Why patients clash with doctors

I’ve seen several loved ones frustrated by interactions with the medical system lately, and after my initial knee-jerk reaction of “how dare they mess with one of my people” and “we have a shitty system, and we probably always will,” I got to thinking more about it. Why do people who are seeking help from a medical professional so often walk away feeling demoralized and disrespected, in addition to whatever problem brought them in in the first place?

Generally speaking, people choose careers in medicine because they want to connect with and help others. Medical school is grueling, and expensive, and people generally don’t do it if they don’t have some inclination towards service of others. Likewise, people seek out care from physicians because they want to feel better. Something isn’t right, and physicians are there to tell you what it is and how to fix it. They’re not stupid or lazy, just sick. By and large, this all lines up. So where do things go wrong? Let’s check out this handy chart:

Medical Visit

 

A few thoughts:

  • Doctors expect to be able to fix any “real” problem. This is how they’re trained— “true disease declares itself” is a common mindset.
  • Patients expect doctors to be able to fix any problem. All problems are “real.”
  • Some problems are well defined and understood within the structure of allopathic medicine.
  • Some problems are not well defined and understood within the structure of allopathic medicine. But they are not less real!
  • When patients present to doctors with problems from column b, things can go bad. Patients feel like they are not being listened to, taken seriously, or understood. Doctors feel like patients are being non-compliant, have unreasonable expectations, or are hypochondriacs. Everyone thinks everyone else is a jerk.

So what’s the root of this mess?

Some of them are in fact being jerks, but most of the time, at least part of the problem comes back to a profound misunderstanding of how allopathic medicine works. How physicians are trained, and paid. How patients are communicated to. Both doctors and patients miss the boat on this. Generally speaking, doctors have a toolkit, and it’s great for a lot of things.  It’s good for managing acute illness and injury (pneumonia, say, or a broken leg). It’s good for prevention and detection of set of pretty gnarly diseases (like cervical cancer, for example).  It’s OK at managing some chronic disease (diabetes, high blood pressure). All this goodness is pretty much related to disease, though— detecting it, preventing it, managing it.  Things can be pretty black and white: normal or abnormal. Above the cutoff or below it. Disease or not disease. Of course, not all physicians (and not all healthcare professionals are physicians!) fit this mold, but many do. It’s mainstream, it’s first line, it’s the common denominator.

The standard Doctor Toolkit doesn’t have tools for some things, though. Patients who have symptoms that don’t fit an established pattern are often (not always, but too often) treated badly. Physiologic measures that are within a range defined as normal are not always optimal for that individual, and allopathic medicine doesn’t have a very good way to deal with that. This makes some docs defensive, or annoyed, or incredulous. It’s outside of their expertise, and their comfort zone. It’s not what they know how to do.

If you’re in this boat, your standard-issue MD might not be working for you. What to do?

  • Bring a friend for moral support.
  • Ask “what else could this be?”
  • Say, “understanding this symptom is important to me, can we address this first?”
  • Recognize when your MD isn’t responding to your concerns, and consider a) a different physician or another kind of provider, and/or b) another modality of diagnosis and treatment.

Since the mainstream approach fails to address some problems altogether, some people go looking elsewhere— and rightly so. If a disease-focused approach doesn’t turn up answers, there are lots of other places to go. People turn to functional medicine, integrative medicine, naturopathy, Chinese medicine, Ayurveda, spiritual healing, nutritionists, herbalists, chiropractors, health coaches, and more. Some of these modalities have centuries of experience and coherent systems of thought and education behind them. Some have scientific evidence supporting them, but many don’t— they haven’t really been studied well. Some practices are completely bonkers and potentially dangerous. Differentiating these can be difficult, at best, and the internet has made this 10 times harder. Yes, it connects people who are similarly struggling and facilitates sharing of experiences. It can also spread dangerous misinformation right alongside life-changing ideas. What a mess. So, what to do? It’s the wild west out there.

Ways to be careful in alternative health spaces:

  • If it sounds too good to be true, it probably is.
  • If it feels sketchy, it probably is.
  • Just because it worked for someone doesn’t mean it will work for you (but it might!).
  • Don’t equate absence of evidence with evidence of absence (this goes for benefits as well as harms).
  • There’s not a magic pill your doctor just isn’t telling you about. Most non-western-standard therapies that work are not  medicines you take once and feel better. Many of them are lifestyle changes, ongoing practices, and new ways of relating to the body. Be open to these ideas— they can be very powerful.

And finally, don’t give up. We need medical professionals— but they can’t fix everything that’s wrong with our bodies. Recognize limitations and seek opportunities. Balance skepticism and openness. And remember, you are the owner of your body, no matter what.

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