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.