Why Do People Follow Medical Authorities? - Page 9

[Rrrrrachel]

Originally Posted by IdentityCrisisMama 

I received a flag about this post. Rrrrrachel, would you please clarify your intent with this comment? Are stating (without any snark) that you simply missed this? Or is your comment meant to doubt that something like this was said?  Or something else? Confusion about this sort of comment has derailed many a thread. 

Everyone has been great about asking and answering questions -- let's keep the spirit of that open. 

The comment should be taken at face value. I don't recall seeing that, so I must've missed it.

[Rrrrrachel]

I guess I'm not really clear on why, even if it was expressing doubt, that's a problem? An I not allowed to question the veracity of other people's claims? It's not long ago someone told me something along the lines of "you could just be making that up." This is the second time something asking (or perceived to be asking) for clarification or more information on a factual claim has been moderated, so I just want to make sure I'm clear on the rules.

[pek64]

Originally Posted by Rrrrrachel 

I must've missed, on other threads, where people expected others to take the word of their personal doctor.  

Originally Posted by pek64 

I think the reason for the debate is because on other threads there has been a few who speak often of the advice of their doctors, as though the rest of us should accept the word of a doctor who has not earned the trust of the rest of us.
That led to what seemed to be a 'why don't you trust doctors?' attitude.
Those of who had more bad than good experiences are making it clear why we won't accept the word of a medical representative without first evaluating the individual and determining if trust should be given.

Replace 'advice of their doctors' with 'advice of the CDC' and my point stands even more firmly.

[pek64]

Originally Posted by CatsCradle 

I have a bunch of work to do today but somehow got sucked into reading this whole thread.  I'll throw in my two cents simply because I might have a different perspective (if not already stated somewhere here).  A little background:  I'm an attorney, not a doctor, but I think there are a lot of similarities between the two professions in terms of ethics, professionalism and the requirement to stay informed and knowledgable on issues as it pertains to one's practice.  I also think there are engrained cultural biases that play into peoples' perceptions of both.

Both require a significant amount of "client" contact.  Herein, I think is the biggest challenge.  When I was in law school (and I imagine that it is the same for medical/dental/other students), the focus was on learning the theories, the law, the consequences, etc.  Law school was purely academic.  I came out of law school with proverbial pistols loaded ready to apply all that "knowledge" that I had aquired in law school.  Problem was, no one had taught me anything about the most important aspect of my practice:  the client.  I understand now that the purpose of law school, more or less, is to provide the foundation.  Upon entering the profession, I was fortunate in that I had some great mentors who guided me in the fine art of client management.  One of the harsh realities that I learned was:  all clients are different and have different needs.  One thing that they do have in common, though, is that they want the best result for their particular circumstances.  This means that I can't apply a cookie cutter law school approach to everyone's needs.  The best lawyer, in my opinion, asks the client a lot of questions.  A lot of questions.  This is the only way that you can proceed to get the best result for your client. 

I've seen the same approach in the medical profession.  We actually have a great pediatrician who listens to us and spends time discussing how our desires and options can work best.  This is what makes a great doctor...someone who doesn't take a cookie cutter approach to every patient and who respects his/her patients.  I've had a couple of distasteful experiences with other doctors who seem to not give a rat's rear end.  The ability to communicate with the client/patient and the ability to tailor your practice to the clients' needs is paramount.  Personally I think that a lot people in the licensed professions never learn this (I can think of a number of lawyers that I've run across that have the exact problem). 

That all being said, I really do think that the problem lies in the professionals' inability to move past the academic setting into the real world and all its nuances.  One thing I know is that I have to keep learning.  Law, like medicine, is not a static thing.  There are some truths that don't change, but even in my profession the application of what I do is constantly evolving. I think there is this engrained perception that people in the licensed professions are smart, and therefore should have the last word (between:  I'm not implying that I'm smart...LOL!).  But, I really do think that as rapidly as the world is changing, the academically smart people need to do a better job of catching up with the program.  Just my unsolicited two cents!

Which supports my earlier point, that too often doctors don't listen well.

[Rrrrrachel]

Originally Posted by pek64 

Replace 'advice of their doctors' with 'advice of the CDC' and my point stands even more firmly.

I don't understand your point at all.

[rightkindofme]

Originally Posted by chickabiddy 

Respectfully, that is not the fault of the doctors.

Who said it was? The question was asked, "Why do people stay with untrustworthy doctors" that would be because all of the "Just do _____" advice is slanted towards people who have a lot of resources and is dismissive and rude towards people who don't have other options.

Just because someone doesn't have a car that doesn't mean they should have no choice but to see bad doctors, but it happens. It is not an individual persons fault that there are no good doctors within walking distance of their house either.

[Rrrrrachel]

Insufficient access to primary care doctors is a major problem in this country, and likely to get worse with increased access to health care. It's exacerbated for people with Medicare/caid because reimbursements are so low. That's really an interesting conversation all on its own.

[IdentityCrisisMama]

Originally Posted by Rrrrrachel 

I must've missed, on other threads, where people expected others to take the word of their personal doctor.  

Originally Posted by Rrrrrachel 


The comment should be taken at face value. I don't recall seeing that, so I must've missed it.

Originally Posted by Rrrrrachel 

This is the second time something asking (or perceived to be asking) for clarification or more information on a factual claim has been moderated, so I just want to make sure I'm clear on the rules.

Comments that say one thing but mean another are often interpreted as snark and comments interpreted that way often get flagged. Posts asking for more information or clarification are very much welcome. Thank you for your clarification. Feel free to PM me if you need more help. 

[pickle18]

Originally Posted by kathymuggle 

This has been my interpretation as well.  You are not alone.

I still do not understand the point of a statement such as:

"I trust my doctor. I vaccinate."  *

….unless it is to imply that those who do not vaccinate do not trust their doctors?  Trying to paint non-vaxxers as anti-doctor is assumptive and annoying.

On the flip side, I have met people who do not like or trust doctors but still vaccinate.

I don't think trusting a doctor (unless it is blind trust) is a huge factor in vaccination.

_________

*  I did try to find statements like the one I wrote above and failed,  so perhaps they do not occur as often as I think. They are just memorable when they do!

It's entirely possible some people do have that blind faith - but I think we've seen that the word "trust" is loaded for some people, and doesn't always mean complete abdication of decision-making - often, I think it simply means "I agree with my doctor's analysis or opinion."

Anyway, it's an oversimplification, and anyone who ONLY has that to add to a vaccine debate, probably isn't going to have a lot more to say about the nitty gritty (if they really haven't done any of their own research to support their opinion).  So, it kind of solves the problem.

I'd like to point out, though, that that statement isn't any more ridiculous than some of the blanket "big pharma" boogie men statements or wilder conspiracy theories I've seen offered on the other side.  Blind faith occurs there, as well.

[rightkindofme]

Originally Posted by pickle18 

I think you are misunderstanding me.  My statement was referring to something said by Adaline'sMama - who, by the way, said she is on medicaid.  She said she has a good doctor because she worked hard to find one, within those limitations.  My only point to pek64 was that just because bad doctors exist, that doesn't mean all doctors are bad - there are good ones, though you may have to try hard to find them.  Glass half full or half empty kind of thing.  To me, that effort is simply to be expected, because of the kinds of factors you mentioned (demographic), the individual values of the client, the temperament of the professional (and the fact that doctors are individuals) etc.  To her, it may be evidence that there is an unacceptably high number of crappy doctors.

I absolutely understand that some will not have a choice - I addressed that in a previous post, when I asked those who aren't inclined to trust *any* doctor, whether they felt that might be due to limitations on who they we able to see, and bad experiences resulting from that.  So, your response is helpful, because it answered that question in the affirmative.

I don't think anything I said was based on privilege.  Do some people only have one option?  Sure, and it might suck.  Do some people not have the gas money to drive to a different doctor, or the ability to spend less elsewhere to do so?  Maybe not - again, Adaline'sMama mentioned this was a priority for her.  

If you have the ability to "set priorities" then you already have a level of privilege not available to everyone.

[IdentityCrisisMama]

Knee deep in the process of choosing a middle school for my DC (in a district with few zoned schools), I am preoccupied with the idea that there are schools that are good for some kids rather than the focus on "good schools" or "bad schools".  I wonder if this is another way for this conversation to go. I'm sure that just as there are very poor schools that are poor for all the children who attend, there are doctors who simply don't serve any of their clients all that well. But, more often, there are probably doctors that are a good fit for a certain type of client. 

For pediatricians, I like a pretty hands-off approach. I never ask or invite in anyway questions about things I do not want advice on (parenting style, sleeping, feeding and etc). I want someone who will look out for major problems and help me if I need any thing checked. I know a lot of folks who want way more than this. Like I said upthread, I know someone who wants more when it comes to led results. I know folks who want to talk to their doctor lots and etc. 

Long story short - I can think of some reasons why folks search for a "good doctor" that doesn't necessarily mean they think there are tons of "bad doctors" out there. It can be more that there are good fits and bad fits. 

[pickle18]

Originally Posted by rightkindofme 

If you have the ability to "set priorities" then you already have a level of privilege not available to everyone.

Absolutely - that's why I said maybe not.  And let me be clear - by "setting priorities" I really mean "making sacrifices."  Most people make choices about how to prioritize their spending, even if they have very, very little to spend.  You prioritize what groceries to buy with food stamps or WIC, for example.  I mean prioritize as in, gas money is pulled from the already-tight food budget.  As in, kids wear clothes with holes or shoes that are too tight.  As in, going without other basic necessities if you have any room to at all.  If medical care is your priority, it may override these other things, for some people.

For those in extreme poverty, that might not be an option.  I get it.  Do I think it's fair people have to make those hard decisions to get to a better doctor? Of course not.  I don't think anyone here is saying so.  The only point I'm trying to make is that trustworthy doctors exist, and that is why some people on MDC say they trust their doctors - I have never claimed universal access to one.  I wish I could.

[kathymuggle]

There seems to be this idea floating about that people should have a doctor they trust.  If they do not have a doctor they trust they should work hard at finding one.  Those with serious resource issues may be off the hook in this.

Well I say…pfft.

I like my doctor.  I do not love her.  I give her a B-.   I am not going to bother driving all over Ontario looking for another doctor.  I cannot be bothered.  We are all in reasonable health, and I am lucky to have no need of a doctor I completely or almost completely trust.  I get some people might want a strong relationship for one reason or another (health issues, life stage, baggage) but that is not me.

I do think if your relationship with your doctor is so bad that you dread seeing them or will not listen to them on anything, you are probably better off finding someone else if you can.

I don't think all people need to seek out a strong doctor/patient relationship, though.  It does not make you a bad person or a bad parent.

[Minerva23]

Originally Posted by pek64 

Medical school doesn't teach about parenting, yet they feel they are parenting experts. The same is true of breastfeeding (no training), yet they are taught formula is just as good. They go through residency and internship programs that involve many aspects of cult brainwashing. Is it any wonder we can't talk to them about medical issues? It is rare to find a doctor who listens. Most jump to conclusions, playing the odds. "You can't have x, because that's so rare." They need to listen before they can reestablish trust.

Absolutely right!

And there are just human like you and me and the person next door. Not Gods! and they are not perfect. To err is human. I trust myself and my instinct more than anybody else in the world whatever expert he/she claims to be.

[Chicharronita]

Originally Posted by pickle18 

It's entirely possible some people do have that blind faith - but I think we've seen that the word "trust" is loaded for some people, and doesn't always mean complete abdication of decision-making - often, I think it simply means "I agree with my doctor's analysis or opinion."

It seems like more of the older generation and/or people who don't research things on the internet have more of that blind trust.

My mother is like that; I think she's still on Premarin despite all the bad press, and a variety of other pharmaceuticals (she started with a couple, and when they caused "side" effects, started taking more for them).

She never goes on a computer for anything.

My father who does, is very wary about medications, and is resentful that it seems like it's open season to put the elderly on as many meds as possible. My friend's mother who is a healthy 82 told me her doctor said she was a "miracle" because she's not on any!

I have to admit when I hear stories like this it diminishes what little trust I have in the medical profession.

One of my biggest fears is getting in a big car accident because I don't want to have to go to a hospital and be at the mercy of god-knows-who. I think that's sad; shouldn't I feel confident that with my full insurance I'll be taken care of? Instead I feel like I should perhaps get several cards of lawyers with experience in medical lawsuits and have them on hand.

[chickabiddy]

Originally Posted by Minerva23 

Absolutely right!

And there are just human like you and me and the person next door. Not Gods! and they are not perfect. To err is human. I trust myself and my instinct more than anybody else in the world whatever expert he/she claims to be.

I'm a CPST (and I'm not claiming that my training and experience is anywhere close to that of a physician), and I see parents whose "instincts" tell them their children are safest harnessed, but they have outgrown the 40# limit on their seats, which means that they are far LESS safe than they would be in a properly used booster.

Instinct is indeed valuable, but so is knowledge.

[WildKingdom]

Originally Posted by Minerva23 


Absolutely right!

And there are just human like you and me and the person next door. Not Gods! and they are not perfect. To err is human. I trust myself and my instinct more than anybody else in the world whatever expert he/she claims to be.

I always find it amusing when people say, "Doctors are not Gods!" Yes, doctors are well aware that they are not gods. The reason I find this amusing is because those that say it seem to be most likely to expect doctors to be just like gods. Take, for example, some of the comments that have been made here about doctors not knowing enough about parenting and breastfeeding. Despite my comments about the many hours of training I received, people are still not satisfied that its enough. Kathy feels doctors should be held to a higher standard than all other practitioners. Others seem to want all doctors to be perfect compassionate listeners all the time. Others expect to never receive bad advice.

Wake up people. If you don't want doctors to be treated like gods, then stop expecting them to perform like one.

[pickle18]

Originally Posted by kathymuggle 

I like my doctor.  I do not love her.  I give her a B-.   I am not going to bother driving all over Ontario looking for another doctor.  I cannot be bothered.  We are all in reasonable health, and I am lucky to have no need of a doctor I completely or almost completely trust.  I get some people might want a strong relationship for one reason or another (health issues, life stage, baggage) but that is not me.

I do think if your relationship with your doctor is so bad that you dread seeing them or will not listen to them on anything, you are probably better off finding someone else if you can.

I don't think all people need to seek out a strong doctor/patient relationship, though.  It does not make you a bad person or a bad parent

I agree with all of this.  I think the idea that people "should" (really, it was "might be able to", with exemptions) find a doctor they trust came out of people basing their general dislike/distrust (disdain?) of all doctors on limited negative experiences.  The point was, you might not actually hate *all* doctors, you might just hate your doctors.

Or who knows, maybe you could personally meet every single doctor ever and hate them all and still not see how anyone could trust a single one of 'em.   

[rightkindofme]

Originally Posted by pickle18 

Do I think it's fair people have to make those hard decisions to get to a better doctor? Of course not.  I don't think anyone here is saying so.  The only point I'm trying to make is that trustworthy doctors exist, and that is why some people on MDC say they trust their doctors - I have never claimed universal access to one.  I wish I could.

Well, of course. :) These days I have a *fabulous* dentist. I drive really far to maintain that relationship. I have to travel 3.5 hours roundtrip to see my therapist and I *do it* because otherwise I can't find a trauma specialist who can work with me.

Yes, we all make choices. But I'm harping on my perception of the question, "Why do people stay with untrustworthy providers".

At this point I may just be hysterically over here doing my own thing. Carry on. :) Excellent discussion.

[rightkindofme]

Originally Posted by WildKingdom 


I always find it amusing when people say, "Doctors are not Gods!" Yes, doctors are well aware that they are not gods. The reason I find this amusing is because those that say it seem to be most likely to expect doctors to be just like gods. Take, for example, some of the comments that have been made here about doctors not knowing enough about parenting and breastfeeding. Despite my comments about the many hours of training I received, people are still not satisfied that its enough. Kathy feels doctors should be held to a higher standard than all other practitioners. Others seem to want all doctors to be perfect compassionate listeners all the time. Others expect to never receive bad advice.
Wake up people. If you don't want doctors to be treated like gods, then stop expecting them to perform like one.

:( I don't expect doctors to be Gods. But when I go to several OB/GYNs in a row and ask for help with severe vaginal pain during intercourse I was told (I quote): "You need to relax more" "Use some lubricant" and "It doesn't matter how it feels for you anyway--you are just doing it for the man."

I managed to find a lovely dyke. Normally she specialized in incontinence issues (which I don't have) but I saw a picture of her sitting on her Harley in full leathers and I knew I had to see her.

She was the first doctor to seriously look at my vagina. When she did so she and I used a confusing combination of flashlight, mirror, and clear speculum (those things are neat!) to look inside my vagina. She asked me how old I was when the sexual abuse started and how many times I've been raped. I couldn't even answer her because I was crying so hard. My entire vagina is a spiderweb of scar tissue. There isn't an inch of my internal bits that can be visible from the outside that doesn't have multiple scars.

"Just relax more." "It doesn't matter how it feels for you."

The cool doctor helped me. It doesn't hurt anymore. Amusingly the biggest factor in lessoning the pain is I no longer use condoms (woo monogamy) and my husband is intact.

I don't know why I felt the need to drop in that little novel.

Uhm. I suppose to say that yes, there are good doctors. But the ability to go out and pick someone who is going to be a good fit is a great luxury that I have not always had and I greatly treasure about my current life. I see it as one of the biggest privileges I have acquired in moving to the upper middle class from the lowest class.

I think I get a little twitchy about people not perceiving good medical care as a privilege. I have not seen it be a right. It's closer to a crap shoot. Yes, I trust individual doctors--but only after I've done a ridiculous amount of research into that particular doctors pedigree so that I know I am ok with who influenced them.

kathy--I really wish I could do well with just any doctor. The last time I tried to find a GP (it's been a year because my insurance only covers one exam a year and I'm due to try to find another doctor soon) I was told that she wouldn't work with me on my stomach pain or send me to physical therapy for my arms until I dealt with my psychiatric problems. Wouldn't work with me. Then I went to psychiatry and was told that either I start taking this pill she wants me on (I don't remember which one but it has a laundry list of nasty side effects--like they do) and it would necessitate that I stop breastfeeding. Because my kid was over one she was very snotty and dismissive.

She told me that I was "outside the norm" by extended breastfeeding and she would not work with me until I fell into line.

And that was the end of what I could afford to shop for last year. A year later my stomach still hurts and I wrote a book (it's awesome!) and my arms hurt worse.

Almost time to try again. I feel like I'm throwing darts at a dart board with my eyes shut.