Three reasons not to trust your doctor

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.

Electronic health records

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.

The influence of Big Pharma and the Standard of Care

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.

Insurance

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.

Ignorance

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.

Conclusion

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.

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Leave a Comment:

15 comments
mommadoc says April 10, 2016

I understand your reluctance to give your history to a physician, but let me not sugar coat this–if you need medial care, you need to give your health history to your physician if you expect the best diagnosis and outcome. You could die if don’t give it your anesthesiologist if need surgery.
Just sayin’
You are a bright guy, but this is about as stupid a post as I’ve ever read. Pick your primary care doctor carefully, to make sure s/he appreciates the huge role diet plays in our health; but don’t be an idiot and think you can keep information from your doctor and expect to get good care.

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Teapartydoc says April 10, 2016

The solution is to abolish medical licensing.

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Randall Parker says April 10, 2016

You could travel abroad for vacation to the same place a couple of times a year and see a regular doctor there. Difficult I know.

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Dave says April 10, 2016

Questions about alcohol use, drug use, and gun ownership have nothing to do with the ankle injury I’m seeing the doctor for. Therefore I don’t drink, I have no other medications, and I never owned a gun.

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Simon says April 11, 2016

Off topic, but still relevant to this blog: man playing hockey at the ripe age of 94. www. youtube.com/watch?v=jTgkNULABSU

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Joc says April 11, 2016

Off topic question: does eating salt during fasting disrupt the benefits of fasting in anyway? And whats your overall opinion on optimal salt intake?

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    P. D. Mangan says April 11, 2016

    Hi Joc, no, salt doesn’t impede the benefits of fasting at all. As for optimal intake, most studies have shown that lowering salt intake results in worse health. If you don’t eat many high-salt processed foods, which you shouldn’t, then feel free to salt food as much as you want.

    Reply
Dusan says April 11, 2016

Bill Burr on lying to your doctor and insurance companies collecting info on you (starts at about 5 mintues) https://soundcloud.com/themonday-morning-podcast

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George Ironthumb says April 13, 2016

@Mangan-
” (That’s a photo of him on the right.) ”
I don’t see any photo, man…only the photo of you on the sidebar? Is it just me?

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George Ironthumb says April 13, 2016

On a side note, I wish there is a real doctor like Dr. House, you know the series?
Badass doctor who doesn’t care about rules, will bend anything for the challenge of healing you.

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Ollie says April 13, 2016

The same could apply for veterinarians too.
I had a dog with an unknown spinal injury causing rapid onset paralysis. The bastards wanted over $5K for surgical treatment and refused to offer a myelogram unless I signed off on the surgery. Needless to say, I opted for a run of steroids and 2 days observation, instead. The docs prescribed a three week regimen of prednisone, which after only 3 days, led to profuse intestinal bleeding. The instructions were to discontinue the corticosteroid, and treat the bleeding with a regimen of sucralfate, and metronidazole for a week, and then (this is the bad part) get my dog back onto the prednisone. I followed through with the antibiotics, but avoided restarting the prednisone, instead opting for a heavily tapered regimen of high dose fish oil and curcumin.
https://www.sciencedaily.com/releases/2012/06/120626113930.htm
http://www.cnn.com/2014/01/18/health/fish-oil-recovery/

Now, I have no doubt that the initial run of prednisone may have saved my dogs spine, but the continued administration of it betrays a lack of understanding of the drug’s actual mechanism of action in the event of acute nerve injury. What prednisone does that is actually useful in traumatic spinal cord injury, is prevent the secondary ischemic damage to spinal cord tissue that results as a result of lipid peroxidation. In other words, while prednisone is primarily characterized in clinical use by its abilities as an anti-inflammatory (via its role as a glucocorticoid receptor agonist), in this case, it’s the drug’s secondary function as an antioxidant (and importantly, one capable of quickly getting into spinal tissue) that is getting the job done. From a 2004 paper on the subject:

“Inhibition of post-traumatic lipid peroxidation appears
to be the principal neuroprotective mechanism and this
is unrelated to glucocorticoid receptor-mediated actions”

http://link.springer.com/article/10.1602%2Fneurorx.1.1.80

Prednisone is useful, but only if it is applied within a relatively short window (8 hours or so) following the injury. http://www.neuralrepairinstitute.org/methylprednisolone.html
https://tspace.library.utoronto.ca/retrieve/4146/is04038.pdf

After that window, its effectiveness at preserving function/tissue dramatically tapers off.

I suppose the vet has a rationale for the prescription in terms of anti-inflammatory function, but with its extensive side effects, prednisone is a poor choice.

Nevertheless, this example shows that:
1. It pays to understand the mechanism of harm in one’s illness, as well as the mechanism of action behind the
drugs/treatment prescribed.
2. Medical professionals know a lot, but they are not infallible gods.

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Doesn't Matter says April 18, 2016

No need to publish this. Your website is the only site I check on a regular basis that doesn’s display properly: right sidebar items but blank space to the left then the opposite when sidebar ends: main article on left but nothing to the right.

Checked with latest versions commodo dragon, commodo ice dragon, internet explorer, sea monkey and recent versions of firefox and palemoon.

Reply
    P. D. Mangan says April 18, 2016

    Don’t know what to say. Everything looks fine to me in Chrome via Windows and Android, also on Kindle Fire browser.

    Reply
Weekly Roundup #18 - Charles Sledge says July 15, 2016

[…] P.D. Mangan’s “Three Reasons Not To Trust Your Doctor” […]

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