A Very Fine Whine

Musings of a Conservative Christian Resident Physician.

On Cynicism

In medical school, especially the first two years, it is rather easy to be idealistic. Our professors teach us what tests are necessary in order for the doctor to make more money better diagnose and treat the patient, and we all live in our ideal dream that everyone has a right to health care, yada-yada-blah.  We are at times grossly uninformed of the repercussions of free health care for everyone (or whatever topic is being discussed), and most of the time we eventually realize that, particularly pertaining to the “non-science” side of medicine, most of what we hear is merely some one or group of persons trying to indoctrinate us for their beliefs.  And the more we realize that, the easier it is to become the stereotypical cynical doctor(-to-be).  This, however, is only the beginning of our cynicism.  There is, however, another aspect of doctoring that I would argue has a much greater influence on our cynical views toward people in general.

The vocation of medicine, especially the counseling side of medicine, is unarguably the field in which one deals the most with people in need.  There are many occupations in which one deals with other people on a regular basis, but few (I didn’t say “none”!) have the potential for impact that the couseling doctor does.  Often, the physician sees a health problem with his patient, and recommends lifestyle changes/medications/other interventions for the patient; it is up to the patient to accept that these interventions need to happen, and to subsequently implement these interventions. This is where cynicism enters the picture.

  • The 85-year-old patient refuses to use the walker that you prescribe and Medicare provides, and ends up falling and breaking bones.
  • The 25-year-old patient refuses to stop smoking, and 20 years later has COPD and can barely maintain a conversation.
  • The 55-year-old man with a family history of colon cancer refuses to have a colonoscopy because “it costs too much,” and is devastated when 8 years later bowel movement changes tell you he has cancer.
  • The 60-year-old woman doesn’t get her mammogram done because “it’s a little uncomfortable and it costs too much,” and 8 years later dies of metastatic breast cancer.
  • The 30-year-old patient doesn’t think that being 5’6″ and 425 lbs. with a daily intake of 5,000 Calories is problematic, and refuses lifestyle changes. Oh yeah, at 55 he’s lost both legs from venous insufficiency, and has the use of only one eye (it has a cataract).
  • The 35-year-old mom who’s been experiencing palpitations doesn’t want to see a cardiologist because “it’s probably nothing,” and falls over 6 weeks later of sudden complete heart block due to her hypertrophic cardiomyopathy.
  • The 15-year-old thinks that promiscuity among his classmates has no repercussions, but can’t figure out why he has ” ‘roids”. Or maybe she just doesn’t get that PID is terrible, and AIDS and herpes are for life.
  • Possibly even worse is any personal friend or family member who asks you for your opinion on any given health matter, then continues on doing whatever they have already made up their mind to do.
  • I could go on.

No, none of these instances are true cases, at least to my knowledge. But I can guarantee you that there are doctors, most likely in your hometown, that would say, “Yup, that’s my patients, exactly.”  Doctors see patients that need help, are making unsound or even dangerous life choices, and come to the doctor because their health is failing them and they can barely get around.  Problem is, it’s not their health that is failing them: they failed their health a long time ago. Your doctor knows that you haven’t been keeping your diet under control: your A1c tells him that. She can see that you are not taking your blood pressure medication. Really. You think 180/115 is lower than 165/100 normal?!  Seriously, it’s not difficult to see the non-compliant non-adherent patient.  But you come see the doctor, she’ll tell you what you need to do for your chronic health problem, and she’s pretty certain that you’ll be back, with no improvement because you refuse to do what you need to do.  Contrary to popular belief, those tests he orders and those medicines he prescribes for you do not make him more money; they are for your benefit, to help you get better (which is what you are there for, right?)  But we know that you won’t listen, but you still want us to be on a first-name, good-friend relationship. And we roll our eyes (inwardly), and we add one more block to the cynicism wall.

Of course, this can apply to other areas as well (finances, spiritual life), so apply it as you will.  Most health issues have a moral aspect as well, and are addressed in The Ultimate Life Guide, the Bible. But for those who won’t listen, all the persuasion in the world won’t change their actions.


February 13, 2010 - Posted by | School

1 Comment »

  1. Excellent insight on how doctors think. I was prescribed blood pressure medicine after going to the doctor for I think a sinus infection. Needless to say I don’t take my medicine, but I’ve lost 60 pounds and it’s low now.

    Comment by al | February 24, 2010 | Reply

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