Most doctors are highly intelligent, morally good people. It takes a ton of work and dedication to become a physician, and my guess is that most of them have, as one of the main motivations for doing so, the helping of other people. My own father was a doctor, albeit of a very old school type. (That’s a photo of him on the right.) So my purpose in this piece isn’t to cast aspersions on doctors as morally reprehensible or untrustworthy, but to show why their interests aren’t necessarily aligned with yours, and how the modern medical system has corrupted the practice of medicine.
As part of Obamacare, it was mandated that physicians maintain electronic health records, which can be and are readily transmitted out of the doctor’s office or clinic.
Even before the advent of electronic health records, I realized that telling a doctor anything the least pertinent was put down in writing. Thus, if your doctor asks you if you’ve ever used marijuana, and you answer in the affirmative, your statement is as permanent as if you had sworn it in front of a judge.
The same goes for all kinds of facts about you: whether you’ve ever had a problem with alcohol, been depressed, had marital problems, been in a fight, had a sexually transmitted illness, and so on.
These days in some states, doctors will ask you if you have a gun in your house. There have also been moves to remove guns from people who have been depressed, the logic being that they’re mentally ill and are incompetent to own a gun.
Do you really want something as sensitive as, say, alcohol use, to follow you around the rest of your days? Will it be used to deny you a job or insurance? In my view, those are outcomes that are probable.
Do you want your guns confiscated because you told the doctor something?
In my opinion, little good can come from being as open and honest as your doctor wants you to be.
What about his differential diagnosis? He needs to ask you lots of things to determine your diagnosis, and if you withhold information, then your treatment may be compromised.
Unfortunately, this is just the cost of doing business. You will have to determine whether what you say is relevant, damaging to you, or both.
Personally, I have a good enough grasp of these things to understand. If I were drinking a bottle of whisky every day and developed liver problems, I don’t need a doctor to tell me to quit drinking.
While the Electronic Health Record doesn’t directly impact how a doctor treats his patients, two others, the influence of drug companies and the standard of care, both of which are related, do.
The relentless promotion of drugs by pharmaceutical companies has worked. Two good examples of this are SSRIs for depression, and statins for heart disease and/or lowering cholesterol.
If there’s anything the medical profession got as wrong as cholesterol causing heart disease, I’m not sure what it is. But in any case, statins have become some of the most prescribed drugs around because doctors think cholesterol should be lowered.
Yet not only are statins ineffective and may actually cause heart disease, they come with a long list of side effects. Some doctors have semi-seriously advocated putting statins in the water supply. If you’re a middle-aged or older man, chances are very good that a doctor will want you on a statin. In fact, I know a 25-year-old man whose doctor recently suggested a statin for him. (I think he probably has NAFLD.)
The problem is not just your odds of getting a statin; the problem is larger than that: it’s the standard of care.
The standard of care:
1. A diagnostic and treatment process that a clinician should follow for a certain type of patient, illness, or clinical circumstance.
2. In legal terms, the level at which the average, prudent provider in a given community would practice. It is how similarly qualified practitioners would have managed the patient’s care under the same or similar circumstances. The medical malpractice plaintiff must establish the appropriate standard of care and demonstrate that the standard of care has been breached.
Statins for high cholesterol have become part of the standard of care. That means that if you go to a doctor, have high cholesterol, and subsequently have a heart attack, the doctor can be sued if he didn’t prescribe you a statin.
The doctor’s hands are effectively tied.
The same strictures even apply to cancer treatment. Dr. Mercola tells the story of a man who self-cured his brain cancer by evading his doctors. One thing he didn’t do was tell any of what he was doing to his oncologist.
If you go in for a checkup, and your cholesterol is high, you may be offered a statin. (Happened to me.) If you refuse a statin, you may hear from your insurance company wondering why you’re not refilling your prescriptions.
Not too many years ago I was covered by my employer’s health insurance, and I followed the standard practice of seeing a doctor relatively often. I have a chronic condition, hypothyroidism, that requires testing and prescriptions every so often, and over the course of a few years had a few other health problems.
When I got laid off from my job, I applied to continue my insurance coverage with the same medical provider.
It was denied. On the denial letter, the provider listed all of the ailments that I had been treated for over several years as reasons for denying coverage. (I’m not sure what the current state of Obamacare and medical insurance is, but that was the case at the time.)
So, if I hadn’t told anyone of my ailments, I wouldn’t have been denied insurance. This is another reason to keep your mouth shut.
If I go to a doctor now, I’ll say “Doc, I have a fever [or whatever symptom].” I don’t think I’d volunteer much else.
It will not came as news that doctors are not omniscient. Some of them are not even scient.
They are prejudiced against natural treatments and may not know about them.
If you have something like Lyme disease or chronic fatigue, you’ll even find most of the profession lined up against you or calling you a liar or a malingerer.
I had a doctor tell me – after remarking that I was in very good shape – that weightlifting wasn’t good enough and that I had to add cardio to my routine.
Doctors know little and care less about diet and exercise, which ought to be the first treatment option for a chronic illness.
Many doctors think surgery or other radical treatments are perfectly ordinary and acceptable and will quickly recommend them to their patients. Doctors used to regularly remove tonsils. They performed lobotomies. They don’t know about excess iron. They prescribe insulin instead of a low-carb diet and weight loss for type 2 diabetics. The list goes on.
If you want competent medical treatment in this day and age, being well-informed is a must. You can get some understanding of your condition and use a doctor for his gate-keeping function. Fortunately, the internet has made that much easier.
Doctors hate well-informed patients. They don’t like being shown up or questioned too closely.
In the old days, we thought of the police as trustworthy authority figures who were only trying to help. Undoubtedly many of them are, but a healthy skepticism should be the watchword when dealing with them. Don’t tell them more than they need to know – or don’t talk to them at all.
Unfortunately, another of our once-trusted institutions, medicine, is also less trustworthy now. In many ways, doctors perform absolute miracles compared to what they could do only a few years ago. But they now also have the government peering over their shoulders, and they are constantly on the lookout for potential malpractice lawsuits. Add to these their preference for drugs and surgery and going to see a doctor means exposing yourself to harmful and/or ineffective treatments, and government surveillance.
The problem here is a subset of the principal-agent problem: when you hire someone to do a job for you, whether it’s managing your company or treating your illness, his interests are not necessarily the same as yours, and in some aspects may even be opposed to ours.
You just can’t naively see a doctor and expect everything to turn out for the best.