Usually not a day goes by where I do not see a Facebook post or directly hear (Facebook is my primary form of communication) comments on anti-vaccination, both for and against, as well as homebirths, dieting, diet supplements, extraordinarily rare diseases and proof positive testimonials about how somebody’s grandmother cured them of incurable cancer with some Dr. Jeckle worthy concoction cooked up in her kitchen.
So I decided to try to explain this popular acceptance and even preference using my knowledge of human behavior and patient care experience.
One of the biggest problems in medicine today is the concept of “the ivory tower.” In the industry we sarcastically use this phrase to describe a tertiary care facility filled with the greatest minds and the latest technology. But I think it quite accurately describes all of medicine as the general public (aka patients) perceives it.
From the perspective of my experience in US Emergency Medical Service (EMS), the paramedic is the only healthcare provider left that actually sees people in their native environment. While some doctors still do house calls, and home health nurses may rightfully claim some experience, only the paramedic will be there at 0’dark 30 on the average night and the only provider who will show up without prior planning and approval.
In most modern nations, from the US, to Britain, and even Poland (anyone doubting if Poland is a first world nation should come and visit and I will put that debate to rest) the healthcare systems accidentally place the EMS provider in the position of being the most accessible. It is easy to contact EMS, they usually come within the hour, and it is a medical opinion without “bothering”, waiting for, or the cost of a doctor.
In modern times, most “emergencies” are exacerbations of chronic disease or an acute on chronic condition. But how does this examination of EMS relate to “alternative” medicine?
As medical systems evolved, they got so complex that they are not understandable by people outside the system. People are faced with an insurmountable choice of who to call, where to go, and when. One of the most common questions I heard as a firefighter and paramedic was “Do I need to go and see a doctor?” Closely followed by “Do I really need to go to the emergency room?” I even have 1st hand stories of people coming to the station, stating they are not going to the hospital because they cannot afford it or have no way home, and could I please do what I could.
On the list of most trusted professions, doctors and nurses have fallen out of favor compared to their pre-hospital counterparts. While everything from industry conspiracy theories, poor treatment by healthcare providers, and numerous other theories attempt to explain this, if we just use the theory of Occam’s razor, from the time we are little kids we are told: “Don’t talk to strangers”. Certainly don’t get into their car, go to their house, etc.
Our Ivory towers have made us strangers.
Furthermore, our behavior and lifestyle puts us absolutely out of touch with our patients. Let’s face it, we speak our own language. Whether I am talking to a doctor from Russia, Japan, Poland, France, The UK, Nigeria, Kosovo, or anywhere else that has a different language, we can exchange meaningful information about patients in the language of medicine.
How do you feel when people are speaking a language you do not understand in front of you?
At best unintentionally left out and at worst purposefully excluded. What’s more, unlike people speaking in a different language around you, medical providers are definitely talking about you!
Aside from language, we fail to communicate in other forms. Our body language and tone of speech often conveys we do not really have time for patients or a desire to speak with certain ones. From both our familiarity of the system we see things like the patient sitting in the waiting room for 14 hours wondering how bad they were while we dismissed them as trivial in the first 10 seconds we talked to them to not knowing that after we draw your blood, it will take at least 45 minutes to even get results, perhaps longer to get around to them, and even longer to see other people more urgent before we get back to you.
Moreover, we also have cultural exclusions. Many healthcare providers are not first generation college graduates or if they are, they have been away from “the normal people” for so long; they forgot what “normal people” know and don’t, what their concerns, and fears are. What they need from medicine, and in the worst case, belittle or negatively judge them for their lifestyle treating them accordingly. We don’t live in their communities; we don’t associate with them outside of work. We fail to understand what they want and need.
As if that wasn’t enough, we go one further. Medicine and science are so advanced that the average person simply cannot understand it. We (at least I hope most of us) do understand at least enough to know when to refer somebody to another provider. Once we reach the level of “doctor” we understand a considerable bit of it. After all, we have spent nearly an equal amount studying just medicine as other have total education in all their lives! Oh, and we also work with it too. Nothing drives patients crazier when they pay to see a doctor and they have a problem so simple, that it really looks like we did nothing and didn’t even give them enough time to finish their story, much less address their concerns. In their eyes they paid us a lot for nothing!
We are worse than strangers, we are the arrogant witches and warlocks in the tower where you only go when everything else fails and there are no other options.
All of this together creates a disconnect between people and medicine and like all things, where there is emptiness in life, something will fill the void. In the case of medicine, this void is filled by people who are less knowledgeable, more sure of themselves, (it seems the more you learn the less certain things become) and offer a definitive solution to the problems plaguing people.
From blogs and non-peer reviewed publications on the internet, to print, TV commercials, and even at the mall, these charlatans are readily available to people. For free. Like all people who know very little, they are very sure in what they do know. They present these headlines and incomplete snippets of information as often as possible. They completely buy into their own bullshit. They speak the language of the common person. They offer solutions (too good to be true).
What are these solutions? Feel bad? Take this and feel good! Do you need to see a doctor? No, just do this… Do you need to go to the doctor every month for a new prescription? Nope…just stop by the shop or we will send it in the mail. Just like snake oil sales, they can cure whatever ills you. Even if your only ill is concern.
Look at the examples, anti-vaccers. They latch on to a few buzzwords or a handful of negative outcomes. They present this as the norm, or at least so common it should affect your decisions. After all, who are you going to believe? Somebody who is a parent like you or those greedy, conspiring, doctors and scientists (strangers in the ivory tower)?
Even nurses get in on it. “Let me tell you what I have seen…” How can you explain what you haven’t seen? Just asking…
Do I get vaccinated? Absolutely! Not with the flu shot I will admit, because the evidence seems to point out I do not have a high level of benefit. I make sure my daughter is vaccinated, with everything out there, on schedule. I encourage my wife to get anything that might benefit her. (They are in different risk/benefit categories than I am)
Do I know there have been a handful of negative affects? Yes I do. Do I know that at any time something can go wrong? Yep, I know that too. It’s not even a choice between risk/reward. The risks so low and the reward so high, it is a no-brainer. But I have some benefits in making that decision that not everyone has which makes it so clear. For example, I have an advanced professional education. I work in the industry. I have access to the latest science (which costs well more than most people can afford, with some journal subscriptions upwards of $1000 a year), not just the stuff free on the internet from very professional looking, but highly questionable websites and adverts.
You see the exact same thing with home-birthers. ( I think these people are a bit more sinister than anti-vaccers because they actually collect evidence and then selectively exclude anything that doesn’t support their case, where anti-vaccers simply have no evidence and are selling fear). The use of the scientific method for social or economic gain is well documented through the ages in a variety of issues, this is just one of the latest appearances.
Do you need a doctor to have a baby? I am told “no.” but because of my personal experience of making it through a Fire/EMS career, medical school, medical practice, and internship time in OB/GYN, I have never seen an uncomplicated childbirth. In fact when my daughter was born, despite absolutely no indication through prenatal care and early labor there was a complication.p>
I am compelled to point out the infant and maternal fatality rates during times and in places where medical care during birth is not available. Morbidity is also a major concern. As well, I would be remiss if I failed to point out that the medical discipline of anesthesiology was developed to ease the pain of women in labor by Dr. John Snow! (which is where the term “getting snowed” comes from)
I will also point out that where medical care, pre, during, and post labor is greatest, they have measurably the best outcomes in all respects. (Including total medical costs) The US for-profit system is the only exception to cost benefit.
There is also the biological reproductive strategy associated with various populations. Rats have lots of babies, because they have a high mortality rate prior to reaching the age of reproduction. So do fish. So do dogs. (We have all heard of the runt of the litter). Humans too, in some parts of the world, follow a similar reproductive biology. Out of 7 or 8 kids maybe 2-3 will survive to reproduce. This is a fact of life they live with. How many people in a modern country, where they might have 1 or 2 children per lifetime would accept a 70% child mortality rate? Are you willing to accept it? How about the financial costs and family stress associated with a severely disabled child? Obviously some do accept this, but very very few and in countries where there is social support systems for it.
Some claim that surgical birth is overused in medicine. I tend to agree, but perhaps not for the reasons many people think. First, there are indications for a C-section. Only some of these are identified prior to labor. Many would not argue against them. Trial of natural labor and deciding on a C-section is tricky. If you decide early, you may over-triage people who ultimately could deliver without surgical intervention. But if you wait too long, you run the risk of mortality and long term disability. Prudence dictates you err on the side of caution. Consequently, many will have C-sections that were not required, but that is simply the perfection of hindsight.
But this has profound effect on patients; surgery, scars, complications, costs, future pregnancy costs. It is a big concern for non-medical people.
I have even been at the table for “elective” C-sections. Most notably after a vaginoplasty. (Yep you heard that right, plastic surgery to improve the look of the vagina in a female prior to childbirth.) Body image and sexual health occupy a larger role in modern society than in the past.
But for all of the decisions with pregnancy; age to get pregnant, keep/not keep, abortion, types of childbirth, costs, etc. There is somebody there to tell people their experience and advert their “easy way” or justify their decisions. After all, in Western cultures women generally seek consensus, rather than correctness. (at least that is what the psychology of women professors I sat through thought, and it did seem to be true at the time) What better way to find consensus than to get as many women as possible to do what you already did?
4 pages on this already, wow!
I could probably write another 4 or so pages on diet supplements, diets, and herbal remedies, but it really all boils down to the same things I already talked about, only the details change a little.
So it seems, the more medical providers separate from the community, locking themselves in the ivory towers, and forcing patients to play the game their way or no way; the needs, desires, and opportunity to take advantage of the lay-person will only expand, and all of this nonsense will expand with it.
The solution is really simple. Medical providers need to understand and be proactive in their communities, visibly and not just when people pay or become desperate for help. It seems to be working for paramedics. There are even parallels to the fire service and police officers. Some will argue that is public safety, not medical care, but I will leave you with this though:
Medical providers draw their social and economic status from the values of their patients. If you alienate yourself from them, how does that work out in the end? Who and what will fill the gap?