I often wonder what exactly a doctor is. I am surrounded by doctors who treat patient care as something of a computer program. If:Then
They perform the exact same treatments on patients, regardless of their condition, complaints, etc. I wrote about this McMedicine before, but it never stops amazing me. In fact I am not even sure they are doctors, I could probably take a homeless person off the street and teach him to do what they do in a few hours. Perhaps my favorite of this doctor species are the ones who claim they are afraid of being sued. Let’s face it, when you ignore patients’ concerns, make them wait hours or days to even see you, keep telling them they are not your problem (aka endlessly refer them to specialists) then charge them money, all the while lamenting how hard you studied and worked for too little money, you essentially did nothing for them. I don’t have any sympathy for these doctors. They deserve to be sued and lose.
It is even worse when “experienced” doctors perform outdated treatments because they do not want to change what they have done for the last 50 years. In Poland, it is particularly bad because the paramilitary style of medicine actually calls for senior doctors to order younger ones around, and gives them absolute authority to do so. I have witnessed many times junior doctors cringe knowing something was wrong, and then, in order to keep their job, went right ahead and did it anyway. It makes me wonder if anyone learned anything from the Nuremberg trials. “I was just following orders” is not an affirmative defense.
Not a day goes by it seems that I am not arguing with some non-medical cretin in the US pushing their homeopathy or anti-vaccination stance. These people claim to be healers. I can see how if you give your “patient” a glass of water with some “natural” remedy and they don’t die you can call that a success. It is even better if they have some illness that will self-resolve even if you did nothing and you can get them to pay you for your treatment. If you die, well, at least you didn’t get sucked up into the conspiracy of modern medicine right?
So what actually is a doctor? Well, if I objectively look at what I do, I would describe it more like necromancy. Humans rarely heal and medicine rarely cures. The physiologic response to injury for the body is regeneration or repair. Those are the technical terms. But in everyday English what it means is the cells will either divide and replace damaged ones or a scar will form. In most cases, it is the later. A scar is like a patch, it doesn’t actually “do” anything. It prolongs the ability of the organism (the medical word for you) to compensate before it ultimately dies. (We all will) When it comes to illness, easily 90% of medicine, and likely more, does the exact same thing. It is a patch. It modifies things just enough to keep you going.
It is however, a Faustian bargain. Whether by surgery, you cut something out or put in extra parts or by “medicine” of swallowing pills and applying poultices, you are altering the body just enough to keep it going, but it comes at a cost. Sure the obvious cost is money and whether you are paying directly or indirectly, that may seem like a lot, but that is only part of the price.
Every medicine or surgery you ever get treated with harms another part of your body. Your heart medications may destroy your kidney or your brain. Your brain surgery may destroy your endocrine system. The list is endless. You are making a deal, save your heart today at the cost of your kidney tomorrow. When tomorrow comes, you will double down on your deal. You will get renal replacement therapy or a transplant which will destroy your immune system and eventually succumb to infection. That is if you don’t have a transplant rejection or so upset your electrolyte balance that your heart gives out again.
Then there is pain. Despite what military instructors say, pain is not a good thing. It tells you when you are sick. It causes you to be sicker. In order to relieve your pain, you may have to trade addiction. Some medical experts and moralists would rather you not make this trade. So you are forced into living with pain or living with addiction. Let’s face it. What it really comes down to is life as you knew it is over, your days are numbered, and the choice is how and how long before you reach your end.
Perhaps that is why I don’t really like homeopaths. They simply steal from people. They do not offer the benefit part of the devil’s bargain. They charge for a placebo, one that must be scientifically proven not to do anything to your body. If it did, they would have to legally fall under the confines of medical practice.
So what is medical practice? Evidence based? Science based? Western medicine? Pills? Surgery? We have lots of ways to describe it.
But what does it all mean?
What I do is study (aka observe) natural phenomenon. I then report my observations in a standard way. Hopefully if they are worth reading, somebody will publish them and others will read them. If all really goes well, other will care. In the best circumstances, others will be able to make my observations work for them. Science is collaborative so I read the observations of others, and together with our education and experience, we try to figure out what works when and how well. That is the “science”
The second part is referred to as “the art of medicine.” This means taking the knowledge gained from science and education and applying it to actual people in order to give them the benefit of the Faustian bargain. (prolonging productive life, reducing suffering, saving life, all the things we recognize as medicine)
That means what works for some will not work for others; sometimes for physiologic reasons; sometime for cultural reasons; sometimes for economic reasons. It is the role of a doctor to take into account all of these things in order to “help” people.
To guide in these decisions, there are ethics, morals, culture, and laws. Like any rules or definitions some people always fall into exceptional circumstances, which make these “rules” conflict with each other. In fact, I have noticed the more absolute a rule or moral, the more often they conflict.
When we consider the factory workers I described earlier doing the same thing no matter what, they are not really acting in the capacity of a doctor. They are not giving people the benefit of our devil’s bargain. They are giving patients a chance to spin the wheel and maybe win it. They justify this as best because it removes their responsibility and culpability as the person offering the bargain. Their behavior is not for the benefit of patients, but for their own benefit. “Pay me for a chance to spin the wheel and get better. If you lose, you are unlucky, but it is not my fault.”
A more modern trick is to employ the ethical principle of “self-determination” The patient chooses what they want after being properly informed. Sounds great right? The doctor is not responsible because the patient chooses. Patient cannot complain because they chose it based on their circumstances. Except offering treatment that way is like selling a used car. A doctor can easily make one treatment seem better or preferable to another. It takes years to educate to the level of a doctor so in seconds, minutes, or weeks, patients without benefit of education, scientific research, etc. will be expected to make a “reasonable” decision their life or health relies on. (or a close family member)
Doctors can even object to various treatments on personal moral grounds. In other words they choose for you while making it impossible for you to choose otherwise. Not exactly an objective, educated, and reasoned opinion.
A doctor is often said to be a medicine man, a person who uses their knowledge and experience to help people. Help them with what? The obvious answer is their health and wellness. As I described above, health and wellness is more than simply a disease process.
So I will close this post with a great quote from the former dean of my medical university.
“There are many who have a medical degree. Few of them will ever be doctors.”