The Longer I’m In This Class, The More It Scares Me…   4 comments

I once asked my favorite history teacher in high school why medieval doctors would bleed patients; wouldn’t they realize after so many patients that their methods did not work? His response: Well, when someone gets sick, odds are they’re gonna get better.

That one inconsequential line that for some reason has stuck with me now seems so horrifying.

Its obvious to point out that the real problem medicine has is sick people, but think about all the otherwise healthy people that medical science does not need to treat. All those cases where not intervening would have been just as effective (one possible explanation for the placebo effect) serve only to give the confidence-inspiring illusion that it was the doctor, not the immune system, that fixed the patient.

Then someone like I was walks in, a child who is chronically ill and desperately needs medicine to just feel normal, and get nothing because the doctor assumes I’m faking.

The parallels between the history of migraines¬† and hypochondria, from the belief that the patient was merely “attention seeking” right down to the sexist roots of these attitudes, are probably the most troubling. Couple this with the fact that its primarily men that are the subjects of medical testing, and how many diseases might we assume there are that are ignored by medical science? Were women having heart attacks, which we now know are very different from men’s heart attacks, told they were just hypochondriacs? The fact that we have to have patient advocacy indicates how widespread this problem has become.

The worst part? I cant think of a way to fix it. What all this boils down to is bias, a naturally occurring reaction in all humans, something that we cannot simply remove via training (if current behavioral science is to be believed). So how do we train a doctor to not have a normal reaction?

And this is probably the worse part of the readings this week, because there is a training method being used to eliminate this human element from diagnosis: turning doctors into walking encyclopedias. The ridiculous automated approach that we were all appalled by in Montgomery might be a response to all the things we’ve read since. The system of treating the illness, not the patient might be a reaction to natural human bias and emotion disrupting the doctor’s ability to make a reasonable diagnosis.

If this were effective, I’d be on board. After all, as proud as I am to be a hardcore gamer, I’d trade that in if I could erase my bedridden childhood. The sad thing is, the automation approach isn’t working either.

So what then is the solution? I would like to say that a body of scientific inquiry into the nature of human suffering might allow doctors insight into a patient’s psyche. Body language, posture, even facial expressions could all be subtle hints to the patient’s mental and physical state, and since much of what a doctor does is akin to a detective, why not use the same concepts found in interrogation theory with a far more gentile set of practices? But then who decides which methods are “effective”? After all, don’t sick people usually just get better?

Posted September 14, 2010 by capochetta in Uncategorized

4 responses to “The Longer I’m In This Class, The More It Scares Me…

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  1. Interesting that you turn to scientific inquiry to answer your question of what can be done. What about rhetoric? When we get to it, Wells’s book might offer a compelling example.

    • Heh, I guess Ive been hanging out with Dr Wardle a bit much. I think we can study best practices and see which are most effective and why via some sort of qualitative research study the same way we’ve been reinventing the rhetoric classroom, or at least we can begin case studies of successful doctors.

      Now that I think about it, how do we know who are the “successful” doctors? Is anyone even keeping track?

  2. I feel you!!!!

    I had to put the hypochondria chapter down many times because I couldn’t focus – thinking of all the times I “might have been” one of “those people.”:)

    Questioning doctors is one thing – but questioning myself was a completely different ballgame!

  3. I don’t know what you’ve read of Montgomery’s, but I am interested in her account of medical epistemology–her separation of “scientific” knowledge from “narrative” knowledge. Narrative Medicine has been an interesting response to the sort of alienated medicine so many of you have been talking about. But I have been especially drawn to the work of philosopher, Miriam Solomon (at Temple), and her naunced view of types of medical knowledge. I’d give you the citation if I had it.

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