Patient, Heal Thyself

I feel about doctors the same way I feel about the police and the armed forces of the United States. I am surrounded by hostile forces whose goal is to kill me. It is their job to protect me. But increasingly doctors seem to be shirking their duty. They expect me to become Mad Max while they kibbitz. Why has a profession once known for its God complex suddenly gotten timid, deferential, equivocal?

Case in point. I was in my car and “The Diane Rehm Show” was on. The subject was a study comparing the outcome for various treatments of Stage Zero breast cancer. It suggested that radical treatment at so early a stage might be premature. Ordinarily my hypochondria doesn’t extend to worrying about diseases I have almost no chance of contracting, but rather than try to find something other than hip-hop, country music or Limbaugh to listen to I stayed tune.

The learned doctors discussed the results with great vigor and confidence. Then people started to call in and one asked the obvious question: “In light of this study, if you got this diagnosis and had to decide between watchful waiting, lumpectomy or mastectomy what would be the best course?”

“Oh, you’d have to make the decision,” the doctors all said without a moment of hesitation.

Really? What does the average person know? We’re CPAs or shopkeepers or dairy farmers. We aren’t oncologists. To get medical advice you don’t look into your soul, consult your mood ring or go back to school for seven years. It’s the reason you’re sitting in a small, windowless room wearing an embarrassing gown that ties in the back. To be told, “Oh, you decide” is not helpful. Indeed, it seems like an abdication of responsibility.

Yet this sort of thing keeps happening with diagnoses large and small. My wife has had a test result for a condition which shall remain nameless. Suffice it to say, the doctor’s advice was, “Well, you could do ‘A’ or you could do ‘B’. ‘A’ might work or it might not. ‘B’ would probably work, but it might not be necessary, and could have side effects. You decide.” Is this a medical practitioner or the King of Siam? You may recall, he sang the following lament:

“In my head are many facts
That, as a student, I have studied to procure.
In my head are many facts
Of which I wish I was more certain, I was sure.
Is a puzzlement.”

But the patient is even more puzzled. He has zero experience with the problem. The doctor, we assume, has seen the problem every day for decades, hundreds, probably thousands of cases. Wouldn’t he be more likely to make an educated guess about the best way to proceed?

More than once I have had a doctor describe in some detail what was going on with some part of my body using one of those blood curdling cut-away illustrations of bones or muscles or viscera they all hang on their walls to freak patients out. But I get nothing out of these lectures because I am averting my eyes, as from a splatter movie, to keep from fainting. I don’t want an anatomy lesson. I want to feel better.

I have been told several times I could try this injection or that medicine, but almost never has anyone said: “This is the solution.” Generally they say, “This might do the trick, do you want to try it?” Putting the onus on me. I don’t know. Do I want to try it, or don’t I? One doctor’s office has even got a recording, that you get stuck listening to when put on hold, that boasts that their practice strives for the least aggressive treatment.

Is this the medical equivalent of being a conscientious objector, of small is beautiful or a having a low carbon footprint? It’s as if God Almighty decided one day to be Mr. Rogers or a slacker from “Clerks.” It’s as if the fire department showed up at your blazing house and said, “You could try water or that foam stuff or just watchful waiting. You decide.” How has this happened?

I suspect doctors now get better training in medical school in how to avoid malpractice suits than in how to cure their patients. I am positive they only provide those treatments that insurance companies are willing to reimburse for. Also, it seems probable that doing a lot of little things that don’t work, over and over, before doing the one big thing that might cure the problem pays better. This is called Defensive Medicine. But it isn’t defending me. It’s like the doctors are playing a game of darts. And I’m the dart board.

All of this leaves the frightened, ignorant patient, who is not medically knowledgeable, with the responsibility for choosing his own treatment from a menu of options, and taking the blame for the malpractice he subjects himself to. How weird is this? Movie critics tell you which movies are worth seeing. Politicians tell you which party to vote for – theirs. Insurance agents tell you which policy to buy – either the most expensive or the one least likely to cost them money.

Teachers, priests, carpenters and auto mechanics all cheerfully tell you what’s right and what’s wrong, how to behave and how not to behave, what to do. Even gardeners tell you when to watchfully wait and when it’s time to kill the damned crabgrass. Only doctors, who have your life in their hands, are reluctant to venture an opinion. Help, defensive medicine is killing us!