How Much *Don't* the Doctors know?

[peter]

Recent news stories about the mis-diagnosis of early breast cancer signs leading to thousands of unneccesary lumpectomies being performed [and thereby giving a positive 'skew' to the sucess rate of such proceedures in preserving the life of patients], the continued debate at to the actual existence of such conditions as ADHD, ME, SAD, PMT and a host of others, the 'statins', vaccination and 'fat' debacle's, have prompted me to ask the question 'How much is it that the doctors don't know?

We are continually being told how much the medical proffession does understand about what goes wrong with us [and this is indeed no doubt a graet deal] but every time I go to the doctor I never seem to be able to make any headway. My sciatica is as bad as it ever was; I get dizzy spells that are apparently beyond the GP's to diagnose [appart from that I'm possibly nuts], and my digestive system goes into convulsions if I so much as shake a pastry at it.

Now I'm not one of these people who 'mistake medicine for magic', I don't expect every condition under the sun to be 'cureable', I don't hold doctors to blame when they, with the best of intentions, get it wrong or reach the end of their rescorces - but I do think a bit of humility on their part in this respect might be in order. Their problem is, in my weak estimation, that they have fallen victim to their own publicity. They start believing that what they can't see, can't diagnose, can't demonstrate in a laboratory doesn't exist. And in building up an almost infallable image in the public eye they run the risk, and frequently fall foul of the inherent dangers of 'flying too high on borrowed wings'.

So my advice is this; start actually leveling with people. Be honest about it. "What we don't know about human disease, what causes it and how to put it right far, far, outweighs what we do. The chances are that when you come to see me I'll have very little more knowledge about what is wrong with you than you do yourself, but what little I do know will be at your disposal." If the medical profession starts being realitic about what can be expected of it and stops trading on an unwarrented degree of belief in it's capabilities, then I for one will be the more prepared to aknowledge the debt of gratitude we owe it and to say "Fair enough, it 'aint much but it's the best we've got!"

[Hashi Lebwohl]

In my experience, physicians are the last people who will ever say the phrase "I don't know". This could be due to the general sort of personality which is drawn to the medical field but I suspect it typically has to do with patient confidence--no one who is sick wants to go to the doctor and be told "we don't know what is wrong".

I agree with you, though--I would rather my physician tell me "I don't know" than to make up some crap to calm me.

[Fist and Faith]

I have neuropathy in both feet, and adema in both ankles/calves. I've been tested for damned near everything that might possibly be causing either. Diabetes, congestive heart failure, vitamin deficiencies, yadda yadda. My GP fully admits that she doesn't know, as does the neurologist.

[peter]

The exeption Fist, rather than the rule.

There is much however to what Hashi says. Merely making a visit tothe doctor can often give people a sufficient 'boost' in optomism, such that they begin to feel better almost at once. Placebo is not a false effect, it is a very real one pertaining to the very real psychological aspect of all illness.

In the veterinary practice where I spent much of my working life, the old school vets [much to the horor of the younger graduates] followed the 'three point rule' of any consultation. One - always tell the people what is wrong with their animal [even if you don't know]; two - always be seen to do something [ie an injection or the like]; three - always give the client something to do. They swore that by following these three simple rules the people would love you and think you were the best thing since sliced bread - and I must say their results seemed to bear this out!

[StevieG]

The exeption Fist, rather than the rule.

Not in my experience. My wife works at a doctor's surgery, and perhaps they are also the exception, but all 5 of them are honest with their patients. It is true though that some people prefer a diagnosis, even if it is wrong, to an honest opinion.

[peter]

Don't get me wrong - I don't accuse doctors of dishonesty, rather the profession of hubris.