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Some years ago, I went to see a dermatologist for a minor condition, a wee rash on my arm that would occasionally itch. I had to get a referral—a detail I add to emphasise the theatre of present-day medical systems, and the runaround one is put through for the simplest of situations. We are dealing with “the best and brightest,” after all, so it makes sense that us intellectual plebs should be spun around, bllindfolded and guided through a game of pin the tail on the donkey.
It was a challenge to find parking near the clinic, but I did manage to grab a spot and pay for two hours, which I knew would be more than enough time for my visit.
I arrive, and present myself to a surly receptionist, who hands me an intake form. The waiting room wasn’t packed. But it was a large room filled exclusively with women, reading magazines. (Yes. This was before smartphones had gobbled everyone’s attention.)
So I’m waiting, and waiting, and waiting and waiting, and I realise this guy has us all booked at the same hour. Now it’s coming up to the end of hour two, and I’m thinking, Crap, I have to go out and feed that meter. So I approach the lovely personality behind the reception desk and explain my situation, then run out, feed the meter, and rush back to discover that I haven’t missed a beat. I still had another forty-minute wait.
It is not insignificant to point out that the specimen of the Best & Brightest I was waiting to behold was deemed better and brighter than the rest—that is, according to a reputation that was handed down to me from more than one source. I mention this item because you’ve probably heard the same about the various white coats to whom you’ve been referred. My mother’s knee surgeon, for instance, is one of these fellas who never admitted to a mistake, so his reputation is stellar. In her case, the operation was a success, but the patient never walked again. When another MD suggested that the operation was botched, he flew into a rage. Those following A Midwestern Doctor on Substack may be aware of how these undeserved reputations are engineered. I won’t digress other than to point out that it has nothing to do with patient outcomes. In short, how Dr. Betterthan acquired his reputation as better than your average best and brightest has more to do with self promotion and skullduggery than competence.
I’m lead to a room and instructed to sit on a convincing exam table, so my feet are left dangling like I’m a kid. And there I wait another twenty minutes swinging my legs. So I’ve been there for three hours by the time I am finally granted an audience with one of the greatest geniuses in the city (if not in the northern hemisphere). He offers no apology for the wait. As he reviews papers on a clipboard, I make a joke about how it’s like the warranty has run out on my body. Dr. Betterthan informs me that the warranty ran out when I was born. This was oneupmanship, not humour.
He looks at the few minor skin eruptions and tells me it’s too small to tell what it is. He informs me that according to the statistical probabilities, however, it’s either psoriasis or eczema. So he scribbles out a script and says, “Here. Use this cream for a few weeks and hopefully it’ll get worse.” For real. I kid you not: “hopefully it’ll get worse.” I can see why he had such a stellar reputation. The cleverness of the approach was as over my head as his humour. I mean the guy barely looked at me and had zero questions about diet or anything else health related. Clearly, he didn’t need to look at the patient owing to his knowledge of the stats. I said, “Thanks doc.” And walked out quacking and tearing up the script on my way to the door.
It is further worth mentioning that after all the waiting I did, he spent no more than five minutes with me. Since he’s paid by the patient, this too is an item of pure genius: book as many in the same hour as possible and run ‘em through like chickens in the slaughterhouse.
I relate this anecdote because it’s not an unusual sort of tale. In fact, everyone I know has had a comparable experience. . . though plenty of folks wouldn’t have noticed anything especially wrong with what went down. Their feet dangling in front of a stuffed lab coat would have been convincing enough to elicit awe and compliance.
For those paying attention, however, Dr. Betterthan had bent a few essential elements of medical ethics: namely, the notions of Do no harm, and Treat the whole human being (not just a localised symptom). There are other contributing factors than statistics. No doubt, specialisation lends itself to looking at a skin eruption or a bum knee without reference to the person presenting. Specialisation itself, however, comes as a package deal with stats and probabilities.
I can’t emphasise enough that viewing health as a matter of stats is dehumanising. It has its place in analyses of all kinds, and it can be helpful with diagnosis, but in the end, a patient is an individual requiring some personal attention. In my case, for instance, I needed a change in diet. I switched to an alkaline regimen and the problem disappeared. The stats and even the categories of skin conditions were part of a paradigm that obscured the phenomenon.
Regular readers may recall that the Hippocratic Oath is out of fashion and the new oaths omit the principle of Do no harm, since the cornerstone of pharmaceuticals is Some harm comes with the territory of side effects, therefore a statistically acceptable amount of harm and death is A-okay. The most popular, modern version of the oath does, however, retain the notion of treating people rather than symptoms:
I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person's family and economic stability. My responsibility includes these related problems, if I am to care adequately for the sick.
This quotation is from the oath composed in 1964 by Louis Lasagna, then Academic Dean of the School of Medicine at Tufts University. I have this information from Peter Paul Rubens, in an article called, “The Oath: Meaningless Relic or Invaluable Moral Guide?” Significantly, Rubens tells us that “some doctors see oath-taking as little more than a pro-forma ritual with little value beyond that of upholding tradition.” Moreover, “fewer than half of oaths taken today insist the taker be held accountable for keeping the pledge.”
So the better part of present-day medical practice is all razzle dazzle and sleight of hand. The patient is viewed as a package of stats and probabilities that allow an MD to run his finger down a chart that informs him which pharma product to prescribe in under five minutes. Essentially, we’re not seeing doctors anymore, we’re seeing pharma reps. Most of what’s going on could be handled by pharmacists. As for the surgeries these days, I recommend you read “The Forgotten Art of Surgery” by A Midwestern Doctor, here on Substack. Robots are doing the work, cauterising scalpels are being used, and patient outcomes aren’t really a la mode. It’s all about doctor success, and the stats are looking mighty healthy.
Asa Boxer’s poetry has garnered several prizes and is included in various anthologies around the world. His books are The Mechanical Bird (Signal, 2007), Skullduggery (Signal, 2011), Friar Biard’s Primer to the New World (Frog Hollow Press, 2013), Etymologies (Anstruther Press, 2016), Field Notes from the Undead (Interludes Press, 2018) and The Narrow Cabinet: A Zombie Chronicle (Guernica, 2022). Boxer is also the founder and editor of analogy magazine.
Recently i had cause to go for a 'medical check-up' at the local hospital -
first interaction with the Big Medicine in seven years... Very quickly i was
x-rayed, had blood pressure and blood taken, then a four hour wait to
learn "one more test, just to make sure." It was recommended i get myself
a personal doctor... So i went to one. That doctor spent a good ten minutes
studying the A4 page report of 'results' of the tests taken at the hospital...
Then asked that i submit to another blood test, next day, as there was
something in the report that was unclear. (I gave more blood, but bothered
not to find out the results, as i expected the same that had happened seven
years before, when, sure enough, reason then was found for me to take
some prescribed, guaranteed side-effects, drugs).
On the rare occasions i'd ever gone to a medical doctor, always there was the
required "Lift your shirt so i can check your heart and lungs.". This medical doctor
did neither, didnt lay a hand on me... I didnt feel cheated. But I've wondered why
the doctor didnt think it necessary to confirm for herself what was written on the
report... Was it Fear of Contagion ? Or automatic acceptance of the authority
behind the report ? Was it she was used to "Look ! No Hands !" tele-consultations ?
puzzling !!
"I relate this anecdote because it's not an unusual sort of tale." You're right about that, dear Asa. The health care system is getting worse, not better, and apparently by design. Where does that leave us? Do we all need to get some medical training and learn to manage our own health care? You did something like that with respect to curing your arm rash. I recently got a nasty leg injury that required daily disinfection and dressing changes, but because I had to spend over an hour every day on the phone trying to find a medical clinic that wasn't booked up, I decided to learn how to treat it on my own. Given that the condition of our health care system looks terminal, I wonder if the best a person can do is try to minimize the risk of having to see a doctor by eating healthy, exercising regularly, and studying medical books a little every day.