Bioethics Discussion Blog: In Defense of Medicine: Why Doctors Do as They Do

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Thursday, May 12, 2005

In Defense of Medicine: Why Doctors Do as They Do

I would like to elaborate a bit more about the reason for satire of physicians and medicine. I hope this isn’t too rambling as I try to express my thoughts.

The satire of doctors and the profession of medicine has gone on for ages and surely it will continue to go on. Everyone will have their laughs and maybe as suggested will feel a bit more cheerful about the unknown. And I think there have been good reasons for society taking the harder look at medicine, scratching their heads and then finding humor in what they feel is the unexpected and the unwelcome part of the profession. Why is it that the public doesn’t understand doctors and their behavior?

I think there are explanations for the way doctors do their job and how they behave and the public may really not be fully aware about them. The behavior starts with consideration of the job. Becoming a doctor nowadays requires our own hard look at what we are getting into. Whether one goes to a private or a state run medical school, it is expensive. The expense has a large monetary dollar sign but also one will be spending a significant part of one’s early life just studying to be a doctor. And that studying can be at the expense of a starting family life or years of missing an income amongst other losses. The hard look also looks ahead to the career, often without stable, readily calculated working hours. Yes, many hours will be rewarding and ego-boosting as a true professional. But there will be the hours of frustration and uncertainty that are handmaidens to the doctor and his or her work. Sometimes, when busy doing doctoring, a doctor will go from a encouraging high to a discouraging low all in the same day or part of a day or even from patient to patient. And there is a lot of self-reflection. What did I do right? What did I do wrong? What will happen with the next patient? Sometimes physicians have to develop behavior techniques to mitigate those feelings that can lead to discomfort. Doctors are under observation by their patients, their colleagues and others and always at risk of getting sued for malpractice. This leads to a defensive practice behavior that may be misunderstood by the patient. These investments of money, time and emotions all affect how the doctor behaves attending to a patient.

I think that the public can’t understand what doctors are all about because they don’t know about the “split personality” that is part of being a doctor. From the very beginning of medical school out to the professional practice of medicine, we are morphed from one into two personalities. There is the white coat part of the physician who has been indoctrinated from the beginning into a guild of doctors with their own special speech, special thinking and behavior and special requirements of practice and ethics. This is indoctrination and not being simply taught to “act” as a doctor. But there is also the original personality and character of that body and mind which is still present and who simply wears the white coat at work. This “split personality” provides the basis for conflicts involving communication and behavior. Being the guardian of medical resources, those in the white coat find that a paternalistic approach to communication with patients most natural and what many doctors feel is expected. Also, with the need to care for more patients in a limited time, paternalistic communication is the more efficient. Being also a husband, wife, mother or father with family responsibilities leads at times to attempts to avoid doctoring responsibility in favor of the family. This can produce inconveniences or worse for the patients. Patients now come to expect less paternalism and more dedication of time and interest by physicians to their own complaints. When this doesn’t happen, patients may become disillusioned with the doctor.

In conclusion, I believe that the public has an image of a physician which is based on some historical character, some wise, caring, idealistic and altruistic character, which is the representation of all doctors, particularly expected in their own doctor. The patient expects the doctor to be this unified imagined character, especially when they are sick. If they see doctors as pompous, paternalistic, uncaring and greedy, intent on their own self-interest, the doctor and the medical profession becomes the subject for satire. What is missing in the understanding by the public is the fact that all doctors are as human as they are with many of the same foibles they bear. Most doctors try to create a persona that attempts to deal with and do right for the patient despite their own burdens including the burden of trying to live and practice medicine with their “split personalities”. ..Maurice.

7 Comments:

At Saturday, May 14, 2005 10:36:00 AM, Anonymous Anonymous said...

Is that split personality necessary to the practice of medicine? Would it be possible to learn, and practice, medicine while retaining one's humanity and individuality? Dr. Perfect doesn't exist, and if both patients and physicians could accept this, maybe the move toward humanity and reality in medicine would benefit both.
5in9years

 
At Saturday, May 14, 2005 10:35:00 PM, Blogger Maurice Bernstein, M.D. said...

The reality is that there is a culture within the profession of medicine that has been passed down all these years and extending even into today's "modern times". As I have written in previous posts, in medical school we try to teach the student the humanitarian aspects of being a doctor but as they move to the wards and up through internship and residency, they get the "practical" guidance of experienced clinicians who have gone through both early experiences and their later practice. This provides the novice professional with a set of rules or behaviors, some of which may be frankly anachronistic. It is this culture which must be integrated with the basic personality and ethics and goals of the physician. Sometimes this integration leads to awkward results which disillusions the public about "Dr. Perfect". ..Maurice.

 
At Sunday, May 15, 2005 11:59:00 AM, Anonymous Anonymous said...

It is perpetuated from the other side as well. The incredible reluctance of people to question the magic initials, and their willingness to continue to see doctors who have nearly killed them, is frightening. I'm referring to blatant incompetence here, but that it is so rarely addressed is part of the overall paternalism inherent in our system. Change will be slow.
5in9years

 
At Thursday, June 16, 2005 8:47:00 AM, Blogger TexNNYC said...

I have suffered from a relatively unknown aliment for over two years now. The frustrations that I have experienced in attempting to get a doctor to open his mind to something that he has not yet learned are becoming extreme.

I am a very intelligent person who observes subtleties, nuances and minutiae in most situations and when I decide to focus on a particular situation I can spend months speculating, on and off, without coming to a conclusion. When I arrive at a conclusion it is only after exhaustive research and eliminating all the possibilities that are close yet inadequate to explain the situation. I have always been a very adept person who is not quick to react to difficult situations with negative feelings.

I have spent the first year and a half researching my symptoms in every possible way. I have read extensively both from standard medical sources as well as from research sources. I have talked with medical persons who may in any way know something about the problem I am having. I have finally arrived at the best possible conclusion given all the facts. I am open to a better diagnosis but it would have to fit the symptoms better than my conclusion.

In these years I have discovered a fundamental truth about the more than 12 or more medical professionals I have consulted with. With the exception of two persons all the rest would appear to listen to my problems and then, and this is universal, attempt to persuade me that the diagnosis must come from what they have already learned (about the etiology of my problems). What they do end up describing does not, in most ways, fit what is occurring!

They would ignore, as though they had not heard, the parts of my discourse that did not fit their diagnosis. This response, of selecting from what I have told them that which fits their diagnosis of the moment, is so knee-jerk as to be funny if it were not that it involved my suffering.

It had to be obvious to them that I had learned a great deal about the symptoms and the possible causes for them; yet they would proceed as though I were a first grade child sitting at the feet of the wise man and explain to me that which was patently obvious as not able to explain my problem. It is at this point that I would, with diplomacy and tact, attempt to discuss with them the issues that were not reasonable in their conclusions or diagnoses or simply did not fit my descriptions. When I would point out inconsistencies or inadequacies in their analyses they would invariably appear to not hear me and consequently to not respond to these points. The end result would be that I would receive one of three responses; either annoyance or immediate referral to another physician, or both.

I cannot help but wonder how many millions of persons have suffered and even died needlessly because they presented something that the medical profession had not yet heard of from “reliable sources,” i.e. each other and medical journals and consequently did not receive the treatment that might have alleviated their suffering and perhaps have saved their lives.

I have two important things to say about this behavior:
1) That these doctors (and from my sampling I would guess many if not most other doctors) will never learn anything truly new. They may add on to the information they have stored up to that point but anything new is beyond their grasp…at least when it comes from the mouth of a patient!
2) That there is a terrible arrogance in this position that they take. Only other physicians or medical research can truly change what they have learned…certainly not something from the mouth of a once again, God forbid, patient!

I am truly deeply disgusted with the medical profession. They have chosen to ignore much of what I, the patient, have to say. When all is said and done, and what physicians appear to have forgotten or never have learned is that in spite of all the assumed effectiveness of diagnosis from test results, the best diagnosis will come from the mouth of the patient.

I continue to suffer and be insulted. It has been suggested to me that I may be delusional. I have been asked if I am seeing a psychiatrist. I have been told that what I am describing “is physiologically impossible.” How dare these people not only ignore what I am truly saying but indeed add insult to injury? And I still have not even been offered palliative care for my symptoms.

One, and just one, of the disturbing facts that come out of this situation is that since licensed physicians are the only persons who have availability, by and large, to the necessary tests and treatments that could possibly help me I end up being excluded from access to these very things which I need.

If it were up to me I would strip every physician of his license and let market forces dictate as to who should practice and who should not. This meddling in the rights of the individual ends up with an elite class who are not only arrogant but paternalistic. Do not underestimate the public’s ability, in the end, to choose the best providers both by their education and by their ability to hear their clients!

The two medical practitioners who believed me responded by saying that as they have not learned of my condition it is best to refer me on.

PS I am truly tired of hearing the argument that so often defends doctors’ behaviors: that they have lost so many potentially income earning years and, that they have put such effort in their becoming a physician. This is rot! They only have chosen their path and everything points to the fact that they intend upon making up for the lost wages! Do not make others pay for their behavior!

 
At Thursday, November 23, 2006 2:17:00 PM, Anonymous Anonymous said...

Let's all be glad it is not 'up to you'.
As a surgeon I try daily to provide the best care and advice I can to those who seek it in good faith.

We all act in good faith. If this is lost then neither party will be willing to commit to the partnership required to effectively manage disease.

To the above blogger I would ask why she sought expert opinion when she is clearly expert in herself? Is it that she cannot buy the appropriate medication without licence or that she lacks faith in her own diagnostic abilities or rather that she accepts that the objectivity of a doctor may be needed to temper her introverted fixation.

Perhaps the public do not appreciate that in medicine there are no certainties. We work on the balance of probabilities and in good faith. We are burdened with the responsibilities that torment our souls and prematurely age us.

Would the public rather make decisions that are simply informed by medical advice - I have seen over the years patients now demanding direction on treatment. It seems that patients are now too burdened by the reponsibility to make independent choices. You can't have your cake and eat it.

 
At Friday, May 18, 2007 11:01:00 AM, Anonymous Anonymous said...

all doctors don't give a shit about anyone, they just want to get you out of their office fast so they can get more money.

 
At Friday, May 18, 2007 5:15:00 PM, Blogger Maurice Bernstein, M.D. said...

I think Anonymous from today's generalization is too broad and unfair to all the doctors who perform their professional duties with the patient's best interest as paramount and primary and not the doctor's best interest first.

What about me? I just came home after spending 3 hours in a free clinic seeing sick patients who don't pay (they are poor and have no medical insurance) and for which I don't get paid anything.
Would I be doing this if I didn't care about the patients? ..Maurice.

 

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