but so does every other professional. You cope, or you get out of the business. You don't take it out on your clients, or excuse your poor quality work by "I had a lot of work and it was haaaaard."

As human beings, they can't emotionally or physically do it all, every day, for the duration of a 30 year career. (I'm not excusing the arses, but I am defending the ones who are trying their best.)

Why should doctors have it any different than any other professional? They're all human beings doing demanding work over decades.

Let me repeat that I believe there are amazing doctors out there giving everything they have to do their jobs well (as is true in all professions). They deserve our respect and admiration. That doesn't give the rest of arses a pass to act like they're God's gift to the world. They're no better than any other highly-trained professional.

 

[Butydoc]

I certainly don't expect them to skip lunch, stay late, and so on... at least no more so than the average professional in any other field. Doctors have stress, but so does every other professional. You cope, or you get out of the business. You don't take it out on your clients, or excuse your poor quality work by "I had a lot of work and it was haaaaard."


Why should doctors have it any different than any other professional? They're all human beings doing demanding work over decades.

Let me repeat that I believe there are amazing doctors out there giving everything they have to do their jobs well (as is true in all professions). They deserve our respect and admiration. That doesn't give the rest of arses a pass to act like they're God's gift to the world. They're no better than any other highly-trained professional.

Hi SOC,

I agree, physicians come in all colors; good, bad and indifferent, just like all other people. Most are competent in the United States. Some are extremely smart, dedicated and giving, others, not so much. Some have caring, nurturning attitudes while others are arrogant, sterile without people skills. I become offended when people on this forum paint all physicians with a broad negative brush. I can understand the frustration of many of us concerning our interaction with the medical profession, but like any other profession such as teaching, we come in all varieties.

As a group, we need to figure out how to educate the majority of the primary care doctors to help circumvent the type of response given by this arrogant, poorly informed doctor.

Best,
Gary

 

[Gijs]

Gary, nobody on this forum paint all physicians with a broad of negative brush. Unfortunately there are many in the field of ME/CVS, sorry but this is the truth. It look as if you take it personally. Best, Gijs

 

[Sushi]

Unfortunately there are many in the field of ME/CVS, sorry but this is the truth.

I don't think there are many (if any) MDs who specialize in ME/CFS and treat it "medically," guided by abnormal lab tests, who fit in this category. I have not heard of any in the States. Sure, there are those who treat it with CBT and GET who claim to be ME specialists, but I don't think any one here considers them to be so.

Sushi

 

[Gijs]

I don't think there are many (if any) MDs who specialize in ME/CFS and treat it "medically," guided by abnormal lab tests, who fit in this category. I have not heard of any in the States. Sure, there are those who treat it with CBT and GET who claim to be ME specialists, but I don't think any one here considers them to be so.

Sushi

You get me wrong, not the ME specialists off course. Most of them are real nice doctors.

 

[SOC]

Hi SOC,

I agree, physicians come in all colors; good, bad and indifferent, just like all other people. Most are competent in the United States. Some are extremely smart, dedicated and giving, others, not so much. Some have caring, nurturning attitudes while others are arrogant, sterile without people skills. I become offended when people on this forum paint all physicians with a broad negative brush. I can understand the frustration of many of us concerning our interaction with the medical profession, but like any other profession such as teaching, we come in all varieties.

As a group, we need to figure out how to educate the majority of the primary care doctors to help circumvent the type of response given by this arrogant, poorly informed doctor.

Absolutely! There are brilliant, caring doctors out there with wonderful skills, and there are dreadful ones. My field is research engineering (not that I can work in that field anymore thanks to ME), and the same is true there. Some people are good, caring people, others are arrogant and self-centered. The only difference I see is that in research engineering we don't claim to be a profession that is caring for people or making major decisions about their personal lives, so our arrogant SOBs are not directly harming people by not living up to the professional advertising.

Education, on the other hand, has a similar problem to medicine in that regard. Educators should be caring people with the best interests of their students at heart. When people enter the profession for reasons other than providing the best possible education for their students in a supportive and caring environment (and there are too many people who do), then bad things happen to students through no fault of theirs. Those people are one reason why I would never work in an elementary - high school. As in medicine, the bad apples make it difficult for everyone, clients and professionals alike.

Perhaps the fields that claim to be about caring for and nurturing people need to police themselves better. It's not enough to say, "There are bad people everywhere." The fields that expect us to trust them with our health, lives, and children need to set standards for themselves that justify the trust they expect people to put in them.

 

[Butydoc]

Absolutely! There are brilliant, caring doctors out there with wonderful skills, and there are dreadful ones. My field is research engineering (not that I can work in that field anymore thanks to ME), and the same is true there. Some people are good, caring people, others are arrogant and self-centered. The only difference I see is that in research engineering we don't claim to be a profession that is caring for people or making major decisions about their personal lives, so our arrogant SOBs are not directly harming people by not living up to the professional advertising.

Education, on the other hand, has a similar problem to medicine in that regard. Educators should be caring people with the best interests of their students at heart. When people enter the profession for reasons other than providing the best possible education for their students in a supportive and caring environment (and there are too many people who do), then bad things happen to students through no fault of theirs. Those people are one reason why I would never work in an elementary - high school. As in medicine, the bad apples make it difficult for everyone, clients and professionals alike.

Perhaps the fields that claim to be about caring for and nurturing people need to police themselves better. It's not enough to say, "There are bad people everywhere." The fields that expect us to trust them with our health, lives, and children need to set standards for themselves that justify the trust they expect people to put in them.

Hi SOC,

I'm not sure how you would police the medical profession for bad attitudes. It is hard enough to police physicians for malpractice or incompetence yet alone for non-caring, arrogant behavior. When I was chief of surgery at our hospital, one of my responsibilities was to police the surgeons on staff for poor outcomes and frank malpractice. It was near impossible to remove a poor surgeon because they would immediately lawyer up and file a law suit against the hospital and me for restraint of trade, etc. When I started practice, the good doctors had the most referrals because of their reputation. Now, because of managed care, HMO, etc, patients can't go to the best doctors because they are not on the preferred list. In my experience, the cheapest plans had the least qualified physicians. Since these plans funnel their patients to specific doctors, not because of their demonstrated excellence but rather they accept the cheapest rates, there is no incentive to build a practice based on patient and physician referrals.

Best,
Gary

 

[SOC]

Hi SOC,

I'm not sure how you would police the medical profession for bad attitudes. It is hard enough to police physicians for malpractice or incompetence yet alone for non-caring, arrogant behavior. When I was chief of surgery at our hospital, one of my responsibilities was to police the surgeons on staff for poor outcomes and frank malpractice. It was near impossible to remove a poor surgeon because they would immediately lawyer up and file a law suit against the hospital and me for restraint of trade, etc. When I started practice, the good doctors had the most referrals because of their reputation. Now, because of managed care, HMO, etc, patients can't go to the best doctors because they are not on the preferred list. In my experience, the cheapest plans had the least qualified physicians. Since these plans funnel their patients to specific doctors, not because of their demonstrated excellence but rather they accept the cheapest rates, there is no incentive to build a practice based on patient and physician referrals.

Best,
Gary

I'm not sure, either. I suspect the place to weed out those people who shouldn't be in medicine is in medical school, before they are ever practicing. Once they're in practice, it has to be next to impossible to get rid of them. They spent a LOT of time and money getting into the lucrative profession; it is understandable that they'd fight tooth and nail to stay in. I agree managed care is making the situation worse.

Perhaps medical schools need to spend more time teaching the human skills necessary for being a decent physician, since theoretically medicine is all about interacting positively with vulnerable people.

 

[Sushi]

Perhaps medical schools need to spend more time teaching the human skills necessary for being a decent physician, since theoretically medicine is all about interacting positively with vulnerable people.

I think most do attempt this now. I was a volunteer in a program to train med students to be human. We were trained to be "fake patients" with the symptoms of a certain condition and then we rated the med students on the clinical as well as human skills.

Sushi