Some of what people object ot about doctors comes from a feeling that they ought to be like shamans. This feeling affects many, usually unconsciously, and, unfortunately, some doctors feed into it. Since part of what I see as my job is to help physicians in training develop some psychosocial sense of their patients, over and above their medical understanding, I try to help them understand that she short-term glow of approbation when they accomplish, quickly and easily, something good is only part of what medical practice is about. And that they need to consider clarification to the patient as part of their responsibility too. In other words, they should explain and not just cure, because in the future some other doctor may encounter the same patient with a new problem not so susceptible to rapid resolution. If the patient then hasn't learned that successful diagnosis and treatment are more than just derivatives of the doctor's personal genius, then s/he may simply blame the doctor for the awkwardness of the process of diagnosing and treating the blue leg.
Christopher Rhoades Dÿkema
Alexandre Fenelon wrote:
> -----Mensagem original-----
> De: owner-lbo-talk at lists.panix.com
> [mailto:owner-lbo-talk at lists.panix.com]Em nome de Marta Russell
> Enviada em: sexta-feira, 11 de maio de 2001 18:44
> Para: lbo-talk at lists.panix.com
> Assunto: Re: doctor disease
>
> Joanna clearly meant that when you have more experience with the
> profession out of a personal medical issue you may learn the pitfalls
> of believing that doctors are mostly competent and enlarge your view
> on the topic.
>
> When it takes going to three or four doctors to find one who can
> diagnose a blood clot in the leg when the leg is turning blue as
> happened to a good friend of mine (and caused him hospitalization
> cause of their ineptitude and failure to catch it when it started),
> ain't it obvious? This friend of mine won an Oscar years back and he
> and his partner were horrified at what they were put through. They
> went from believers in the medical profession to a better to know more
> than the docs do position just to survive the medical practioners.
>
> Marta
>
> -I would like to make some statements to defend my profession here:
> 1-It´s true that medical mistakes cause a lot of harm to people, however,
> much of this harm is due to the limitations of medicine as science. Each
> disease has many diferential diagnosis, so it´s not always possible to
> establish a correct diagnosis. Furthermore, many medical treatments have
> a certain rate of complications, however, they are used despite this
> because benefits overcome the risks. If we use Tamoxifen as adjuvant
> therapy for breast cancer, for instance, you must expect an increasing
> of venous thrombosis, uterine cancer and lung embolism, some of them
> fatal, however, the benefits here far overweights the risks, as
> Tamoxifen is associated with a decrease in breast cancer related mortality.
> 2-Medicine is heavily dependent on a support structure that is not always
> present. This is probably not very important in your country, but I´m quite
> sure that many of my patients die from lack of critical laboratory or radio-
> logical exams that are not disposable in a Third world country. Probably
> it happens in your country with the uninsured or those who have relatively
> poor insurance.
> 3-Medicine is becoming very complex, and I think medical schools are
> somewhat
> confused about what to teach, what abilities must be learnt by students.
> When
> I ended my graduation, I became horrified with my ignorance (and I was
> graduated
> in one of the best schools of my country, probably at the level of an
> average
> school in USA). The same trouble is saw with post graduation courses. In
> many
> institutions, medical residents are used as cheap workforce and in some
> cases
> they work more than 60-70h/week (in both your and country and mine)
> 4-As medical care is becoming a commodity, there is a complete pervertion of
> medical practice, since it´s oriented by immediate profits. Off course, many
> (maybe the majority) doctors are aware of the contradiction between the
> patient
> well being and immediate and monetary gains, but its difficult not to follow
> the "market logic" in a market economy.
> 5-The pharmaceutical industry has a big influence over medical practice and
> we are subjected to a massive brainwashing. Not all doctors have time enough
> to study in order to keep themselves up to date with scientific advances
> (many
> doctors in Brazil work more than 50-60h/week, I don´t know how it works in
> the USA), so they usually are very vulnerable to this brainwashing.
> 6-In my country (and other third world ones) we are experiencing a
> proletarization
> of the medical profession, ie, increasing working hours, decreasing wages,
> worsening of labor standards, obviously this led to a decline in healthcare
> quality. This happens together with privatization, which increases the
> demands
> for growing productivity. I don´t know what is happening in the USA, but in
> some European countries we are seeing similar complaints.
>
> Alexandre