From: sbharris@ix.netcom.com(Steven B. Harris) Newsgroups: sci.med Subject: Re: Gregory demonstrates that Medical denial is a reality! Date: 13 May 1999 09:44:04 GMT In <3739BCCA.61FD799A@Mindspring.com> Jim <JDBarron@Mindspring.com> writes: >> And I note that you didn't get Harris's silly response to the above >> either. My problems are rilly important to me, yours to you, and, >> collectively, funny to someone else. Such is life. Find something >> to laugh at. Try starting with yourself. Then go after me or >> anyone else (hint) who vexes you. lol, hd Yep. Or as a friend of mine once observed: "Laugh, and the world laughs with you; cry and the world laughs AT you." One of the privileges of a life in medicine is that you get to see people dealing with some of the worst situations imaginable, and get to see how human beings got to be where we are on this planet. In short, we got here because we are really tough, nasty, courageous and resourceful critters, even if we are more than a little wierd looking. When things get bad, all those survival genes are there, and the average person is often found to be just as resilient as they need to be. Which makes it all the more outrageous to see emotional decompensation and complete irrationality in people who by comparison with people who are dealing with things just fine, have no medical problems at all. What can you do but shake your head at the oddness of it? I've seen people get more upset by hospital food than by the news that they have a skull fracture and CSF leaking from their cribiform plate through the nose. I've seen people having acute MIs, who knew they were having MIs, crack jokes and be philosophical. I've seen people who had to wait an extra 10 minutes for an office appointment practically beet red with hysteria. I've had affluent people so selfish that they expect me to fill out 10 prescriptions in triplicate so that they can have a set to send to Florida for a 10% discount, another set to use while waiting, and a third to try at the Air Force Base pharmacy to see what they can get there. And I've had families of people who just died, and who are still in shock, look concerned for me and say I looked tired. I once had an elderly lady, who was in dire danger of going into cardiac arrest from a saddle pulmonary embolism and knew it, and while lying in an ICU bed gasping for oxygen while we started the TPA, comment on my nice tie. That kind of thing changes you. In medicine 10% of the patients have 90% of the problems, but they don't have 90% of the anger and the fear and denial and the obnoxious behavior. That kind of thing, by contrast, seems distributed almost completely independently of objective pathophysiology. If I had a graph of disease seriousness vs. emotional distress in medicine, I don't know if I could even draw a line with even a good r value. The Buddha would say that a good fraction of pain and all of suffering is only what we manufacture for themselves. Alas, only the Buddha can get away with saying it. Nobody else is supposed to notice. We doctors in particular are forever accused of thinking that 90% of our patients' problems are in their heads. How did we get that idea? Obviously something they told us in medical school. Some pernicious idea that stuck, dispite all evidence to the contrary. Yeah, that's it. Can't be anything to do with the *job.* -- Puddin'head Wilson From: sbharris@ix.netcom.com(Steven B. Harris) Newsgroups: sci.med Subject: Re: Gregory demonstrates that Medical denial is a reality! Date: 13 May 1999 20:37:21 GMT In <373ade8e.47179079@news.tiac.net> cgregory@gw-tech.com (Carey Gregory) writes: >I think what often leads patients to become disgruntled is when they >perceive a huge, life-threatening crisis and the medical people they >see do not. The patient who is indeed dying is usually recognized as >such and greeted with rapid, aggressive care. All the stops get >pulled out and they're relieved they were treated with such fervor. >They come away saying "That doctor saved my life." > >But the fellow who had too many chili dogs comes away disgruntled that >his "heart attack" seemed to elicit mainly boredom from the emergency >room staff. It's hard for him to understand why his pending death >didn't elicit all those exciting scenes from "ER" as it should. After >all, it's often the first REAL fear of death he's ever experienced, >and he's furious that everyone around him isn't alarmed. "Can't they >see I'm dying?! Where the hell is the doctor?! And that bitch of a >nurse damn only cared about my insurance. Damn doctors! They're >arrogant bastards only in it for the money." > >Meanwhile, in the next room, someone's grandmother is lying there >quietly, politely dying, terrified, but complimenting Steve's tie and >telling the nurse what a nice young lady she is. All in all, I can't >remember seeing a patient die angry at the care they received, but >I've seen quite a few go home fuming about the bottle of Maalox they >got. Yes, you're probaby right. Somewhere in E. Hoffer's _The Ordeal of Change_ (which, as with _The True Believer_, is a wonderfully wise book), he makes the point that revolutions historically seem not to happen when people are worst off. Rather they happen when people's fortunes are rising most rapidly, and they can see the good life coming, and are impatient (as before the French revolution). It's the gap between *expectation* and reality that jerk's people's chains, not the absolute reality. The thing that gets people in medicine is not so much the absolute level of care, but the gap between what they get and and what they think they are going to get. Which is to say, people hate surprises. And when they are anxious about something else, they REALLY hate surprises. One could view this as the kind of provincialism which makes the U.S. tourist supposedly such a terror: in this case these folks are visiting a foreign country called Medicalandia, where they don't speak the language, there is no tipping, and they've got only the packaged, cut rate tour (the one that includes the terrorists, wups). Medical shows on television don't help much, since they all seem to show the equivalent of polite Parisian waiters, reserved Italian men, and smiling Russians with good teeth. What's left to do but scream to high Heaven when reality turns out differently? On the other hand, perhaps the great secret of the Canadian and British systems is that they are UNIFORM, and people in those countries know that wereever they are they in that country, they can expect a certain thing from medicine, just as when you go to McDonald's in Peoria or Ft. Huachuca or Boston or Weedpatch, California. As the guy says in _Memphis Belle_, that's comforting. It's comforting even if the food isn't fancy. What we've forgotten (and which "alternative medicine" reminds us), is that in medicine, relief of anxiety is 75% of the treatment. At least. |