Concetta’s Response to Montgomery   1 comment

Last time in class we focused on the concept of narrative as a way in which doctors could avoid misdiagnosis by looking at the symptoms and letting them tell the story. However, after this week’s reading, I am beginning to wonder if narrative may be the problem, not the solution.

What makes a doctor more like the one that treated Daniel Pink’s patient 2 and less like the one that let patient 1 die (as mentioned in Elle’s Montgomery response)? Coming from a field as self-reflective as teaching, I find it shocking that medicine isn’t more conscious of its shortcomings, especially since there are so many instances of misdiagnosis and clinical error that as “scientists” they should be able to recognize some flaw in not being self-conscious. I also find it extremely horrifying that Montgomery implies that doctors only adopt the idea of medicine as art and science purely for the authority it grants and that they would sacrifice reliability and logic for a false sense of security. I can, however, see why they feel compelled to do so.

Doctors often demand horrible things of their patients by way of treatment, especially when the disease is fatal and the science uncertain. Rather than go through the loss of her breasts and the pain of cancer treatment, my aunt, like thousands of others, turned to herbal and non-invasive treatments to cure her cancer; she did not last a year after diagnosis. Some might dismiss her decision as ignorant (and for the record, I do) but when the narrative that doctors put forth is that of the infallible doctor of Science with a capital “S”, and then patients face the reality of a treatment with an uncertain success rate, it destroys the doctor’s credibility. Yet this fear of losing credibility is exactly why doctors perpetuate this narrative; if a doctor fails to convince someone that the treatment, though painful, will save their life, that patient will most likely die.

Even doctors who doubt this narrative of certainty will fall back on it; when proposing her solutions to this problem of authority, Montgomery needs to frame them in the form of a narrative:

As for (authority), it arises more strongly from human need in time

of illness than from science. A widespread appreciation of clinical judgment

would provide physicians a human and fallible but still trustworthy authority.

Montgomery 39

It cannot be a matter of finding statistics on what methods are best; Montgomery needs to reassure doctors by preserving this narrative of authority. Even her colleague, who equally expresses doubt about medicine’s certainty, became authoritative when telling her that her daughter “would not die”, not that there is a slim chance that she will die or giving her the national statistics (190). In that moment he became an authority solely to reassure Montgomery, not to adequately prepare her or to dispel the myths of medicine’s certainty.

This becomes even more troubling when Montgomery states that “Physicians …have been trained to expect of themselves a perfection of effort” but that “people with chronic diseases know better” (191). One thing I noticed was missing from the curriculum at UCF’s medical center is a class on basic problem solving skills. Do they expect new doctors to just pick it up as they go? A new physician who has not had or know someone with a chronic disease will more than likely buy into this narrative at first, seeing the more experienced doctor as simply being better at being “perfect”. Even once that narrative has been dispelled for the new doctors, they might find themselves using it to their advantage when faced with a patient that refuses treatment. What gets lost here is the ability to admit error, to admit that a patient might have had terrible things done to them for no reason, from something as simple as undressing in front of hospital staff, as was the case with the cancer patient in last week’s reading, to having a double mastectomy only to have the cancer return.

If doctors cannot admit fallibility, than perhaps it isn’t just society that thinks too highly of doctors. It may seem counterintuitive to say this in a profession where lives are at stake, but there has to be room for error and doubt. If not, misdiagnosis can lead to more harm than loss of credibility.

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Posted August 31, 2010 by capochetta in Uncategorized

One response to “Concetta’s Response to Montgomery

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  1. I’m not sure I read Montgomery as arguing that doctors don’t admit fallibility but that this narrative is spun more by patients and our culture(s).

    Interesting idea about a problem-solving course.

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