"Removing Gloves" - Joe Wilder, M.D., Dartmouth College '42
What makes your doctor’s education unique from that of other health care providers?
Recently, I was sitting in on a lecture by one of my favorite physician-teachers (certainly my favorite neurologist). I’ll call him Dr. Deeds (for his resemblance to a character from the movie, Mr. Deeds). He was giving a sort of broad, generalized lecture to prepare us for a series of lectures on neurodegenerative diseases (Parkinson’s, Alzheimers, and the like).
Medical students are busy, and under constant pressure to memorize and apply knowledge in short periods of time, while maintaining busy schedules filled with research activities and a blend of simulated and actual patient encounters. Appreciate the picture I’m trying to paint for you – by all means, this should have been one of those lectures that made us wish we stayed home or went to the library to catch up on work. Instead, it wound up being a potent reminder of why I decided I wanted to spend my life learning & practicing medicine.
Dr. Deeds went off on a tangent about apoptosis and caspases, which seemed better suited for a lecture to first year medical students (who learn largely about processes at the cellular & biochemical level), but pulled it together with one of the best quotes I’ve ever witnessed in the field of medicine:
“. . .Now, the reason for understanding [these] pathways is that, if you just know medicine and you say ‘Okay, I’m gonna take this drug and give it to so-and-so who has [a] headache, and the headache is gonna improve,’ you’re no better than my grandmother, who was a ‘certified healer.’ She had only a third grade education, and she knew all about herbals and [pharmacopoeia] and all that. People would come [to her] and she would perform a ritual and give them [some] Willow bark to boil and then drink the water. Willow bark, as you know, has a lot of [aspirin] in it, and if someone had a terrible headache or pain and they drank that, they got better.
And the reason for that, it was sort of an empirical medicine – she knew that this thing [was] gonna work for this, and she was very good at it, in fact. But the difference between you, who pay $250,000 for your education, and you [go through] residency, and torture yourself through this, and her who had only a third grade education, is that you know these sequences of pathophysiology. Okay? And [in] these sequences of pathophysiology . . . at each point of understanding, you have an opportunity for intervention. Right? And you say, ‘I’m gonna choose this drug that’s gonna block this pathway, or activate this pathway, and as a consequence I can fix this disease. . .”
I’ve been meaning to write an article on the complexity of disease and why we can sometimes only hope to slow the progression of certain processes with our current understanding and treatment options. The idea came to me while reading some critical reader comments on a medical news article – it’s disheartening to see such a large number of people be so skeptical of doctors (whether they think they’re liars or in bed with the pharmaceutical companies, it doesn’t matter).
The problem is multifaceted – science and health literacy in America are dismal, and with credulity abound (credulity toward anything but “Western medicine,” that is), there is far too much room for people to be swayed by misinformation. We in the health care system are also to blame – seldom do we have the time (or patience!) to explain the disease process to our patients (who deserve nothing less). We also have a difficult time admitting when we don’t know the answer to something (whether that’s a common personality fault, a product of the system we work in, or a result of our training, I can’t say). The role of the media is also important, as are many other factors, but I’ll spare you and return to my point:
I oftentimes feel that if we helped people to just grasp how modern medicine works – what doctors do, and how they make decisions based on evidence – that there might be some hope in salvaging the cherished doctor-patient relationship that is threatened by the growing anti-medical rhetoric, opportunistic “alternative medicine” practitioners, and fallacious & misinformative resources (both in print and on the web).
“Be careful about reading health books. You may die of a misprint.”
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-Mark Twain
Steven Davidson
February 14, 2011
My Dad, an internist-gastroenterologist, taught that “Physiology is Medicine” and coming to medical school from a physical-chemistry honors and research lab undergraduate program, I was totally prepared and gloried in the building of this level of understanding.
I admire you for pursuing it still, though the quantity of detail is even more daunting nearly four decades later. Today, I settle for intervening in the processes of people (clinicians, technicians, administrators, et. al.) working together in the care of patients and the communities they come from.
Jim
February 14, 2011
Steven,
My friends and I joke sometimes (read: often) that it would have been nice to have been born 50 or 60 years earlier, just so we wouldn’t have to know as much – so I appreciate the nod.
With an undergrad background in public health, and about 4 years as a personal trainer, I really value personal & community intervention. I was discussing this piece earlier and mentioned that the above philosophy also contributes to our (perhaps) over-reliance on pharmacotherapy.
It’s easy to get caught up in the mindset: “What drug do I use for this again?”
Tony
August 25, 2011
Great blog. And I like the article too. I agree that’s it is important to know why we do what we do and I personally really enjoy teaching my parents how their body works. Often, however, I come across treatments provided by practitioners from other theoretical basis than mine. When these work I encourage my patients to pursue them.
I’ve frequently found this causes great consternation among my colleagues. Allopathy seems to come with a double helping of hubris. I never venture to explain to my patients why the acupuncture works, I don’t know and tell them so. But nothing destroys that relationship you’re talking about faster than playing the “know it all” card.