Why Doctors Hate Science

[T.A.M.]

I think the confusion is in the different levels of decision making which go on between the patient and a doctor.

Sure, doctors make decisions that their patients would be unable to make, just as engineers make decisions which the users of their products would not be able to make.

But ultimately it is patients who should be directing their treatment, just as the users of engineers' work specify what they want it to do, given the constraints pointed out by the engineer.

Doctors are a human user interface for medical technology.

Thank you very much. I love it when someone reduces my 11 years of post secondary education down to an "interface for medical technology". Do you insult everyone this way?

Engineers are a human interface for engineering technology...nothing more. Nothing you could do that a computer, a CAD program, and a village idiot with mechanical skills couldn't do, right?????

I think you merely fear having things out of your control. Are you the same way when you step onto a plane? You despise that someone, such as a doctor or a pilot, could have such power as to make decisions FOR someone else. Maybe I am wrong. Please clarify for me the root cause of your distaste for myself and my physician colleagues.

I am not a big fan of the paternalism either, but it exists, and as you have said, and I would agree, a large portion of people actually prefer it that way...get use to it...it ain't gonna change in our lifetimes.

I am a 100% believer in the Doctor-Patient negotiation model. I always tell my patients that ultimately I am their information provider and ADVISOR. I do also, however, tell them that whatever decision they make, they must live with...and I record such in the chart.

TAM

 

[Ivor the Engineer]

<snip>

Under the model you are suggesting, the health care provider would be an employee of the patient. If that were the case, the patient could ask for drugs and surgery that was not indicated. Surely you can see the problem that would create?

Well they could, just as the operations department we (engineers and physicists) design borehole logging tools for could request that we supply them with all sorts of technology they don't understand, or would not be appropriate to achieve the measurement. This does not happen*.

Instead they request tools which can make particular measurements under certain environmental conditions, and it is left to the engineers and physicists how to achieve this specification. If there are ambiguities in what operations want (and there are always ambiguities in what operations want), we discuss the options we consider feasible and let them decide which of them they want us to implement.

This is how I see the doctor's role with a patient after the diagnosis has been made.



*Except when marketing get involved, then it becomes important to be able to match or out-spec. the competition.

 

[paximperium]

Thank you very much. I love it when someone reduces my 11 years of post secondary education down to an "interface for medical technology". Do you insult everyone this way?

Engineers are a human interface for engineering technology...nothing more. Nothing you could do that a computer, a CAD program, and a village idiot with mechanical skills couldn't do, right?????

I think you merely fear having things out of your control. Are you the same way when you step onto a plane? You despise that someone, such as a doctor or a pilot, could have such power as to make decisions FOR someone else. Maybe I am wrong. Please clarify for me the root cause of your distaste for myself and my physician colleagues.

I am not a big fan of the paternalism either, but it exists, and as you have said, and I would agree, a large portion of people actually prefer it that way...get use to it...it ain't gonna change in our lifetimes.

I am a 100% believer in the Doctor-Patient negotiation model. I always tell my patients that ultimately I am their information provider and ADVISOR. I do also, however, tell them that whatever decision they make, they must live with...and I record such in the chart.

TAM

Such petty digs by Ivor are amusing. I've already met my "life saved quota" for the week and my "piss off the drug seeker" quota is almost there.

This medical interface's ego is satiated.

 

[Ivor the Engineer]

Thank you very much. I love it when someone reduces my 11 years of post secondary education down to an "interface for medical technology". Do you insult everyone this way?

Engineers are a human interface for engineering technology...nothing more. Nothing you could do that a computer, a CAD program, and a village idiot with mechanical skills couldn't do, right?????

I only lowered your status to that of an engineer or physicist. Quite a drop, but (hopefully) still higher than "a village idiot".

I think you merely fear having things out of your control. Are you the same way when you step onto a plane? You despise that someone, such as a doctor or a pilot, could have such power as to make decisions FOR someone else. Maybe I am wrong. Please clarify for me the root cause of your distaste for myself and my physician colleagues.

No distaste for pilots or doctors. I do always count the rows of seats to the exits and plan my route out if the worst happens. I do the same when I'm flying.

I am not a big fan of the paternalism either, but it exists, and as you have said, and I would agree, a large portion of people actually prefer it that way...get use to it...it ain't gonna change in our lifetimes.

I am a 100% believer in the Doctor-Patient negotiation model. I always tell my patients that ultimately I am their information provider and ADVISOR. I do also, however, tell them that whatever decision they make, they must live with...and I record such in the chart.

TAM

I've been impressed with and interested in your posts in this thread. I apologise if I have caused you any offense. (Not meant to sound patronising.)

 

[paximperium]

I only lowered your status to that of an engineer or physicist. Quite a drop, but (hopefully) still higher than "a village idiot".

Nope. I doubt you'll find too many engineers or physics who will take kindly to your assessment of their expertise as nothing more than a "technology" or "science" interface.

You've lowered a physician's or just about any professional or expert's status to bus driver so excuse us for finding your attitude not only insulting but exceeding moronic.

 

[Skeptic Ginger]

[snip]
This is how I see the doctor's role with a patient after the diagnosis has been made.....

You seem to be confusing what health care providers do with your misconception they are not doing it.

When I started my practice 18 years ago, I bought a mailing list. I was going to send a brochure of the services I provided out to all the potential clients in the county. Before I had a chance to send them out, my practice got too busy through word of mouth. I still have the brochures and mailing labels. [Hmmm, now that I am thinking about it, I think I may even have some unused rolls of stamps. I should go look for those.]

My point is, some of us have a lot of feedback we are doing a good job. You must have had either terrible luck with poor quality providers, or you have the problem because you think you know more than you actually do. I'm leaning toward the latter explanation.

 

[Skeptic Ginger]

Such petty digs by Ivor are amusing. I've already met my "life saved quota" for the week and my "piss off the drug seeker" quota is almost there.

This medical interface's ego is satiated.

You rival Linda for pith.

 

[Ivor the Engineer]

Nope. I doubt you'll find too many engineers or physics who will take kindly to your assessment of their expertise as nothing more than a "technology" or "science" interface.

You've lowered a physician's or just about any professional or expert's status to bus driver so excuse us for finding your attitude not only insulting but exceeding moronic.

I didn't think I did that at all.

The level of complexity of the interface to technology a scientist, engineer or doctor provides depends very much on the user. But the function of scientists, engineers and doctors is always to allow those with less expertise than themselves use the products of their labour.

ETA: I'm off to bed. See you tomorrow.

 

[jj]

I think the confusion is in the different levels of decision making which go on between the patient and a doctor.

Sure, doctors make decisions that their patients would be unable to make, just as engineers make decisions which the users of their products would not be able to make.

But ultimately it is patients who should be directing their treatment, just as the users of engineers' work specify what they want it to do, given the constraints pointed out by the engineer.

Doctors are a human user interface for medical technology.

So, you assert that doctors have no knowlege base, they just look things up on the innertubz or something?

Given your take on doctors and engineers (which includes me), how does new knowlege ever get made, created, happen, whatever?

 

[Ivor the Engineer]

So, you assert that doctors have no knowlege base, they just look things up on the innertubz or something?

No, not at all.

Given your take on doctors and engineers (which includes me), how does new knowlege ever get made, created, happen, whatever?

By clever scientists, doctors and engineers discovering and/or creating it. They then allow other people who are not as clever as they are make use of this knowledge by presenting it in a more user friendly way.

 

[BillyJoe]

I think there is too much trying to fit patients and doctors into a mould.

Hey, guess what, everyone's different. Patients come in all varieties. What doctor could possibly want all his patients to be fully informed and armed with information from the internet. What doctor could possibly want all his patients to be docile and obediant. Variety is the spice of life. A businessman in a suit sent in by his wife for a prostate exam. A single mother with three rag kids in tow. A spotty teenager looking for a cure. A carpenter who just wants a couple of stitches whacked in. An elderly woman wondering whether [insert quack cure] will help her arthritis. All with different attitudes and expectations. A doctor surely would want to be able to deal with all these types of patients. Patients, in turn must not expect to dictate how a doctor does his job as long as he does it competently and helps him get better or deal with what can't be cured. If a patient has a problem with the doctors attitude and demeanor, he can always find another doctor more to his liking...you know, the doctor the next patient left to come to this one!


And patient autonomy is a joke?

Hey, it's only an exercise in political correctness and, as Linda says, it is pure illusion. I am reminded of a alternative health practitioner who wanted the paternalism of doctors to stop and wanted every patient to decide for themselves whether they would have the new gardasil vaccine. Can you imagine the time it would take to research the pros and cons of the gardasil vaccine? Google it and you will see what I mean. And then to make sense of it all they will need to get themselves knowledgeable about immunology, the conduct of clinical trials, statistical analysis etc. etc. etc. It's just too ridiculous. The solution is not patient autonomy, it's better trained and informed doctors explaining what the problem is and how it should be treated and communicating that to the patient. That's where communication comes in, not sharing the decision with the patient! If there is no clear treatment course then the patient can be afforded some input.
I don't go to my mechanic and be expected to make a choice about whether to change the brake pads. I wouldn't have a friggin clue. Just change them mate if you think they need changing.

BJ

 

[Dancing David]

More seriously, many GPs will print out a prescription before they even tell you what they are giving you. This then makes it seem like an imposition and a nuisance to say anything that might make them reconsider.

Wow, some doctors are a pain!

Is this recent? Most doctors I have met, discuss the medication prior to writing the script. Mainly to check on the history of side effects and allergies.

Was this recently? (Now I do admit I go to a great giant practice, associated with a teaching program. Sometimes they are a little, um , clinical vs. homey. But I prefer that.)

That would be rude. On the doctors part, but then as a mental health advocate I got very used to asking doctors questions.

 

[Dancing David]

Come on Linda - you have a very obvious sarcastic streak. Some doctors can turn that off when they are with patients (I have no idea whether you are one of them), but others seemingly cannot keep their sarcastic/arrogant/condescending/patronising personalities out of the surgery. This in turn makes many patients reluctant to bring up anything that doesn't fit in with what the doctor already has planned.

To me the problem is not about *who* makes the decision, as long as the patient has been listened to and their views taken into account. The main problem, for me, is that many doctors create an atmosphere wherein patients find it very difficult to provide this sort of input. It's not enough for a doctor to say "well they didn't tell me about their problem with x" when they have created a situation in which it is very difficult for the patient to air their concerns. See Ivor's link to the book about communication skills.

This strangely enough cuts into a common area of professionalism, not just doctors.

In the Computers Forum, there have been similar discussions on this issue.

There are two (more like five hundred) sides to the issue.

A person who presents an issue(Person Requesting Services), their level of understanding may or may not be related to issue of technology at hand.

A person who is there is 'deal' with the issue (Person Providing Services), their social skills may or may not be similar to those commonly used by the other person.

This play out in a very similar fashion to what happens with doctors
-the social skills often make the situation uncomfortable and create animosity
-the technical jargon and discussion of the issues in jargon causes a deer in the headlights look or a glassy eyed look
-the person PPS is often knowledgeable about the current issues and can eliminate possibilities out of hand, which interacts with the communication skills
-the PPS may be very frustrated by the interesting ideas and concepts the requestors has, often involving policy issues that are way beyond the providers control
-the PPS may have a unique and often idiomatic/quirky way that they tend to do things, that may or may not have any bearing on what is the best for the requestor or the system level issues

-the PRS sometimes asks for something that just can't be done
-the PRS may have many interesting and unrelated ideas about what the problem is, that are not going to be realistic
-the PRS often wants the IT person to make things 'the way they used to be', when this is just not possible
-the PRS often wants special exceptions or permissions to do things that don't make sense or even worse would really mess things up
-the PRS often wants the provider to do things that are outside the scope of their job, especially provide emotional counseling

 

[Ivor the Engineer]

<snip>

And patient autonomy is a joke?

Hey, it's only an exercise in political correctness and, as Linda says, it is pure illusion.

Well if Linda, high priestess of all of medicine says it, it must be true.

Kumar & Clark: Clinical Medicine 6th Ed.

The three duties of clinical care

The rights of patients may be summarized by three corresponding duties of care which apply to all patients for whom doctors have clinical responsibility.

Protect life and health. Clinicians should practise medicine to a high standard, taking care not to cause unnecessary harm or suffering. Patients should only be given treatments which they need. Treatments should not be prescribed, for example, just because patients request them.

Respect autonomy. Humans have autonomy - the ability to reason, plan and make choices about the future. Respect for these attributes goes hand in hand with respect for human dignity. Doctors should respect the autonomy, and thus the dignity, of their patients. This respect for the autonomy of patients leads to two further rights - informed consent and confidentiality. Competent adult patients should be able to choose to accept proposed treatments and to control personal information which they divulge concerning such treatments. Denying patients such choice and control robs them of their human dignity.
Protect life and health and respect autonomy with fairness and justice. In the conduct of public and professional life, it is generally thought that people have the right to expect to be treated equally. Medicine is no exception and doctors have a duty to practise accordingly. The access to, and quality of, clinical care should be based only on the dictates of need rather than arbitrary prejudice or favouritism.

The purpose of the doctor is to present the patient with the options for treatment, along with sufficient information in a form for them to be able to make a informed decision.

I am reminded of a alternative health practitioner who wanted the paternalism of doctors to stop and wanted every patient to decide for themselves whether they would have the new gardasil vaccine. Can you imagine the time it would take to research the pros and cons of the gardasil vaccine? Google it and you will see what I mean. And then to make sense of it all they will need to get themselves knowledgeable about immunology, the conduct of clinical trials, statistical analysis etc. etc. etc. It's just too ridiculous.

The purpose of producing statistics is to convert complicated information into a form which others with less detailed knowledge can use to make useful decisions with.

The solution is not patient autonomy, it's better trained and informed doctors explaining what the problem is and how it should be treated and communicating that to the patient. That's where communication comes in, not sharing the decision with the patient! If there is no clear treatment course then the patient can be afforded some input.

There is rarely only one way to crack a nut.

I don't go to my mechanic and be expected to make a choice about whether to change the brake pads. I wouldn't have a friggin clue. Just change them mate if you think they need changing.

BJ

Or your mechanic could say: "There's X mm left on your pads (mate), which is good for about Y thousand miles. Do you want me to change 'em now?"

 

[T.A.M.]

The purpose of the doctor is to present the patient with the options for treatment, along with sufficient information in a form for them to be able to make a informed decision.

Where is that head banging on the desk smilie!!!!

No, the role of the physician is to listen to the patient's problem, ask relevant questions in order to make a diagnosis, or a list of probable diagnoses, and then present the recommended treatment(s), from which the patient may chose (if a selection is available) from, or chose no treatment at all.

Why must you minimize (inaccurately) the role I play in patient care so?

TAM

 

[T.A.M.]

I think there is too much trying to fit patients and doctors into a mould.

Hey, guess what, everyone's different. Patients come in all varieties. What doctor could possibly want all his patients to be fully informed and armed with information from the internet. What doctor could possibly want all his patients to be docile and obediant. Variety is the spice of life. A businessman in a suit sent in by his wife for a prostate exam. A single mother with three rag kids in tow. A spotty teenager looking for a cure. A carpenter who just wants a couple of stitches whacked in. An elderly woman wondering whether [insert quack cure] will help her arthritis. All with different attitudes and expectations. A doctor surely would want to be able to deal with all these types of patients. Patients, in turn must not expect to dictate how a doctor does his job as long as he does it competently and helps him get better or deal with what can't be cured. If a patient has a problem with the doctors attitude and demeanor, he can always find another doctor more to his liking...you know, the doctor the next patient left to come to this one!

<snip>

BJ

Well put, very insightful. Thank You.

TAM

 

[T.A.M.]

This strangely enough cuts into a common area of professionalism, not just doctors.

In the Computers Forum, there have been similar discussions on this issue.

There are two (more like five hundred) sides to the issue.

A person who presents an issue(Person Requesting Services), their level of understanding may or may not be related to issue of technology at hand.

A person who is there is 'deal' with the issue (Person Providing Services), their social skills may or may not be similar to those commonly used by the other person.

This play out in a very similar fashion to what happens with doctors
-the social skills often make the situation uncomfortable and create animosity
-the technical jargon and discussion of the issues in jargon causes a deer in the headlights look or a glassy eyed look
-the person PPS is often knowledgeable about the current issues and can eliminate possibilities out of hand, which interacts with the communication skills
-the PPS may be very frustrated by the interesting ideas and concepts the requestors has, often involving policy issues that are way beyond the providers control
-the PPS may have a unique and often idiomatic/quirky way that they tend to do things, that may or may not have any bearing on what is the best for the requestor or the system level issues

-the PRS sometimes asks for something that just can't be done
-the PRS may have many interesting and unrelated ideas about what the problem is, that are not going to be realistic
-the PRS often wants the IT person to make things 'the way they used to be', when this is just not possible
-the PRS often wants special exceptions or permissions to do things that don't make sense or even worse would really mess things up
-the PRS often wants the provider to do things that are outside the scope of their job, especially provide emotional counseling

1. A well rounded, well trained GP will hopefully have acquired sufficient skill to remove the social discomfort. Very few of my patients find it hard to talk to me, and most tell me I am "much better at it" then there previous doc.

2. A well rounded, well trained GP should have the ability (though not always the time) to break down the technical jargon into laymen terms.

3. A well rounded, well trained GP will likely find policy issues brought up by the patient to be frustrating, not due to any power struggle, or sense of insecurity, but likely out of time constraints.

4. the remainder of your post seems relatively accurate.

TAM

 

[fls]

I am a 100% believer in the Doctor-Patient negotiation model. I always tell my patients that ultimately I am their information provider and ADVISOR. I do also, however, tell them that whatever decision they make, they must live with...and I record such in the chart.

TAM

Let me put Pax's example to you, then.

Do you present Mr. Soandso with some information and then have him decide whether or not to get a lumbar puncture?

Linda

 

[T.A.M.]

Let me put Pax's example to you, then.

Do you present Mr. Soandso with some information and then have him decide whether or not to get a lumbar puncture?

Linda

In an earlier post of mine, I did stress that there is an "ER Doc" method, and then a "GP in the office" method. In the former I tend to ask relevant questions. I perhaps should have said, that in that setting, and depending on the nature of the illness, I might be more or less paternalistic.

However, if a patient were to present in my clinic with a headache, neck stiffness, coryza, and a fever, I would probably tell them this.

"You likely have an viral illness, a variation of the cold, but with your symptoms, and based on your physical, there is a possibility of meningitis. I strongly suggest we send you to the hospital for a CT and lumbar puncture, at the accepting doc's discretion, to rule this out."

If the patient is competent, and refuses to go, I will strongly urge he/she to reconsider, and then write in the chart that the patient was informed, competent, with a GCS of 15, and refused to take my advice.

TAM

Edit: so you, see this would be the ADVISOR part of the quote from me that you used.;D

 

[Ivor the Engineer]

Where is that head banging on the desk smilie!!!!

No, the role of the physician is to listen to the patient's problem, ask relevant questions in order to make a diagnosis, or a list of probable diagnoses, and then present the recommended treatment(s), from which the patient may chose (if a selection is available) from, or chose no treatment at all.

Why must you minimize (inaccurately) the role I play in patient care so?

TAM

I thought we were focusing on the role of the physician after a diagnosis has been made? If so, how is what I have said inaccurate?

Sometimes I think people are just looking to take offence in anything I say...