Saturday, October 18, 2008

Unreasonable patient, or cranky doctor?

About a year ago, I posted a comment on a NY Times blog, in reference to a flurry of dispute about a doctor's column in Time magazine that had just appeared.

A couple of weeks ago, a friend of mine suffered an injury in a bike accident and has been struggling to get reasonable diagnosis and treatment since. When she told me about how she feels she's been learning more about her case from the Internet than some of the professionals she's been talking to seem to know, I remembered the exchange from last November.

Rereading my comment, I thought it might be good to bring it out of mothballs and put it out here in the fresh air. A set of links to the articles in question follow my comment. A few remarks also follow.

I made a couple of changes to my original comment, They appear in square brackets.

Dr. Haig reveals himself to be sexist, stereotyping, narrow-minded and dishonest. “Susan” was better off crossing him off her list, even if if he hadn’t lied about his ability to treat her. In fact, my greatest criticism of her would be that, despite all the research she’d done, she[ gave ]him a visit.

Here’s what Dr. Haig says he believes:

- Patients who ask too many questions are “brainsuckers.”

- (Some?) patients who ask no questions are “Bozos.”

- Nurses are good patients because they trust him and laugh at his jokes. (My guess: they’re skilled at sucking up to arrogant doctors like Haig.)

- Engineers are good patients because they don’t challenge the narrow paradigm of, for instance, a mechanistically minded orthopedist who is proud of “know[ing] what to ignore” — like the possible contribution of dietary mineral deficiency to joint pain. (That’s one of Haig’s examples of Stupid Questions Engineers Don’t Ask.)

Maybe Haig described “Susan” and her manner fairly accurately. But maybe he was way, way off.

Here are some things I wonder.

- Why does he even mention the fact that Susan is, to his mind, “attractive”?

- Why assume “Susan” did all her research via, or the Internet, for that matter? For all we know, she went to the library and hit books.

- Why assume “Susan” knew his street address? She mentioned a highway exit that she assumed to be on his route home. For all we know, she only knows his home’s neighborhood, or town, or even simply its general direction from his Scarsdale office.

- Is it possible that “Susan” can’t afford childcare? For instance, her household income might be — like ours — too much for state-subsidized daycare, but not enough for nannies or preschool or even the occasional babysitter. She needs to see doctors. Where can the child go during her appointments? The lobby?

- Did he exaggerate the child’s misbehavior? For example, did he really investigate and confirm that “Junior”’s sippy cup contained chocolate milk? Is it possible that he just guessed something dark and stainy for rhetorical purposes? And that the cup contained, maybe, water?

- “…ripped up my magazines…” I wonder if the child was paging through some magazines (possibly already tattered and older than the child himself), and tore a page or two, through youthful clumsiness.

- I wonder if the child might have spilled a couple of crackers or Cheerios, and (with a three-year-old’s level of dexterity), accidentally stepped on one or two while trying to pick them up?

- The child was “screeching”? Maybe. We have only Dr. Haig’s questionable account. Regardless, what parenting technique would he have preferred to her reasonably toned admonitions? Shouting? Swearing? Threatening? Spanking? I have news for Dr. Haig. When an active, curious, high-energy three-year-old is on a tear, nothing short of a tranquilizer dart can quiet him or her down.

Any parent of such a child who’s had to wait with them in a tiny space filled with dangerous, fragile items — like a doctor’s office, cooped up 45 minutes waiting for a 5-minute doctor’s appointment, as I’ve done — can tell you how difficult a situation it is. I wonder how long “Susan” and child waited for Dr. Haig.

- Haig complains he couldn’t get a word in edgewise. I wonder. Maybe he’s one of those doctors who doesn’t let you finish your question before charging off with a long, not-quite-pertinent response. In those situations, the you have two options: let the appointment time slip away until the doctor rushes off, leaving your questions unanswered and your symptoms incompletely described, or interrupt — at the risk of being described like “Susan”.

- Finally, I wonder how accurate was his diagnosis. In his essay, Haig tells us he lets his mind wander while “brainsuckers” ramble. At the online directory, [individual doctors are rated on a variety of points. For Dr. Haig,] the “Average User Response” to the question “Does the physician listen to you and answer your questions?” is listed as “2 / 5 (Mostly not).”

— VesnaVK

"When the patient is a Googler" by Scott Haig,8599,1681838,00.html?imw=Y

Then this NY Times commentary on the Time essay. My comment is #254.
"A doctor's disdain for medical Googlers"

As a bonus, you can also read this one:
"Time magazine's Scott Haig proves that patients need to be Googlers"

By the way, I don't think there's anything deficient in using only the Internet for that kind of research. I don't even think there's anything inferior about using Google as one's only search tool. I just was annoyed that this Haig guy was so certain that he knew that's what "Susan" had done. Also that so many people assumed he was correct.

What annoyed me most, I think, was that nearly everyone took his description of the woman and her child at face value: the woman was rude and/or a kook; the child was a brat. Hardly anyone doubted it, no matter what they thought of the rest of what he was saying. Maybe that shows how much authority people give doctors, even as they're disagreeing with them? Or maybe it shows how much authority people give whatever they see published. And this guy gets a column in Time magazine!

Other commenters made huge leaps to things that weren't even implied by what the doc said in the article. One MD said confidently that the woman was a "somatizer," someone who is obsessed with their body and invents or imagines all kinds of symptoms. There's nothing in the article to point to that. Not even jerky Dr. Haig said anything like that. Haig said he knew what her problem was and how to treat it. Haig implied that she was visiting a lot of doctors for that problem, but not that she went to a lot of doctors for a lot of problems.