Compassion? You don't KNOW compassion!

We've often discussed the tactics favored by denialists, and prominent among these is the ad hominem attack. Physicians who speak out against quackery and speak up for science-based medicine are often often accused of lacking compassion. Orac wrote a little bit about the topic today. (OK, Orac never writes a "little bit" about anything, but it's worth the read.)

The basic argument is that "conventional" doctors ignore patients' experiences, deny them care that may work simply because science says it won't, and a whole bunch of other things I don't really understand. And while they whine about our lack of compassion, they wish ill on us and our loved ones. I don't hear a lot of real doctors doing that.

Let me tell you what physicians' compassion is: it's listening to a patient, talking to a patient, and formulating a plan for a patient based on science and the doctor's knowledge of the individual.

What clearly is not compassion is making false promises, and offering miracles. What is not compassion is convincing a patient that you are the only one with access to these miracles, and that everyone else has it wrong. One of the wonders of science-based medicine is that, for the most common and serious problems, most doctors will give you similar advice, and that advice will be based on what is likely to help, and less likely to harm.

Cranks and denialists hate being confronted with truth. An ignorant fool over at some fringe autism website recently launched an attack on a doctor whom he perceives to have wronged him. Orac wrote quite a bit about it, so I won't repeat his points, but there are a few things that need re-emphasizing.

This anti-vaccination cult leader singled out Dr. David Gorski, a surgeon and scientist who writes for sciencebasedmedicine.com. I know this guy. I've sat down and broken bread with him. I've read his posts over at SBM. This guy does not lack compassion. More importantly, he is a real doctor. He doesn't promise miracles, and he actually cures cancers (by most conventional definitions). And that requires teamwork. He actually has to be able to work and play well with oncologists, pathologists, radiation oncologists, and the rest of the supporting staff of a modern cancer center. If he can't cure someone, he won't lie to them. Would it be more compassionate for him to lie and then perform unnecessary operations?

That is what the cranks and quacks offer: bad information, bad advice, and bad outcomes. But they wrap it in a veneer of pseudo-compassion, as if that makes it OK.

It's not OK. Real doctors are out there every day preventing and treating disease, and occassionally saving a life. Quacks, at there mildest, offer pipe dreams, at their worst, a clean kill.

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This is why I became interested in woo and those who fling it: the creation of mind-bending distortions of reality and the targeting of the weak for financial gain.Several years ago, while monitoring my financials at noon,I listened to Null's Woo-topia on the radio;he provided answers to two callers. Both subjects were familiar to me: Serious Mental Illness(my background in Psychology) and CHF( my family experience).In both cases he ( of course) simplified the issues, dissuading the use of pharmaceuticals, substituting herbs and vitamins! HAH!!! My father suffered from CHF from the age of 80 on. He took those terrible drugs, saw actual doctors, and lived quite well -thank you- for nearly 10 years.The care he received exemplified compassion, to him and to me.

By Denice Walter (not verified) on 29 May 2008 #permalink

The reason I stepped into the anti-vax quagmire almost two decades ago was because my firstborn child had seizures when he was two days old. They first started out as a shiver, then a few hours later something more definite... and then the seizures came more frequently, stronger and lasted longer. He was transported to a Children's hospital where he was put in the Infant Intensive Care Unit, but then transferred to the Infant Intermediate Care Unit when a low dose of phenobarbital stopped the seizures (he stayed in that hospital for a week, and got IV antibiotics (in case it the cause was a bacterial infection, but the tests were negative), a CatScan and a few EEGs, the result was "unknown etiology").

Because of this history and the era (Barbara Loe Fisher was active!), he did not get vaccinated against pertussis. This was at the time our county was having a pertussis epidemic (oh, and just before over 120 Americans died from measles!). So I was very careful who he came into contact with. So everywhere I took my baby I asked about the vaccine status of the other kids.

I usually got "of course they are vaccinated"... but it was only one mom-baby group (their initials are only one keystroke away from KKK, and they tend to frown on women who cannot breastfeed, even if there is a good medical reason) where I encountered the "we don't have to vaccinate" attitude.

Ugh.

Absolutely no sympathy for his medical issues.

Even on these blogs the folks who berate Orac for lack of compassion will say stupid things like "well healthy children should have no problem with measles, pertussis, Hib, mumps... etc!"

All I can think when I read this is that kids like mine are considered not worth keeping alive! Not only does my oldest have the history of seizures but he has hypertrophic cardiomyopathy with obstruction (he is first in line for an influenza vaccine each fall!... and he did get vaccinated for the first time for pertussis with Tdap at the age of 19).

One of Orac's trolls even laughs at the fact that my kid got seizures after becoming dehydrated due to what may have been a rotavirus infection (it was rivers of diarrhea!).

What kind of compassion is there when they claim the diseases only harm unhealthy children? Where is the compassion for these kids:
http://www.timesonline.co.uk/tol/news/uk/article1055533.ece

Also, if the diseases do not effect truly healthy children who are breastfed, fed only organic food and never stray near a television or video game... how come the teeny tiny amounts of antigens in vaccines are so dangerous?

This bit still sounds quite high-handed (unintentionally, I hope):

Let me tell you what physicians' compassion is: it's listening to a patient, talking to a patient, and formulating a plan for a patient based on science and the doctor's knowledge of the individual.

... and the patient's wishes too, surely? ... and the patient's knowledge of themself? (I've known doctors who haven't quite understood that even though they know huge amounts more than me about bodies in general, I have lived with mine for decades and know some of its quirks better than they do, and that even if I'm wrong, it's still my body!)

That's not an argument for woo, not at all, but I get twitchy whenever it sounds like the patient has a passive role in accepting treatment, rather than being an active partner in caring for themself and selecting among alternatives where appropriate (surgery or medicine, treatment with side effects or tolerate minor problem without treatment, etc.?). And I don't think you want to give the impression that your patients are just subjects.

The abuse of the term "holistic" and "integrative" by the quacks does piss me off intensely: how a one-therapy-cures-all treatment (OK, homeopaths have different strengths of water!) is holistic or integrative I can't see. They're exactly the opposite. Whereas real medicine considers many factors, such as diet and exercise in cancer rates as well as exposure to carcinogens, genetic history, etc.

Yes, denialists and quacks should be given short shrift; the word "liar" is under-used in respect of these evil people.

@Sam C: "... and the patient's wishes too, surely?"

Why? Yes, I take your point that people often know their own bodies, but that surely comes under "the doctor's knowledge of the individual". It's up to the patient to pass on any relevant information they may have to the doctor, but it's up to the doctor to decide how best to treat the patient (except of course in decisions that really are based on wishes, like appropriate end-of-life care, etc).

Sam C said, "...and that even if I'm wrong, it's still my body!"

I think this is the part that many doctors and patients miss. Most patients would probably be better off to just shut up and do what the doctor said, but it is still their right to be in control of what is done to their body. There is no way to practice truly individualized medicine with a 10 minute visit per patient. A doctor may miss something that applies to the patient, but more often, the patient simply can't understand the reasoning behind the treatment. The patient is usually confusing "knowing" their own body with "feelings" about their own body. But, it is still the patient that is ultimately in charge of what is done with their own body.

I am certain a compliant patient is much easier to deal with. They fit better into today's medical model. I am also certain the liability issues are much easier to deal with when the patient makes the decisions rather than the doctor deciding for the patient.

That was sort of my point in the reiki discussion.

As a patient and as a customer, I think that medicine also leaves a door open to quacks when doctors treat patients as a list of symptoms. It is not a coincidence that most "healers" (psychic and the like) make much of the aforementioned terms "holistic" or "integration".

All too often, both patients and doctors forget their respective places. Patients think they can do medicine and doctors think they are not accountable to patients.

Quacks and scammers will never go away, but maybe we could make it a bit harder for them.

The patient is usually confusing "knowing" their own body with "feelings" about their own body.

Yeah, except when they aren't. The last time the doctor didn't listen to me when I said something was wrong and that I knew exactly what was happening, in the first case, I was back in the office again within a week, presenting with a 104F fever and a really bad sinus infection that took six weeks of antibiotics to kick (chronic sinusitis and I just had the procedure to get rid of the Haller cell in my right maxillary sinus, thanks). The time before that, when I said, "I fell the other day and I'm really in a lot of pain, could you check me out, please," and they said, "People with cerebral palsy are often really sore after they fall. Take some Tylenol and come back," I wound up with an impinged shoulder joint because I'd torn the anterior ligament, and spent about four months out of commission. They tend to pay attention to me a little bit more these days.

The truly good physician will know their patients well enough to know, I think, which patients have good instincts and which don't.

By Interrobang (not verified) on 30 May 2008 #permalink

Compassionate liberals tax you out of your money.
Compassionate doctors bill you for procedures not covered by insurance.
Compassionate "holistic" healers dont take insurance, but take your money.

I see a pattern here. Im sure this is a study in the making!

You forgot one Chuck. Compassionate conservatives, who will cut "some" taxes, to look good, then make up the difference by cutting funding for everything from infrastructure maintenance to basic science research, then **still** have to *borrow* money from social security, medical aid programs, etc., so they can pay for their own bullshit projects.

Its like a *business* based hospital, which tries to charge the "patient" for their room, on the grounds that a) its a single room, and b) medical aid doesn't cover that, but isn't honest enough to "tell" the medical aid people that their "are" no shared rooms in their hospital. Its run down, understaffed, under equipped, and "filled" with doctors that are barely competent, and who actually "tried" to have another doctor's license pulled through false allegations, because he promoted the idea that we had gotten big enough as a city that we "needed" a second hospital. More than half the people I know would rather go to the emergency care clinic in town because a) they get faster service, and b) they might get diagnosed right there. Guess whose running the hospital? Yep, conservatives, who are more concerned with how much they can overcharge patients than proper care, sufficient help, working equipment, or, apparently, the fact that some people would rather be air lifted 150 miles to Las Vegas, than set foot in it, even if they where bleeding to death.

Personally, I sometimes wonder if this isn't a perfect example of how the federal government acts with a conservative majority too, given that they seem to be able to spend endless amounts of non-existent money (and borrow it from things that they already claim an inability to fund) on things they like, but other people consider useless and absurd, but can't find the money to maintain things we have had "in place" for 50+ years, which we "know" do something useful. Really odd that...

"given that they seem to be able to spend endless amounts of non-existent money (and borrow it from things that they already claim an inability to fund) on things they like, but other people consider useless and absurd, but can't find the money to maintain things we have had "in place" for 50+ years, which we "know" do something useful."

Well, at least we know that the current liberal democratic majority does this now.