Friday, 13 March 2009

Doctor's Orders

Do doctors have some out of this world divine quality I was unaware of? That is the question that stuck to my head after a family member of mine reported the latest medical adventures another family member of mine went through.
As events transpire, that second relative of mine has started suffering from severe eye issues. On they went to an eye doctor who gave them some drops. These didn't help, so on they went again to the same doctor who gave them another type of eye drops to try. These didn't help, so on they went again to the doctor who - hold your breath, please - gave them yet another type of eye drops to try. Surprisingly, these didn't work either.
Through some sort of coincidence the family has learnt they can see an eye specialist for a minimal cost using their private medical insurance; all the need is a referral from their existing eye doctor. So off my relative went to their regular eye doctor to claim their referral, which they got in a cinch. Then off they went to the specialist, who told them to stop applying any eye drops for a while to let the eye settle, and then go for a series of tests. At this point, they got annoyed with the first doctor: if the doctor didn't really know what to do, why couldn't he/she give my relative that referral earlier and out of his/her initiative?

Now, the value of critical analysis and healthy skepticism has been previously discussed in this blog. My point with this post is to demonstrate yet again how valuable such an approach is, and how important it is that we apply it regularly on anything and everything. It's really simple: Had my relative applied critical analysis, it should have been clear to them their doctor was playing a guessing game. Had my relative applied some skepticism and challenged their doctor, they wouldn't have had to wait for a coincidence to put the option of a specialist on the agenda.
Yet when I asked my relatives why the doctor was never really challenged I was told it is impossible; you do not mess with a doctor at work. This, in turn, got me to raise the question I have opened this post with, namely me pondering as to whether there is something of the divine in doctors that prevents us from challenging them?
According to the information available to me, doctors are people just like each and every one of us; they eat, they sleep, and they take the occasional dump. The difference is, they have studied and specialized in a certain area for a long time; but that's it, and to that argument I can say the same applies to me yet I have been known to make mistakes on a regular and very frequent basis. Just like me, doctors have a lot of things on their mind while at work, a lot of which has nothing to do with work; and unlike me, doctors see many patients on a typical day and are usually only able to devote a very small portion of their attention to each and every patient. In short, there are very good reasons to critically analyze a doctor's instructions. It's not only that the doctor's are imperfect, it's also to do with what is at stake here: one's health.
No, I am not saying that doctors should be disobeyed, nor am I saying one can always know better than them. However, I am saying that one should ask the doctor "why" from time to time to make sure they understand the rational behind a suggested treatment. I am also suggesting one cross references doctors' advice with other information, through the internet for example (with the added disclaimer that there is a lot of bullshit out there on the internet, especially with regards to medical advice; one has to use reliable sources and be carefully skeptical in general). I maintain that if my family had conformed to this simple analysis things would not have turned out the way they did.
Then again, one cannot say I am surprised. Critical analysis is a rare thing in my family and in society in general: just check how many families fail to install their baby car seat in the center of the back seat, the safest place in a car, for the sole reason of not even thinking up the possibility.
As I have said, critical analysis can save your life. Apply it.


Wicked Little Critta said...

I have recently come to a much better understanding of this point. For some reason, there is something magical and unquestionable about doctors. The health plan I have at work was recently changed to one with a deductable, so now we have to deal with paying a certain amount before the insurance will cover it. When they decided to change over, they had a meeting for everyone in which the insurance representatives gave us a presentation about understanding your conditions, and knowing what procedures you need and don't need so there isn't money flying around carelessly. They told us that no one, even the doctors really, know what most of these things cost, because no one thinks about it like that. Anyway, the rep talked to us about a foot injury he had, and how the doctor wanted to do all these tests on it. When he asked him what the tests would tell him, he learned that really no matter what condition he had, the plan to fix it would ultimately be the same. So...why are the expensive tests necessary again?

When I communicated this to some of my coworkers who didn't attend the meeting, they acted like I was questioning the existence of God. (ha, ha.) "Oh, that's not right to question your doctor. They know more about these things than I do, and I'm not going to mess around with my health like that." I never actually got through.

As a side note, I love my doctor. She makes referrals for me all the time, and actually talks to my face and not to her laptop.

Moshe Reuveni said...

I'm afraid I don't have much of substance to add on top, but here goes anyway:
1. The obvious similarity between unquestionably accepting the authority of a religious dogma, bundled with its system of values, and unquestionably accepting doctors’ words is, well, obvious. Both stem from accepting authority for not much more than it being declared an authority.
2. I obviously don’t know a thing about the foot issue you mention as an example. I would, however, state that I would generally prefer to know what has gone wrong even if it won’t matter immediately. It could make a difference, eventually, and it could also be that the thing which has gone wrong is something "interesting" like cancer (and I’ve heard of enough such unlikely cancers by now).
In general, I like to know the why; in my opinion, not striving to know the why puts you in a similar moral position as someone saying "I have money in my wallet and I don’t care how it got there". Obviously, your ill footed friend is no criminal, but I’m talking about how things would preferably work in a perfect world.
3. Other than hearing horror stories about it I can’t say I’m familiar with the American health system. What I can say, though, is that I have met enough doctors I wouldn’t want to go back to both in Israel and in Australia, and that the Australian health system has been deteriorating in front of my very eyes from the aspiration it once used to have of having a system providing good health services that is accessible to everyone.

Wicked Little Critta said...

1. Yes.
2. Obviously, one must use one's brain. I'm sure it depends on the case.
3. It's funny, because a lot of people in the US talk about horror stories of health care in foreign countries. I guess it depends on what side of the fence you're on.

Moshe Reuveni said...

2. Using one's brains is not a common feature of human behavior. How else would you explain George W getting reelected?
3. When discussing health care, I think one has to distinguish between two things: the quality of the care you get and its accessibility. Health care in the USA is of the highest quality if you can access it.

Moshe Reuveni said...

For the record, I think the thing that annoys me the most about this post's incident is the way in which my family will take any word coming from a doctor's mouth as the holly word of their favorite deity, yet no matter what I do they will always question me. The problem there is that their questioning is not meant to help some sort of a process improvement but is rather designed to make me feel like an idiot. You can never win with them.
So there you go: an example of how blogging can help one explore one's pains.