Medicine’s eternal welcome mat
When patients turn away from medicine, medicine is always there to pick up the pieces
In response to my last few blogs (which you can read here: Cheaper Than Therapy), I’ve received a lot of comments about respecting patient choice and patient-centred medicine.
Let me be clear, I’m all for patients making informed choices on their care. I just don’t expect to compromise their safety or survival in doing so.
The hypocrisy that is crushing mine (and many other medical souls) is when patients choose (often very aggressively and defiantly) to forgo evidence-based medicine yet turn back to this medicine to save them when the chanting rituals, snake oils and juice cleanses don’t quite offer the same healing powers they promised.
Didn’t get vaccinated? No problem - here’s an ICU bed and ventilator to help you breathe. Refused chemo? Let’s get our very best oncologists and palliative care teams to see what we can offer you and hey, you can jump the queue because your cancer is everywhere now. Catastrophic home birth - let’s divert all our resources trying to save you and your baby’s life.
(Now I know there are plenty of other examples of humans making medically unsound (stupid) decisions such as speeding, drink driving, smoking, eating too much, drinking too much, taking drugs etc and medicine always picks up the pieces, but I really want to focus on patients deliberately refusing treatment and then coming back to medicine as a last resort.)
Medicine never says ‘No’. Medicine never says ‘You chose this, now live (or die) with it’. Medicine may sometimes say ‘I’m sorry it’s too late, there’s nothing we can do, but we’ll do our best trying’, but medicine will ALWAYS roll out the welcome mat and give its very best to save you when you come knocking. It seems like the world’s most dysfunctional relationship - you reject us, we take you back. Repeat. Repeat. Repeat.
Whilst patients have the luxury of choice, medicine doesn’t.
There are 2 reasons for this:
Firstly, it’s our job. Most doctors, nurses and health care professionals choose their profession because they care. They like to help people. If you think it’s about the money, you’re just wrong. Nurses and GPs (especially females GPs) are the most poorly remunerated in the medical world. My plumber has a higher hourly rate than I do. True story! I remember when I was an intern working with enormous pressure and responsibility and my sister was a bartender earning more than me, I often wondered why the hell I chose this path. Then, I would have a feel good moment of our team helping someone and my why became obvious. I love that ‘feel good’ feeling. We all do.
The second reason is accountability. We took an oath. We don’t get to deny care or even provide second rate care just because we don’t agree with you. If we don’t do our absolute best for you we are investigated by health authorities and the consequences are dire. Even if we make an honest mistake, the consequences can be dire. We don’t have the luxury of ‘oh well, it didn’t pan out’. There is no stone left unturned to find out what went wrong. Conversely, self professed health ‘gurus’, promoting unproven and often dangerous treatments for self promotion and profit are without consequence from our health governing bodies when the shit hits the fan.
Over the last few blogs, some anti-medicine comments and personal attacks were making me anxious and angry to the point of almost giving up. So I confided in my good friend, writing mentor and former Brumby and Wallaby, Ben Alexander (who writes a fantastic raw and vulnerable blog on life after professional sport - check it out here: Ben’s Blog ) Ben’s advice was perfect: ‘Don’t get angry doc, learn from the haters.’ And then he sent me this picture.
It was a lightbulb moment for me (Thanks Benny!), reminding me to have a growth mindset. ‘Seek to understand…’
So, I’m putting it out there to the world because I genuinely want to understand: Why do people turn away from evidence based medicine and, more importantly, what brings them back to medicine? I know many patients will tell of bad experiences with a medical professional or hospital, but if I have a bad experience with my car mechanic, whilst I may not go back to that depot, I won’t turn away from all mechanics universally, instead choosing to run my car into the ground (and endangering myself or others in the process).
So, what makes someone turn away completely from a whole profession instead of seeking a second (or even a 3rd) opinion? And why, then, do they come back to medicine to be saved when the guru’s goodness wasn’t so good?
I know many (all) of my medical colleagues will have stories for days about this topic and I’d love to hear from you, especially if the patient came back.
From a distraught colleague: ‘Today my patient with recently diagnosed adenocarcinoma (cancer) has told me she’s self discharging from the medical team because her naturopath is going to fix her with a blood type diet and avoiding sugar. I couldn’t talk her out of it. :-(‘
This is what I’m talking about. Why and how does this happen?
There is absolutely no scientific evidence for a blood type diet that will cure cancer. How does this naturopath get away with promoting such a deadly lie? We know how this story ends and it’s not happy one. But as Winton Churchill said, ‘A lie gets halfway around the world before the truth has a chance to get its pants on.’
I don’t know why the patient made this choice in this story. So tell me your stories, even more so, if you’re a patient who has rejected or self discharged from evidence based medicine, I want to hear from you (no personal attacks please and no stories of just one ‘arsehole’ doctor - I’m here to learn why people turn away from the whole medical profession and I’m happy to listen if you’re here to share your story respectfully). Tell me your ‘why’. And even better, if you’ve reached back to evidence based medicine and are brave enough to share (by all means anonymously), I’d really love to hear your story. Please share this blog so we can all learn and grow.
I love this quote from psychologist Adam Grant:
Without understanding why, we’ll never fix the problem and medicine will continue to feel like the beaten and trodden welcome mat.
Dr Kate x
I think there are several reasons why people eschew evidence-based medicine in favour of unproven therapies.
Firstly, , referring to Grant’s quote, every person in the whole world is susceptible to confirmation bias. Only a fool thinks otherwise. So if someone has stage 4 breast cancer they’ll want to believe any suggested combination of special diet, juice cleanse, antioxidant pills and infusions, yoga etc is as effective as chemotherapy. They’ll accept any pathetic evidence that supports what they want to be true. Medical professionals are not free from confirmation bias but are usually naturally more sceptical to get into med school to begin with and have then had training to be aware of such cognitive biases.
Secondly, medical professionals have had to go through intensive training that involves understanding and evaluating evidence. You need to do a medical degree to know what the intensity of a medical degree is like. Without wishing to sound arrogant, most other degrees or diplomas are nowhere near as intense so most people have no idea how much harder an orthopaedic surgeon has trained than a chiropractor and little to no appreciation of the magnitude of the difference in evidence-based study. People will think that a naturopath has done a similar amount of training to a GP even though that’s complete bollocks.
Thirdly, evaluating evidence in itself is a skill. It takes training. Most people think if a study is from a science journal it’s always legit even though many papers are fraught with errors. They massively overestimate the value of anecdotal evidence. They frequently rely on intuition over the scientific method (look at the Monty Hall paradox). Most people have no idea about p values, what a standard deviation is, what a confidence interval is, how to read a forest plot, etc. In short, you need to study science to begin to appreciate what goes into making medicine so much more reliable than quack therapies.
Fourthly, people like certainty because it gives them a sense of security. But as Bukowski said, the problem with the World today is that intelligent people are full of doubt and stupid people are full of confidence. Doctors are usually cautious and work by a process of elimination and always have doubt and healthy scepticism. Quacks can come out with certainty and false reassurance. I’ve been involved in countless social media pandemic debates and been accused of being knowledgeable. I have to point out that I know next to fuck all about epidemiology, immunology and virology but unlike the pseudoscientists, I have respect for experts that know a shit ton more than I ever will.
Fifthly, people with medical training can often immediately spot when a quack is spurting bullshit when someone without medical training can’t. As a veterinarian I’ve seen dogs with ruptured ACLs come to me after seeing the local chiropractor for a ‘back problem’. I’ve checked out a FB page of a naturopath followed by a sadly holistic colleague and scrolled down to see him bragging about how he figured out that the Moon landings were faked. I’m sorry, but anyone who thinks the Moon landings were faked is pathologically stupid and shouldn’t be giving health advice!
Sixthly, time. A GP is under huge time pressure, which makes patients feel rushed. A homeopath might happily spend an hour consulting with a patient. It might/will be an hour of bullshit but the patient doesn’t get that. They feel less rushed and more listened too.
But please don’t give up the good fight, Kate. If there’s one thing I’m a bit disappointed with the medical profession in, it’s that more of them haven’t been like you and spoken out against misinformation and pseudoscience, especially during the pandemic. It hasn’t lost me any of their respect, and God knows I have no idea what stress some doctors are under, but I really wish a few more doctors were speaking out.
Awesome stuff Doc. My 2 cents:
1. I think when someone receive a serious medical diagnosis, they become very scared and want to believe that a left-field quick fix will work. As for the blood type diet, I dont know anything about that, but I can't see how eating less sugar could hurt.
2. There's been a huge change in the way people consume information over the last 10 years with the invention of the smart phones giving everyone unlimited access to all the information on the internet.
And unfortunately the people who are able to get their messages across on the net, are the people who are MOST engaging. And I think there's a lack of presence from the medical community on social media platforms creating entertaining and engaging content.
I know their job is not to be YouTube creators, but unfortunately with decreasing attention spans, in order to fight misinformation, doctors need to be present the facts in a way that engages 21st century brains. You only have to look at Dr. Rhonda Patrick and Dr. Peter Attia and the great success they're having online presenting science and evidence based health advice in a simple and engaging way.
If the medical community keeps saying "you just need to trust us. It's science" then I fear where the world is heading.