Everyone Knows the Doctor Who Acts...

Wednesday, November 16, 2005
...as his own doctor, has a fool for a patient.

And this is true a fortiori for the patient who self-diagnoses and self-prescribes. In today's New York Times we read:

For a sizable group of people in their 20's and 30's, deciding on their own what drugs to take - in particular, stimulants, antidepressants and other psychiatric medications - is becoming the norm. Confident of their abilities and often skeptical of psychiatrists' expertise, they choose to rely on their own research and each other's experience in treating problems like depression, fatigue, anxiety or a lack of concentration. A medical degree, in their view, is useful, but not essential, and certainly not sufficient.

Well, I would recommend that anyone contemplating flying an F-16 be trained as a pilot. In my view, such training is both useful and essential. As to whether it is "sufficient," one should first ask, "Sufficient for what?"

The level of sophistication in both the subjects and the writer of this piece is perhaps best captured in the following paragraph:

"If a person is having a problem in life, someone who is 42 might not know where to go - 'Do I need acupuncture, do I need a new haircut, do I need to read Suze Orman?' " said Casey Greenfield, 32, a writer in Los Angeles, referring to the personal-finance guru. "Someone my age will be like, 'Do I need to switch from Paxil to Prozac?' "

Before asking myself that question, I would "be like:"

(1) Do I have any idea even what my diagnosis is?

(2) Am I even aware that Paxil and Prozac, though they are both classified as "(Selective) Serotonin Reuptake Inhibitors," have significant chemical, pharmakokinetic and therapeutic differences, some of which are subtle and not easily discerned by the person taking them, and that it is possible for me to get quite sick making this switch in the wrong way?

(3) What am I going to do for myself if, already significantly depressed, I develop akathisia in making this switch and am pushed over the edge, and I have no relationship with a physician who can help me?

And so on. Ms. Greenfield though, who is, as the article's title tells us, "young and assured," continues:

"I would never just do what the doctor told me because the person is a doctor," said Ms. Greenfield, who dictates to her doctors what to prescribe for her headaches and sleep problems, and sometimes gives her pills to friends. "I'm sure lots of patients don't know what they're talking about. But lots of doctors don't know what they're talking about either."

Well, no doubt "lots of doctors don't know what they're talking about."

Might be a good idea to look around for one who does.

A study, reported also in The New York Times, in an article entitled "Why The Ignorant Are Blissful," revealed that:

People who do things badly, [says Dr. David Dunning, the Cornell researcher who conducted the study, along with graduate student Justin Kruger] ... are usually supremely confident of their abilities -- more confident, in fact, than people who do things well.

Moreover, Dr. Dunning's work suggests:

One reason that the ignorant also tend to be the blissfully self-assured, the researchers believe, is that the skills required for competence often are the same skills necessary to recognize competence.

The incompetent, therefore, suffer doubly, [the researchers] suggested in a paper appearing in ... the Journal of Personality and Social Psychology.

"Not only do [the incompetent] reach erroneous conclusions and make unfortunate choices, but their incompetence robs them of the ability to realize it," wrote Kruger, now an assistant professor at the University of Illinois, and Dunning.


Food for thought as you write yourself your next prescription. When one reads remarks like that of "Rich," quoted near the end of the article, however, one despairs:

"My initial experience with physicians who are supposed to be experts in the field was disappointing," Rich said. "So I concluded I can do things better than they can."

16 comments:

Knucklehead said...

Does this mean I can't select my own red wines anymore? I know I'm a fool to do so but it makes me feel better.

Rick Ballard said...

Jamie,

The fruit of the hermeneutic of suspicion can be very bitter. It is the most "common" of knowledge that experts cannot be trusted because they are actually paid for their expertise. Who can trust someone who accepts money to perform their work? Work should only be performed out of a glowing sense of altruism and dedication to alleviating the suffering of mankind. Preferably while dressed in rags.

We have a generation that has never been taught to see or to think (as Vnjagvet noted), they only know how to "feel". Fortunately, natural selection has an answer to the problem. As they move through life with reality taking bites out of their butts, one can at least hope that they might learn experientially what they might have discovered through the application of reason. If they haven't fried their brains first.

David Thomson said...

I will initially give the benefit of the doubt to those with credentials behind their name. The non-credentialled individual must present an overwhelmingly strong argument before I take them seriously. Professional degrees are not necessary to impress the insiders. They can readily discern bovine excrement from reality. It is the outsiders who are bewildered---and must demand some evidence of proficiency. The odds dictate that the expert is more likely to know what they are talking about.

Jamie Irons said...

Rick,

You wrote:

Who can trust someone who accepts money to perform their work? Work should only be performed out of a glowing sense of altruism and dedication to alleviating the suffering of mankind.

I take the humor and wisdom in your remark as intended, but you would be surprised at the number of doctors (and nurses and other health professionals) who actually are motivated, at least in part, by altruism. I work with many in my own organization (child psychiatrists, interventional radiologists, vascular and plastic surgeons, among others) who would find private practice much more remunerative (sometimes by a factor of two) and with fewer headaches than working for us.

But I think the distrust of expertise involves more than suspicion about the fact that the expert is paid. Much of it is, as you are indicating, a matter of pure, feckless and willful ignorance, parading as a kind of "sophistication," as in many of the individuals quoted in the NYT story, and to a certain extent, the writer herself: as near as I could determine, no actual psychiatrists or true experts in psychopharmacology were cited in the article!

Jamie Irons

ex-democrat said...

jamie - "pure, feckless and willful ignorance, parading as a kind of "sophistication," "
- this perfectly describes a lot of those i know on the wrong side of the GWOT.
but then i presume you mean to infer that connection, no?

Peter UK said...

Jamie,
On the other hand one would be a fool not to check on possible sige effectx of prescribed medicines.In socialised healthcare many drugs are prescribed on on the basis of cost/ risk/ benefit,often side effects are not mentioned to the patient to allow them to make a choice,often doctors do not know,as evidenced by the recent cox-inhibitor debacle,when a relatively new drug is involved.
Whilst I agree that self medication is mad so is ingesting any substance without question.

Rick Ballard said...

Jamie,

I've never run accross a licensed MD whom I felt was primarily motivated by anything but altruism. Perhaps a few surgeons with curious secondary motivations but the cutters came to the profession wanting to help people - not go to the bank.

I would add "feckless ignorance" encouraged by an incompetent educational system and then refer to Dr. Sanity's pieces on malignant (although I would say chronic) narcissism.

At times I wish that I were starting over in business because plucking these chickens has to be easier than breathing.

Eric Blair said...

Those incompetnent people. Walking around like regular people. They don't see each other. They only see what they want to see. They don't know they're incompetent.

Knucklehead said...

Getting into what motivates doctors, and other people who work in the health care field, to become and remain whatever they are is an exercise frought with a whole lotta troubles. There is undoubtedly a fairly broad spectrum of motivations and very strong among those is the desire to help people.

There is also a spectrum of personal attributes and characteristics that apply and are more and less important depending upon "specialty". My experience with health care professionals, including doctors, suggests that they possess a rather odd combination of "atruism" and "hard heartedness". I speculate that it can be no other way.

Over the years the daily grind of dealing with people who need medical help, honestly wishing to help them, and yet being guaranteed to be unable to do so in so many cases produces a very strange sort of "coldly caring" mix.

Health professionals are an odd bunch. The vast majority wouldn't do what they do if they if they didn't care. Yet ordinary people, non-health professionals, would be totally appalled if they got real exposure to how coldly clinical health professionals can behave.

They go to work every day, among the plethora of reasons we all do so, because they want to reduce suffering. Throughout the workday, day after day, year after year, they are exposed to suffering and must, in order to survive, develope a "coldness" about suffering that the vast majority of the rest of us would be hard-pressed to empathise with, let alone replicate.

Then again perhaps this isn't so odd. Why do people become - and remain - policemen, or social workers, or soldiers?

terrye said...

The internet kills..really..I know people who think that if they can go online and check things out they don't need a professional.

sammy small said...

I tend to agree on doctor management of these types of issues. If nothing else than to manage the Rx requirements and a visit as necessary if changes become evident.

But there are many good web sites where very useful information can be obtained and current users can discuss what has worked for them, what hasn't, comorbids, alternatives, etc. It can't hurt to be prepared to discuss these during doctor visits. And in the psych field, there are few really good doctors as compared to other medical specialists.

markg8 said...

What was the matter with my last post?
It was not only factual it was snark free.

Rick Ballard said...

Mark,

What are you referring to?

markg8 said...

Twice I've posted on this thread and both have been deleted.

blert said...
This comment has been removed by a blog administrator.
blert said...

Perfect doctors...what a joke!

I can't recall a doctor who would listen for more than 15 seconds...

The profession has its devout beliefs.

No amount of contrary data is accepted.

I had to introduce the concept of H. Pylori to a LEADING EXPERT in internal medicine. It had already had been written up in the Economist; and had been propounded by his peers for YEARS. Oh, and he was not alone. It was news to him that the lab already had the diagnostic procedure in place! All news to him.

And with this cardinal failure he would rank as the best doctor I've known. At least he could still learn.

For the rest, they damn near killed me. Boobs. Fools. Arrogant. Properly degreed from major American medical schools.

Wrong, wrong, wrong as hell time and again.

I finally got around them to receive what I needed....

Positive life changing results in 30 SECONDS.

So, yeah.... I guess doctor knows best.