Friday, June 20, 2014

Making Your Doctor Feel Bad

If your physician announced that an evil spirit had taken up residence in your liver, you might object. If he asked you to lie on the floor surrounded by a ring of tongue depressors while he and his office staff demanded that the spirit go away, your confidence in his ability would drop still lower. Yet many cultures consider this the sensible way to treat illness.

If a prescription gave you diarrhea, you would complain. But until well into the twentieth century, people looked on a good “purge” as an excellent way to expel toxins. Physicians took pride in their cathartics, and when patients discussed a doctor’s skill, they gave high marks for the violence of his purges.

People who consult a doctor expect him to behave in certain ways. 21st century Americans frown on exorcism or purges, but this is not a mark of superiority because we seem to expect medicine. It should be one only a doctor can prescribe; over-the-counter drugs don’t count. Pills are good; an injection works better.

Most of you will deny expecting medicine whenever you see a doctor. You want help. If you’ll get well without medicine, you won’t be upset… I often encounter such sensible patients, but the other sort turns up regularly. I’m slower to prescribe than most, so I have many opportunities to see disappointment in patients’ eyes when they realize I don’t plan to “give them something.” This makes me feel bad.

Doctors genuinely want to help you, and it depresses us when we can’t. We also feel bad when we’ve done our best, and you don’t feel “helped.” So we often add a prescription to convince you we’re doing what a proper doctor should do.

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