Wednesday, February 27, 2013

Why doctors fail us

I considered more inflammatory headlines for this post, such as "Why are so many doctors complete jerks?" or "Why Your Doctor Is Such an Insensitive Jerk" but these headlines were already taken.  These pages make excellent points, including how doctors' employers don't allot much time with each patient.  But most of the web commentary does not focus on what I consider to be the real culprit.

I have always been annoyed by doctors, with few exceptions.  It's mostly a basic respect/control issue.  My stereotypical visit to the doctor goes like this:

ME: Hi doctor, I have this health issue.
DOC:  [A few questions]
ME:  [A few answers]
DOC:  You need treatment X.
ME: What if I need treatment Y?
DOC:  OK/Maybe/Not sure; regardless, you need treatment X.  Do it.

It is easy for such irritable bossiness to seem normal and OK, because we've become accustomed to it.  And it's also easy to take the doctor's side on this; the doctor is the expert, after all, so they probably know what's best.  Indeed, I typically take my doctors' advice.

However, I still find it odd that doctors get away with ordering patients around, given that the patient is the paying client.  In most any other area of the economy, the paying client gets to be the boss.  If you are obese and you walk into a restaurant and order a cheeseburger, but the waiter responds "we only serve salads to people like you," you would be understandably upset.  Even though such a rule could be intended for your benefit, the psychological cost is substantial.

Yesterday I spent a couple hours in a room full of people that had been traumatized by doctors and were looking for a better option.  The venue was a tour of a midwife center, a special place where for humans to have babies.  The special thing about a midwife center it that it is run primarily by midwives instead of doctors.  A woman without complications can make it into an out of the hospital without ever having to tolerate the bossiness or insensitivity of a doctor.

At a midwife center, a woman gets to choose how to give birth.  For example, a woman is relatively free to walk around and take a shower while she is in labor instead of being constrained to a bed with lots of IV's and monitoring devices.  Similarly, if a midwife deems that a mother may benefit from some non-emergency intervention, the mother is consulted thoroughly and essentially asked whether she would like to have the intervention done.

There is something to be said for liberty, for its intrinsic ability to promote happiness.  I suspect that the problem with doctors, at the root, is not that they are bad people, but that there are not enough of them to go round.  And the reasons for this are many, including extremely high barriers to entry (many years of medical school and a mountain of debt) and, in general, a legally restrictive working environment.


Anonymous sk said...

And make Part Two "Why Health Care Costs What It Does." First read Steven Brill's report in the March 4 issue of Time. Go buy the magazine. Get your socks knocked off.

12:50 PM  
Anonymous sk said...

P.S. Aren't you sly.

1:25 PM  
Anonymous Anonymous said...

Although I love you using the MW center as an example to prove your point, I think it doesn't quite do so. One reason is because childbirth is not a "medical problem" until things go wrong. The 2nd reason: in the US, if you opt for a non-hospital birth you have no access to certain emergency measures and certain medications. This is unlike many countries where there is a middle-ground where you can have no Dr. involved unless it is required. In many countries there are birth clinics that are much like a US birth center except there are is an anesthetist and OB actually on duty. Unfortunately at MW centers in the US the only option if something goes wrong is to rush the woman to the ER at a hospital. For many women this is too much risk to take. If only there were a better middle ground for having babies in US (and Pgh).

11:48 AM  

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