Respectful Insolence

Steve Novella weighs in on doctor-bashing

For those out there who think it was “beneath” me to have responded to PhysioProf’s rants about doctors and medical students last week, I present to you Steve Novella’s take on the matter. Leave it to Steve to generalize the issue beyond my relatively narrow take on the matter. I also point out that Steve is nowhere near as–shall we say?–insolent as I am. If he’s bugged enough to post a rant, it reassures me that I wasn’t as off the mark as I feared I might have been.

One thing that came out in my post was an observation that skeptics, including those attending TAM 6, share in these attitudes. I was shocked that so many skeptics, including even Neil deGrasse Tyson would so casually dismiss medicine as “indoctrination” and share similar dim views.

Comments

  1. #1 Becca
    August 1, 2008

    It’s a very good post. I really like how Novella mentions his own experience “For me, medical school was a deeply humbling process. It takes years to get over the constant sense that you are overwhelmed by your own ignorance.” .

    Still, there are a few things that bother me about the post. First and foremost, his defense of the original temporary tattooing doctor. I do think it is useful to consider the matter from the perspective Novella presents “he was just trying to be a warm and fuzzy physican, even if he exercised horrible professional judgement”. I also think it is useful to consider it from the perspective PP seemed to take, that this was the sort of thing that should never happen to a patient; that it is the sort of BS that happens much more to female patients than male patients; that it is reasonable to expect physicians to know that it could make patients feel violated; and that that the action legally constitutes battery and therefore demonstrates not mere “professional lack of judgement” but a criminal mentality.
    Truth somewhere in the middle, and all that.
    However , if one sees it as Obvious that the Truth is that this is a deeply disrespectful act, I can see how it would be a touch toubling that physicians such as Novella are confidently telling us how it was all just a big misunderstanding of this poor doctor. That does sound a little patronizing, does it not?
    The other thing that bothers me every so slightly about Novella’s post is this: ” I understand that patients will often walk away thinking – I have two years to live – but that is not what doctors actually say.”
    The burden of effective communication of disease outcomes does not rest on the patient. If doctors aren’t actually saying a patient has two years to live, then whatever they say should not leave the patient with the idea they have two years to live. I realize communcation is always imperfect, and that it’s such difficult news people may process it weirdly, but I think Novella’s attitude sounds just a little like he’s blaming the patient for misunderstanding the doctor, which is totally ineffective.

    As an aside, you responded to a comment there, saying “that’s PP to a tee”. But the comment you replied to was actually a description of this post: http://offourpedestals.wordpress.com/2008/07/27/when-its-a-pattern/- however, the person quoting it may have been describing PP, which strikes me as a conflation.

  2. #2 Pinko Punko
    August 1, 2008

    The original tattoo dock committed battery and a grave breach of patient trust. When one places themselves essentially unconscious and naked in the care of a professional, trust is critically important. Who can now say that the Doctor didn’t do anything else untowards? And now that patient has these doubts in her mind. Despicable.

    On Doctor bashing. People doctor bash for a couple of reasons. They bash because medical care is frightening and opaque to a large percentage of the population. Their fears and insecurities, and their feelings of powerlessness lead to bashing. This is understandable and goes with the territory. Other people doctor bash because they’ve experienced lapses (or what they perceive as such) in care or have experienced patronizing and unprofessional behavior from their physicians and nurses, under situations where they are sensitized due to stress or anxiety about treatment.

  3. #3 Dan
    August 1, 2008

    I went to a doctor once that was as PhyioProf described. I never saw him again. We have prima donnas in every profession including mine. But generalizing does not cut it. Just because I had one bad doctor with a bad attitude does not make them all that way.

  4. #4 Lurker #753
    August 1, 2008

    Orac,
    From outside the profession, it looks like doctors are “produced” by medical schools, and thereafter simply apply (and of course refine) their training. In this view, doctors are a kind of highly trained technician in very demanding field, but this does not equal “scientist”. Of course, a doctor may also be a scientist (like you), but it’s a separate discipline. By analogy: Olympic athletes are highly trained technicians, it is usually outsiders that provide the training.

    Is it not precisely the skeptic who is going to perceive that doctors are athletes, not coaches? Taught how to perform, not necessarily to think?

    Lurker #753

  5. #5 The Christian Cynic
    August 1, 2008

    I was shocked that so many skeptics, including even Neil deGrasse Tyson would so casually dismiss medicine as “indoctrination” and share similar dim views.

    That sounds like a bad (or excellent, depending on your view) pun waiting to happen.

  6. #6 JoJo
    August 2, 2008

    You certainly do nothing to dismiss the impression that doctors are egomaniacs. That all others are simpletons.

    Nice work.

  7. #7 T. Bruce McNeely
    August 2, 2008

    Jojo:
    Thank you for your most valuable insight. Here’s one of equal value for you:

    Fuck off.

  8. #8 S. Rivlin
    August 2, 2008

    I have read PP’s original post, his rediculous attempt to wiggle out of it, while actually digging even a deeper hole for himself, and all the concerning posts and comments here and elsewhere on the topic. I also received my share of sarcastic responses from him when I pointed his own arrogance, which he proudly admitted he possesses. Funny that as a teacher of future medical doctors he has never considered that his arrogance could be an important contributor to the arrogance of physicians he so venomously complained about.

  9. #9 S. Rivlin
    August 2, 2008

    JoJo,

    You do nothing to dismiss the impression that you do not understand at all the issue of generalization.

  10. #10 Samia
    August 4, 2008

    I think Novella unfairly downplayed the psychological effects of what the tattooing doctor did. Waking from anesthesia to find a temporary tattoo beneath my panty line is not going to put a freaking smile upon my face. Good LORD. I’m sorry, this is patronizing as hell, and ironic considering the author later accuses PP of living in the 1950s. “Soft and cuddly?” Eat me.

    “For me, medical school was a deeply humbling process.” That’s good for him. I don’t understand the point here. Would any sane person argue that all doctors as assholes? I don’t think so (it’s certainly not my experience). Are there any physicians out there with attitude problems? Yeah, every profession has those. What is everyone mad about, again? Does PP’s opinion matter that much to the population of Earth?

    I see there are many viewpoints on the issue of physician arrogance. But it seems that beating the “debate” to death is only more firmly entrenching people in their established opinions. I don’t see what can be accomplished without any kind of guiding statistics or meaningful data regarding physician attitudes. Just a bunch of baseless accusations and whinging about “bashing.” From both sides.