Meme-d Misinformation about Medical Management, Part 1: A Mea Culpa For The Medical Profession
A while back, a friend of mine posted this on Facebook. I am not posting this to mock them, but I want to address some of these points and the general concept in a misinformative post like this.
Again, this post is not going to mock my friend that shared this. There are two broad categories of people that share these types of memes: folks that are looking to sell you something (not my friend) or folks who have not been treated well or have been frustrated by doctors.
That's an important point. I can do all the debunks I can, but you know what they say about people in glass houses.
Medicine has a long history of paternalism. Doctors commanded respect and had specialized training (sometimes) in a time when up-to-date research was not as widely available (even to doctors). Patients were just expected to do as their doctor told. The flip side of this was that they did many things without any basis in evidence and there are a lot of stories of people getting mistreated by doctors.
Times have changed. Some older doctors like to whine about how “doctors aren’t respected anymore” but the truth is, medicine is not the one-size-fits-all or paternalistic approach that it once was, nor should it be. We must evolve away from that. Medicine is expansive as a field, and there are more people with chronic illnesses living longer than ever before who have more experience living in their own bodies than any physicians' education may provide. There's a balance to be found there, between the physician's education and knowledge of pathophysiology (which is not insignificant) and the patient's earned understanding (also incredibly important).
Patients have not been allowed to feel comfortable bringing up concerns, whether medical or extra-medical. Patients have access to all sorts of information now, and Googling symptoms is an automatic action in the Information Age. But too many doctors dismiss these concerns ("don't confuse your Google search for my medical degree" is a problematic platitude) or don’t pay enough attention to social determinants of health and don’t make patients feel heard. There is a way to explain an answer to a patient’s question without being condescending. I talked to a journalist about this in an article that I'll link below.
Moreover, even without that, corporate and privatized insurance and a lack of social safety net has made it increasingly more difficult to get access to healthcare. People have a lot of needs and obligations pulling them in various directions, which makes it all the more important for us to partner with our patients and understand their priorities, and how best to address their medical needs within that. This is made all the harder by the demands from insurance companies and administrative bodies that require doctors to spend less time with patients in order to see more of them, regardless of the effect that has on both provider and patient satisfaction.
In addition, we doctors often struggle to say the words “I don’t know.” I know I am guilty of having done this in the past, because I was barely even aware of it during medical school. There are things we do not always have answers to, but doctors don't always acknowledge that. So it’s a small wonder patients don’t always feel they can trust their doctors.
This is likely why people turn to alternative medicine. People without accredited licenses can call themselves medical professionals and earn the trust of patients that were burned before, with explanations and treatments that have no basis in evidence but are sold with confidence ("I can cure this!"). Naturopathic "doctors" and chiropractors that step out of their wheelhouse are two examples, but even licensed physicians use their credentials to grift people out of their time and money (looking at you, Mehmet Oz, Mark Hyman, and the Disinformation Dozen (see below). In turn, those patients latch onto these "diagnoses" and it drives a further wedge between them and their licensed, evidence-based physician, leading to all of the above. The funny thing, as pointed out by Rina Raphael (author of The Gospel of Wellness), is that these alt-medicine peddlers will claim that doctors don't go after root causes while peddling something that does not go after a root cause, or makes up a cause.
A recently-added flavor in the terrible snack mix of physicians undermining our own profession is the doctors who have found an audience during this pandemic through contrarianism. Jay Bhattacharya (a physician who is not licensed in medicine and never did a residency, and one of the authors of the hypocritical and deceptive Great Barrington Declaration), Marty Makary (a surgeon, one of the authors of a fraudulent "analysis" promoting the idea that medical errors are the #3 leading cause of death in the United States, which was debunked), and Vinay Prasad (an oncologist who has railed against masks and posits that anything less than a randomized, controlled trial is bad research, which is patently false) are among these. Interestingly, all three continue to claim that they have been censored by social media outlets, which is laughable. I could not get away from the intentionally false or misleading Tweets from these charlatans if I tried.
That was a lot of information, but there are so many sides to the distrust of healthcare - some historical and some more modern. By empowering people in their own healthcare while combating grifters, I and others hope to encourage patients to trust evidence-based sources instead of turning to and being tricked by disinformation.
As always, I welcome your questions.
Lifehacker article on talking your doctor about meds: https://lifehacker.com/is-it-ever-worth-asking-your-doctor-about-a-medication-1848813644
The Disinformation Dozen: https://counterhate.com/wp-content/uploads/2022/05/210324-The-Disinformation-Dozen.pdf
Medical Error is NOT the #3 Leading Cause of U.S. Deaths: https://www.mcgill.ca/oss/article/critical-thinking-health/medical-error-not-third-leading-cause-death