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    Why Doctors Don’t Listen

    May 22, 2008 by Brandy Vencel

    When I was fairly young {we’re not quite sure how old}, I contracted Lyme Disease. It took many years, however, to get a diagnosis. In fact, I was even told that I needed counseling because I was probably imagining all or some of the problem. Why the diagnostic delay? Two major reasons: {1} “We don’t have Lyme Disease here.” This is perhaps the most closed-minded response possible. Because our area wasn’t considered to be a place where catching Lyme was possible, the doctors ruled it out.

    Our area ended up being a pocket, by the way, meaning many people {including a fellow dancer at my ballet studio} ended up being diagnosed once it was admitted that maybe, just maybe, Lyme was actually the problem.

    {2} I didn’t have a positive blood test, nor did I have the bull’s-eye rash.

    This second reason is what caused years of delay in my diagnosis, and resulted in me spending a little over a decade of my childhood battling illness.

    But this post isn’t about me. It’s actually about why, according to Neil Postman, the stethoscope is to blame for reason number two, and the general problem of doctors not actually listening to their patients.

    The stethoscope was, according to Postman, medicine’s first diagnostic instrument. Postman details what led to the stethoscope’s invention. I won’t go into the details, but I assure you that it was a perfectly reasonable improvisation in an unusual situation.

    However, for the first time in the history of doctoring, an instrument came between doctor and patient. Postman explains that, before this

    the traditional methods [were] questioning patients, taking their reports seriously, and making careful observations of exterior symptoms.

    Relying on the patient’s firsthand report of what they experienced was the essence of doctoring before the introduction of instruments.

    The stethoscope, obviously, was only the beginning. With each tool came a reinforcement of the new ideas involved in doctoring. Postman writes:

    …two of the key ideas promoted by the stethoscope: Medicine is about disease, not the patient. And, what the patient knows is untrustworthy; what the machine knows is reliable.

    Of course, Postman doesn’t place the blame entirely on the physicians. He explains that, with more technologies available, patients are expecting their doctors to use it. And not utilizing all available tests leaves these doctors open to malpractice or neglect lawsuits.

    So the patients are also placing the instruments between themselves and their doctors. Technology, rather than acting as a tool, has become a barrier dividing patient from doctor, person from person.

    Here are a few of the outcomes I see:

    1. The patient can now be told that they are imagining their problem. Though I know that there really are some folks out there that imagine their sicknesses or discomfort, the root of the idea of imagining your own illness is that technology is the authority. If a test cannot prove you are sick, you must be well. End of conversation.
    2. Doctors do not need to know their patients. Technology becomes the substitute for real relationship, when once the relationship was the foundation of almost all good doctoring. When I talk about mommies-as-medical-detectives, coupled with a bit of distrust of doctors, this is the real reason why. Doctors are overloaded with technology. Most of them do not know how to observe their patients. Many do not listen to mothers’ observations {talk to the mother of an autistic child someday if you doubt me}. Observation and relationship now must submit themselves to a technology that functions as a deity.
    3. Doctors themselves are stunted in their souls. This doesn’t go for all doctors, obviously. But think of the worldview embedded in medical schools these days. Technology, technique, and Science reign supreme. Future doctors spend hours every day for many years focusing on such a small part of what will bring about actual health to their patients that, if they are not deliberate, their souls will become small as well.
    4. Patients do not know themselves, do not trust their instincts, and do not recognize symptoms in their own bodies. The dependency on technology has replaced self-awareness. The patient has become uncertain. He now depends on an expert and a machine to tell him if something is wrong. It’s not that technology is bad in and of itself, but technology didn’t just fracture the patient’s relationship with the doctor. It also fractured his relationship with himself, and his ability to guess at root causes.

    I could go on, but I won’t. I have, over the years, found good doctors. I hope that my readers have as well. The doctor who eventually diagnosed my Lyme Disease explained to me that Lyme can hide in the tissues, therefore hiding from the diagnostic tests which were available. He chose to treat me based on what I told him, coupled with his observations of me during his examination.

    Old fashioned doctoring saved my life, you see.

    Later, during treatment, I ended up with a very positive test, and my doctor, who was thought a crackpot by other doctors if I ventured to tell them what he was doing, was vindicated.

    A good doctor is a whole person. I also find it reassuring being able to find some background information about the doctor who is treating me, I came across this website: drtrungquach.com that has been created to provide his patients with an idea of who he actually is. Technology is his tool, not his god. Relationship is central to his success. Health, not defeat of a specific disease, is his goal. Doctors like this are few and far between. If you have found one, be grateful. If not, approach the doctor with care. If he blindly bows down to Technology, your very life may be at risk. Thankfully, doctors are now using an electronical health records software to manage ehr facts of each patient. So, if you were to change doctors or had a medical emergency, all doctors will be able to access your ehr file to ensure you are treated correctly.

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    3 Comments

  • Reply Brandy May 23, 2008 at 3:09 pm

    Rahime,

    I know a good Lyme doctor if you want to try him. 🙂 My original doctor retired, but I recently heard that he passed his existing patients on to a pediatrician who has since become an expert in his own right! He’s in the Tarzana area…

    Kris,

    I can’t imagine how scary that was for your friends! To think that their son’s life was in incompetent hands. I was reading that this is one of the reasons we should require a liberal arts education. Acquiring those broad thinking skills doesn’t just make for a free (liberated) people, but also improves the capacity of our specialists.

  • Reply Kristina May 22, 2008 at 8:10 pm

    On a related note, when our good friends discovered that their infant son had extreme medical issues, they were disappointed (to put it mildly) in the lack of reasoning skills in the doctors. The child’s father, a philosopher, recognized that while the doctors had the medical facts, they lacked the logical skills to make correct inferences based on those facts. This meant Daddy had to play a much bigger role in their son’s diagnosis than he had expected–than he should have had to. Frustrating! “It ain’t fittin’! It ain’t fittin’!”

  • Reply Rahime May 22, 2008 at 7:20 pm

    I thought of you when I read that section of Technopoly.

    I’m still on a search (albeit a passive one) for an old-fashioned doctor who is open to relying on his brain, instinct, and patient more than his technology. I am convinced they are an endangered species.

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