Three More Great Sins of the Medical Profession

 4. Doctors order too many tests and prescribe too many drugs.

Correct. We love tests, but so you. Most patients with a painful injury assume they need an X-ray, but they don’t.  Those with a high fever (“flu”), sore throat (“tonsillitis”), cough (“bronchitis”), or stuffiness (“sinus infection”) assume they need an antibiotic, but they usually don’t. Doctors hate to disappoint patients, so they lean over backwards to “do” something like order a test or prescribe.

 5. Doctors order too few tests and prescribe too few drugs.

We can’t win.  Some clinic directors and insurance plans restrict the tests and drugs we can order. This infuriates doctors as well as patients, but the sad fact is that experts set up guidelines to discourage useless tests and wrong or unnecessarily expensive drugs. They sometimes work.

6.  Doctors ignore alternative and folk medical practices.

I notice enthusiasts treat folk medicine with respect, but no one advocates folk dentistry...  It turns out that many alternative practices work but less dramatically than advocates claim.  Acupuncture definitely relieves pain. Unfortunately, its action is unpredictable and not always complete. Despite vivid reports, Chinese surgeons rarely use it for anesthesia. Chiropractic manipulation relieves some backaches for a limited time.

Three Great Sins of the Medical Profession

Critics regularly denounce us for certain practices. These denunciations are more or less correct, but they miss the point.  Examples -

1. Doctors give treatments that relieve symptoms but don’t cure the underlying problem.

Right, but sometimes this is the best we can do. The cure for severe menstrual cramps is menopause, hysterectomy, or pregnancy. Drugs only relieve the pain, but patients appreciate it. No doctor cures migraine, asthma, emphysema, osteoporosis, or the flu, but we relieve a great deal of misery.

2. Doctors don’t pay much attention to diet, liquid intake, rest, and other natural treatments.

We don’t, and it’s the right thing to do.  Diet, rest, etc. help prevent disease but don’t do much once you get sick... A perfect example were tuberculosis sanitariums, the oldest government supported medical program. They began appearing in the nineteenth century. Patients received nutritious food and plenty of rest in a healthy, rural environment. They were discharged (sometime after years) when their TB became inactive. No one was cured, and many relapsed. When drugs appeared after 1945 sanitariums closed. Nowadays doctors encourage TB patients to adopt a healthy life-style, but they’ll get better if they don’t – provided they take their drugs.

3. Doctors spend too little time explaining how to relieve stress.

Perhaps....  Stress makes everything worse but doesn’t cause anything. Seeing a doctor for stress results from what I call the “medicalization of society” - the notion that life’s difficulties (a hateful job, unsatisfying sex life, shyness) represent a medical problem. There’s no harm in this; a good doctor can listen sympathetically and make sensible suggestions which require no medical training.

More Guests I Didn't Help

A travel insurer asked me to see nine sick hotel guests. My first thought was food poisoning, but their symptoms turned out to be coughing and sore throat.

I love multiple visits at the same hotel, but I wouldn’t love these. I visualized the scenario: a large group arrives for an expensive vacation where many fall ill, and in America you need a prescription for an antibiotic. Luckily, they tell themselves, we have travel insurance. The doctor will come and give us our Amoxicillin, and we’ll be fine.

My philosophy on antibiotics is that I prescribe them if they’ll help, and I don’t prescribe them if they won’t. This puts me at odds with doctors around the world not excluding the US.

When I see victims of a respiratory infections (fifteen percent of a family doctor’s business) I do my best. Almost all seem satisfied, but a few make it clear that I have failed them.

Luckily, there was a nearby walk-in clinic where these guests would get their antibiotics.

A Guest I Didn't Help

A flight attendant at the Airport Holiday Inn was suffering an allergy attack. She couldn’t fly because of the congestion, and her airline required a doctor’s exam and note. This is a common request which I fulfill regularly, but I couldn’t fulfill hers because she was American.

When a British Air, Virgin-Atlantic, Emirate, Singapore, or Cathay-Pacific crew member falls ill, the local supervisor calls a national housecall service who calls me, and the airline pays. US airlines never do this. Their employees are on their own in a strange city with no transportation and their American insurance which is deeply suspicious of housecalls. 

I occasionally make a charity visit to an American flight attendant too sick to leave the room but not sick enough for the paramedics. Mostly I refer them to an urgent care clinic.