Tuesday, November 7, 2017

A theory about doctors


When Christopher Columbus landed in the Bahamas and Hispaniola in 1492 he was absolutely convinced he had reached India or thereabouts, the Indies he called it.(Became West Indies) He didn’t know about the Pacific Ocean and apparently was bad a math, having determined that he had travelled the correct number of miles to reach the Indies. Others, better at math knew he was wrong.  He landed in the Bahamas and was convinced he was in the old world.  He completed a total of 4 voyages to the Americas, still trying to convince King Ferdinand that he would bring back the riches of Asia. He was convinced the world had a circumference of 17,000 miles instead of the correct 25,000 miles. He believed what he wanted to believe, irrespective of clear facts. Human nature has not changed. When investigators have strongly held pre-existing beliefs they take the evidence and fold it into their model. This remains a great human failing.   Einstein understood that facts and knowledge were limiting, as he often said, it is imagination that opens up vast possibilities. 
In 2007, Fallon shows in a highly esteemed, NIH sponsored, peer reviewed study, that patients with post treatment Lyme with neuroborreliosis achieved improvements in cognition with a course of intravenous Rocephin and that the gains disappeared after less than 6 months when treatment was withdrawn.  The IDSA somehow concludes that these findings refute the presence of Lyme persistence after treatment.  These folks are smarter than that.  If they are right, and antibiotics make people smarter (not by killing germs) then I certainly want to get my hands on some! 
Chronic Lyme is it real. Do organisms persist after treatment?  This question is settled. Borrelia burgdorferi bacteria persist in mice, dogs, primates, test tubes and people. No one has demonstrated eradication of organisms in any of the animal studies. And it was really very hard to kill all the bacteria in a test tube, requiring 3 very potent drugs. I agree that the vast majority of bugs are gone after a reasonable course of antibiotics.  I don’t know why some patients need to be on IV antibiotics for many months to achieve improvements.  The collective, empiric experience, of many doctors and many patients is that these very aggressive therapies are at times what it takes. Elite colleagues are quick to deny a patient therapy because it shouldn’t work according to their particular theory. We became doctors to help patients, not to push dogma. Investigators, trying to prove a square is a wheel, over and over again, waste a lot of energy and resources, when they could be searching for real answers. 
We live in a time where a functional MRI – I learn today, can be used to show whether a young person has suicidal thoughts with accuracy. We have unbelievable medical and scientific technology, yet we are antediluvian when it comes to Lyme disease. Those who pull the levers of power are incredibly stubborn, like Columbus, who was sure he had circumnavigated the globe when he bumped into the Americas. 
Is there something inherently wrong with doctors, as a whole – ID doctors in particular?
I have heard the same story a million times. Patients tell me, “I told my doctor I was feeling better when I was on the antibiotics but symptoms came back when the antibiotic was stopped.” My doctor said, “I’m not going to give you any more antibiotics.” No reason given.  You would think the patient is asking for heroin. Why don’t doctors listen to their patients, why don’t doctors trust their patients, why don’t doctors believe in their patients and why don’t they respect their patients? 

There are several reasons. Here is an off the wall theory:  Doctors are imbued with prejudice against their patients stemming from the way doctors are trained. 
When I was an intern, we all read the book “The House of God.” A satiric look at a medical internship.  Much of what one might read in that book is closer to the truth than one would ever want to believe.

These are ancient memories and I hope they are outdated. 
Medical students frequently have first patient contact experiences with the sickest of the sick, including many suffering souls in the final days and hours of their lives.  Mentors and attending instructors objectify patients, a defense mechanism. The attending physician might recommend: take a look my liver in 202, the yellow man with esophageal varices, interesting case; or my lung cancer in 204 with Pancoast tumor syndrome, a must see.  You really don’t want to every be an “interesting case.” Impersonal, groups of young doctors, wearing white coats of varying lengths, round on hospital patients, poking and prodding. These teams of doctors in training provide hospital care for groups of patients called their “service” New admissions frequently are via the emergency room and are referred to as “hits.” Patients suffering with dementia and other debilitating chronic illnesses earn the awful name: GOMER (get out of my emergency room).  An obtunded patient’s mouth is open and the residents/interns call it an “O sign.” If the tongue is also protruding to the side it’s called a “Q sign.” The upper level residents think this is all very cute and very funny. I heard skid row alcoholics in DTs called SHPOS -- Sub-human-piece-of-s.  The new world of medical learning exists in its own space, with its own rules and cultural norms.  These awful things and many others were routine in my experience and were normalized. The mentality was frequently modeled by mentors of the new batch of doctors.   
An exhausted intern, having worked straight since 7am the day before, finally lays down on his bunk and puts his feet up, shoes on, and hears words through the public-address system he dreads: “Code Blue ER.” If the patient survives he will admit the patient to the ICU/CCU.  That beyond exhausted medical resident secretly hopes this one doesn’t make it, so he can get that one hour of sleep.

These were formative experiences. 
I am absolutely sure many colleagues will deny ever experiencing anything remotely like what I describe above. Perhaps their experiences were different.  Perhaps they have selective memories. 
If so, the question remains: why are these intelligent, highly trained physicians, disrespectful, arrogant and condescending to their patient who is simply asking the question? “Why can’t I have more antibiotics?”
As I stated. I have not done any research.
It’s just a theory.

1 comment:

foxy loxy said...

you hit on some VERY good points. I personally think it takes viewing all people as valuable and eternal to be able to give them the loving care that they need. It is amazing how many people down another to raise themselves up. (all subconsciously of course) The ironic part is that you could easily be that very person you are making fun of... or not helping... or despising...

A true Dr. is one that shows compassion to anything that breathes and can feel. Otherwise, is merely a person in desperate need of God.

This whole Lyme war has become more about personal pride and money. Very sad, when you consider the fact that we are all dying and headed for eternity. Very fast too I might add.