Physicians began to actively—very actively!—dislike me. You are supposed to be “compliant,” i.e., sit in the chair, agree with the physician and take the drugs he prescribes. I no longer could. I questioned. In fact, I asked questions to which the physicians had no answers. This upset them. Then they would try to write prescriptions for me.
When I tried to explain how sick drugs made me, they would get mad. Not once did any physician ever acknowledge that I couldn’t take drugs; they said I wouldn’t. Drugs are supposed to make you better but they made me worse. Physicians would not deal with it. They repeatedly cast the problem as one of my cooperation: I wouldn’t take drugs. I was making a choice. I was choosing to not go along with them, never mind that I was choosing health instead of increased sickness.
I began to understand some things about physicians. First, they don’t go to medical school to learn how to treat sick people. They go to medical school to learn how to diagnose known illnesses and to prescribe existing drugs. They have a diagnostic chart and they stand the patient up next to it to see where the patient fits. They are looking at their established set of diagnoses, not at the patient.
Disabuse yourself of the House model. On the television show House, physicians from multiple disciplines gather repeatedly—seemingly every fifteen minutes—to discuss the problem patient with the mysterious symptoms. The physicians kick ideas back and forth, build on one another’s insights, and come up with some new tests. After they’ve done them, the physicians get back together and rehash the whole thing again. In real life, this absolutely positively never ever happens.
In the first place, you have to be taking up a $1000/day hospital bed in order to get any attention. If you are just an outpatient walking into a physician’s office, forget it. In the second place, physicians do not gather in groups over a single patient in the hospital. The admitting physician writes an order requesting a consult. A day or two later, the consult comes and orders his own tests. After the results are in—and are negative—then the admitting physician writes an order for a different specialist to come and take a look. And so it goes. If all my specialists had sat down together to look at what was going on then two things would have happened: first, they might have figured it out; second, the world would have come to an end. The continuation of life as we know it is dependent on physicians never gathering in groups to attend a single patient.
As an outpatient with peculiar problems, the physician would tell me that he either would contact a colleague, or do some reading on my problem, then I would be scheduled for a follow-up appointment a month later. When I got to the appointment it would turn out that the physician had not done any reading or contacted any other physician. He was too busy; he didn’t have time. Actually, he was too busy taking care of the simple cases and wouldn’t make time for the hard one. Why should he? He could see three easy cases in the time it would take him to see me.
One physician actually told me that in ninety percent of the cases he knew before he walked into the treatment room how to treat the patient. With me, even after he walked into the treatment room he didn’t know what to do—and he didn’t research the possibilities. No one is looking at the patient and saying “What is wrong with her?” They are looking at the diagnoses and saying, “Does she fit?” I didn’t, and the more I asked, the madder the physicians got. I was revealing their level of not-knowing; I was forcing them to confront their own ignorance.
They would do the tests for their specialty—lupus, scleroderma, multiple sclerosis, myasthenia gravis, Cushing’s syndrome, Graves’ disease—and the results would come back negative, so they would refer me to somebody else. I dutifully went from one physician to another for several years before I came to terms with the fact that they didn’t know. Except for Dr. Ghaly, every other physician kept stringing me along—well, there was one category of exception: the physicians who flatly told me there was nothing wrong with me.
The fact that they said it didn’t mean it was true. Anybody who walked the walk with me for more than half a day knew darn well there was a lot wrong with me. However, some physicians, faced with their own ignorance, would vehemently tell me there was nothing wrong and I never should darken their doorstep again.
After I learned how physicians approach a patient, then I learned how they react when they can’t write prescriptions: they feel impotent. Physicians live or die by their prescription pads. They exist to order drugs. The typical physician is a one-trick pony: he can prescribe drugs and that is all he can do. When confronted by a patient who can’t take drugs, physicians have no idea what to do. In short, they confront their own impotence—and, boy, you do not want to be in the room when that happens.
(Tomorrow: Doctors with Potent Alternatives)