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 Google.com, 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 healthgrades.com, [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
http://www.time.com/time/
Then this NY Times commentary on the Time essay. My comment is #254.
"A doctor's disdain for medical Googlers"
http://well.blogs.nytimes.com/
As a bonus, you can also read this one:
"Time magazine's Scott Haig proves that patients need to be Googlers"
http://thyroid.about.com/b/
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.
I've had my fair share of experience with doctors like that. When i was pregnant and found out the thing they used to try to get me to start dilating was something that could cause contractions so hard it could burst the uterus (not to mention it was a pill that was not made to be used to induce labor). I told them NO and opted for the option that could be removed if contractions got too strong. I googled my information. My doctor was mad I didn't go with his recommendation and insists if I'd just went with what he wanted, I wouldn't have ended in c-section. I don't care about a c-section, I do care if my uterus was to burst and kill both my daughter and I, though.
ReplyDeleteRecently my daughters pediatrician told me that not only was her vision perfect from the test they did but she can't see an eye doctor without a referral. We went anyway to find that her vision was actually pretty bad and if I hadn't gotten her in sooner she might have formed a lazy eye.
I have my fair share of doctor stories to drive me up the darn wall. When they're paid in some form to see us and determine what might be wrong, I don't think we deserve to be kept in the dark about what is going on. Reading this gave me the impression that this man is a 'brainsucker' to his patients. No degree gives him the right to belittle anyone for being informed, it's our right.
Angel, thanks for sharing your stories.
ReplyDelete"No degree gives him the right to belittle anyone for being informed" -- very well put.
Here's the text of the NYTimes story:
ReplyDeleteCan a patient ever show up at the doctor’s office with too much information?
A doctor’s essay about medical “Googlers” — patients who research their symptoms, illness and doctors on the Web before seeking treatment — suggests they can. The report, which appeared in Time magazine, was written by Dr. Scott Haig, an assistant clinical professor of orthopedic surgery at Columbia University College of Physicians and Surgeons. He begins with a description of a patient he calls Susan, who seems to be clicking on a keyboard as she speaks to him on the phone. “I knew she was Googling me,” he writes.
Dr. Haig’s disdain for her information-seeking ways becomes quickly evident. He describes the woman’s child, whom she brings to the office, as “a little monster” and notes that the woman soon “launched into me with a barrage of excruciatingly well-informed questions.” Every doctor knows patients like this, he writes, calling them “brainsuckers.”
Susan had chosen me because she had researched my education, read a paper I had written, determined my university affiliation and knew where I lived. It was a little too much — as if she knew how stinky and snorey I was last Sunday morning. Yes, she was simply researching important aspects of her own health care. Yes, who your surgeon is certainly affects what your surgeon does. But I was unnerved by how she brandished her information, too personal and just too rude on our first meeting.
The problem, Dr. Haig notes, is that patients can have too much information and often don’t have the expertise to make sense of it. “There’s so much information (as well as misinformation) in medicine — and, yes, a lot of it can be Googled — that one major responsibility of an expert is to know what to ignore,” Dr. Haig writes.
Dr. Haig’s essay, however, has riled patient advocates, who believe patients need to arm themselves with information and take charge of their own medical care. Mary Shomon, who runs a popular thyroid disease blog on About.com, recently highlighted the essay on her site, generating angry responses from readers. Ms. Shomon said she thinks many physicians like Dr. Haig are threatened by patients who use Google and other Internet resources to research their own health questions.
“By condemning Googlers, he made it clear that he’s threatened by empowered, educated and assertive patients who do their own research,” said Ms. Shomon. “He can’t handle a patient who talks and doesn’t just listen. Good patients…are seen and not heard, right?”
Dr. Haig concludes his essay by confessing that he decided not to treat the woman, whom he described as “the queen of all Googlers.”
I couldn’t even get a word in edgewise. So, I cut her off. I punted. I told her there was nothing I could do differently than her last three orthopedists, but I could refer her to another who might be able to help.
Here's the text of Scott Haig's article, "When the Patient is a Google," Time magazine, Nov. 8, 2007
ReplyDeleteWe had never met, but as we talked on the phone I knew she was Googling me. The way she drew out her conjunctions, just a little, that was the tip off — stalling for time as new pages loaded. It was barely audible, but the soft click-click of the keyboard in the background confirmed it. Oh, well, it's the information age. Normally, she'd have to go through my staff first, but I gave her an appointment.
Susan was well spoken and in good shape, an attractive woman in her mid-40s. She had brought her three-year-old to my office, but was ignoring the little monster as he ripped up magazines, threw fish crackers and Cheerios, and stomped them into my rug. I tried to ignore him too, which was hard as he dribbled chocolate milk from his sippy cup all over my upholstered chairs. Eventually his screeching made conversation impossible.
"This is not an acceptable form of behavior, not acceptable at all," was Susan's excruciatingly well-enunciated and perfunctory response to Junior's screaming. The toddler's defiant delight signaled that he understood just enough to ignore her back. Meanwhile, Mom launched into me with a barrage of excruciatingly well-informed questions. I soon felt like throwing Cheerios at her too.
Susan had chosen me because she had researched my education, read a paper I had written, determined my university affiliation and knew where I lived. It was a little too much — as if she knew how stinky and snorey I was last Sunday morning. Yes, she was simply researching important aspects of her own health care. Yes, who your surgeon is certainly affects what your surgeon does. But I was unnerved by how she brandished her information, too personal and just too rude on our first meeting.
Every doctor knows patients like this. They're called "brainsuckers." By the time they come in, they've visited many other docs already — somehow unable to stick with any of them. They have many complaints, which rarely translate to hard findings on any objective tests. They talk a lot. I often wonder, while waiting for them to pause, if there are patients like this in poor, war-torn countries where the need for doctors is more dire.
Susan got me thinking about patients. Nurses are my favorites — they know our language and they're used to putting their trust in doctors. And they laugh at my jokes. But engineers, as a class, are possibly the best patients. They're logical and they're accustomed to the concept of consultation — they're interested in how the doctor thinks about their problem. They know how to use experts. If your orthopedist thinks about arthritis, for instance, in terms of friction between roughened joint surfaces, you should try to think about it, generally, in the same way. There is little use coming to him or her for help if you insist your arthritis is due to an imbalance between yin and yang, an interruption of some imaginary force field or a dietary deficiency of molybdenum. There's so much information (as well as misinformation) in medicine — and, yes, a lot of it can be Googled — that one major responsibility of an expert is to know what to ignore.