Guest Post: Question Medical Authority

by Bill Drake

Doctors wear white coats for the same reason that judges wear black robes, cops wear badges and uniforms, the Pope wears funny hats, kings and queens wear crowns, corporate zombies wear suits, and soldiers wear ribbons and medals – they all want you to see that they have authority, and you don’t. This means, among other things, that you are supposed to do what they say, and not ask questions.

It is an extremely rare doctor who welcomes questions from their patients, unless those questions are asking for their advice – certainly questions that challenge their advice are not welcome. However in my experience that is exactly what you have to do every step of the way if you are going to actually be healed of whatever disease or ailment you are suffering from because if you don’t the odds of a successful outcome drop dramatically.

Doctors are busy people and for the most part stopped keeping up with research in their field the moment they left medical school, with the exception of what they gather attending seminars at medical conventions and from the pharmaceutical industry reps who bring them “the latest research” which incidentally involves giving their patients the latest drug their company is pushing. They certainly don’t have time to study research that is outside their field – a gastroenterologist generally has no idea what the latest research in endocrinology shows, and vice versa. If you go to a cardiologist to complain about pains in your chest, sure enough you’ll get that heart of yours tested, but the heart doc will probably never consider the possibility that diaphragm spasms caused by SIBO (small intestinal bacterial overgrowth) is pulling on your heart, or that you have a massive ulcer caused by helicobacter pylori infection in your stomach.

Likewise if you go to a gastroenterologist complaining of certain kinds of gut problems you’ll no doubt be tested for Celiac disease and Crohns, but there’s almost no chance that the gastro guy will order a panel of thyroid tests to see if you have Hashimoto’s Thyroiditis caused by an immune response to gluten in your diet which causes a parallel auto-immune attack on your thyroid. (Wheat gluten and certain tissues in the thyroid have identical molecular structures, so if you have the genetic predisposition to gluten intolerance the immune system considers them the same foreign protein and attacks both.) Even if you have been tested for Gluten intolerance by the usual blood test, that’s no guarantee that your immune system agrees with the test results. Equally unfortunately your thyroid can be under immune system attack and you can have perfectly normal TSH and T4 test results – Hashimoto’s only shows up when you are tested for thyroid antibodies ( 2 separate tests), which most docs simply won’t do without a lot of arm-twisting, for some reason known only to them. The Thyroid antibody tests are certainly cheap enough, even if you are self-pay, and they are definitive. If you have a lot of gut symptoms that don’t yield to conventional diagnosis this might be a possibility for you to explore.

The point is that while doctors are often very good at diagnosing and treating the 80% or so of patients whose problems in fact do lie within the boundaries of their specialty, almost none of them will ever consider stepping outside that specialized area of knowledge to look for linkages. Now, supposedly, that’s where the generalists like GPs and Internal Medicine docs come in – they are supposed to have an overview that gives them a more holistic perspective on you and your health issues. However these docs suffer from the same lack of time ( and personal initiative) to stay on top of all relevant research in all fields so that they can in fact do their job of finding linkages between sets of symptoms that fall under different medical specialties and then send you to the appropriate practitioners in those specialties.

Most doctors would like for you to get better, and they would like to get credit for it, but even more they want to get paid whether they help you or not, and if they try everything they know how to do and you still don’t get better then a subtle shift takes place and they begin sending you semi-concealed but obvious “go away” messages. You become known as a ‘difficult patient’. You are told ‘there’s nothing more we can do for you’. Far too many doctors like to think of themselves as people with a magic kiss that can make the boo-boo go away, and when their magic doesn’t work, it somehow becomes your fault. That’s just human nature at work – but you wind up on the short end of that particular stick.

This is where you come in. Only you have a really pressing reason to spend the time and energy needed to thoroughly research your health issues – you want to get better! However, before you even start doing your own research there are a couple of things that you must do. The first is to find a GP or Internal Medicine doctor who is a good listener and who doesn’t think they know everything. Next you have to understand what kind of information this doctor (any doctor really) will give credibility to, and why. Finally you have to be able to research within the framework of that kind of information and, as you begin to discover what may be wrong with you, you have to know how to approach the doctor with that information.

Let’s take this one step at a time. If you don’t already know a doc who listens and doesn’t think they already know all there is to know, you are going to have to network with your friends and family until you find someone who knows such a doctor, and then you have to get into their practice. Fortunately there are plenty of good docs out there – you just have to sort them out until you find the one who is right for you.

Then you have to get on the internet and find out everything you can about your symptoms. We all know that the internet is full of as much bad information as good, and it’s a matter of using your judgment. In general I would say that web sites that are pushing something are not good sources of information. Discussion groups and moderated forums tend to be much more productive. Finding people who are dealing with the same set of issues and symptoms as you are can be quite helpful. They can help you connect your symptoms with a set of possible diagnoses – but this isn’t information you want to print out and take to your doctor. It’s just the first of two key steps – identifying what might be the cause or causes of your problems.

The next and most critical step is to understand that doctors only accept one kind of medical/scientific information – the kind that comes from peer-reviewed articles in recognized medical journals. This is actually a good thing because it sets a high standard for the authenticity of the information. And here’s where things get really cool!

The National Institutes of Health, an agency of the US government, publishes an online database containing abstracts of over 15 million peer-reviewed articles from recognized medical journals around the world – not just from the US. There are articles from peer-reviewed medical journals from dozens of countries with advanced medical research facilities. The database goes back as far as the 1960s and comes all the way forward to abstracts of articles that haven’t yet been published. Even better, the articles all cite the names of the researchers who did the work and are publishing it, and there are almost always direct email links to the researchers.

So once you’ve done your background research in forums and discussion groups online, you then move to the NIH database and begin using your symptoms, as well as any diagnosis that you think might apply, as key words to troll for medical journal articles where your symptoms are discussed. This can be time-consuming, and you have to be able to understand some pretty high-level scientific/medical language to make sense of what is bring written, but don’t let that discourage you, because these abstracts are almost always written with good clear language, if not exactly layman’s language, and with a little effort you’ll be able to penetrate the language. It also helps (a lot) if you understand elementary statistics, because most of these abstracts discuss their findings using statistical language in the body of the abstract. But even if you don’t understand statistics very well, or at all, don’t despair, because there is always a short paragraph at the end of the abstract called ‘Results’ or ‘Conclusions’ or ‘Findings’ in which everything is summarized in reasonably plain language.

I won’t keep you waiting any longer for the address of this database, which is http://www.ncbi.nlm.nih.gov/sites/entrez?db=pubmed

Once you log on you’ll see a simple search box at the top of the page where you can enter your search terms and go. On the home page you also see a lot of other specialized search options, but stick with the simple search box at the top at first. Once you get into the database you’ll see that the articles are generally arranged with the most recent on top. When you click on an article that looks relevant, you’ll get the abstract of that article but you’ll also get a box on the right hand side of the screen that suggests related articles you may want to investigate. As you proceed with your research, keep a Word document open on your desktop and just drag to select the abstract and its author data, then copy and paste this into your Word doc, which becomes your file of possibly relevant information.

My suggestion would be to spend a little more time once you’ve collected your abstracts and go through them putting the most relevant at the top of the document, saving your doctor the time and trouble of sorting through the information themselves. You are a lot more likely to get even a good, attentive doc’s attention if you hand them a single sheet with a couple of really juicy abstracts rather than a folder full of stuff for them to read. (And don’t forget, the contact email addresses for the researchers are almost always at the top of the abstract, so your doc can be in touch with the authors if they want more detailed information.) Once they have read what you give them, and you get their opinion on whether or not this might be relevant to what you’re dealing with, then is the time to say “Oh by the way, here are some more articles I thought were relevant – I just didn’t want to overwhelm you with all this before we had a chance to look at the ones I thought were most interesting.”

Let me end this foray into how to research your own health issues and find a doctor who is willing to consider information that lies outside their own field of knowledge with a short story on how I came to understand this process.

My wife was diagnosed several years back with a condition called ‘Barrett’s Esophagus’. There was a pre-cancerous lesion in her esophagus where it joins the stomach. The Barrett’s was caused by reflux, which was in turn the result of SIBO (small intestine bacterial overgrowth) which in turn had been caused by an overdose of the wrong kind of a powerful antibiotic for an operation she had, which destroyed the ‘good bacteria’ in her upper GI tract allowing pathogenic bacteria to move upward from her colon where they are normally kept in check by the good bugs in the upper reaches of the gut. The good news, the gastroenterologist told us, is that the lesion is in its very early stages. The bad news, he told us, is that Barrett’s invariably progresses into cancer and at some point we were going to have to take extreme measures including surgery and radiation.

Aren’t there any treatments for Barrett’s in this early stage, we asked. No, he said solemnly, we have no research that gives us any treatment modalities. (They just love to use words like ‘modalities’.) Now, I have since that time learned that when a doctor uses the word “We” he means the entire medical profession, and that is supposed to end the discussion right there, because if the entire profession doesn’t have a cure, then none exists – right?

Neither my wife nor I take that kind of bulls**t for an answer, so we paid the guy’s bill and left. Having been through this before the first thing we did was to log on to PubMed and start looking. At first we kept running into dead ends, but one thing about research is that you simply have to keep trying – shuffle your key words around, re-phrase, come up with new key words, etc. To keep this story short, we finally found a research paper presented in France by a US gastroenterologist whose research was not accepted by his peers in the US but which had attracted the attention of the European medical community. His treatment method was simple and non-invasive, and it used very inexpensive medications, and it worked – over 97% of his female Barrett’s patients had experienced complete remission within three years of beginning treatment, and most had been successful within one year. In retrospect it’s easy to see why his work was rejected by the US gastroenterology establishment – it was simple, inexpensive, and worked without any of their fancy technology and high-priced drugs. Can’t have that, now can we? We tracked this doctor down (he had retired but a nurse in his former clinic put us in touch with him) and he agreed to call our doctor and discuss his treatment with her. They spent an hour on the phone and our doc came back to us and said that his research was impeccable and that we should begin immediately. We did, and it worked. End of story.

I wish that I could promise that every person’s medical dilemma can be cured as simply as this one ultimately was, but of course I can’t. What I can promise is that if you don’t confront and challenge medical authority, and if you don’t understand how to do it effectively, then your chances of being cured go way, way down. Self-treating with alternative medicines and techniques are excellent choices for some people with some health issues, but they are unlikely to be the overall answer especially when you are dealing with serious health issues, so at some point you are probably going to have to take advantage of the best that conventional medicine also has to offer too. When you do, if you are well prepared with the facts in a form that a doctor who is willing to listen can deal with, your chances of successfully recovering your health are far increased. It really is that simple.

Live long, and prosper.

Bill Drake

www.culturaldimensions.net


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8 Comments

  1. I think my biggest complaint with health care is the fact that most doctors have stopped treating the patient and are only treating the symptoms that the patient has. I do whole heartedly agree with you about the fact that we should question the decisions that our doctors make for us. It is in fact our lives that they are working with here. In my military career I have been trained to question everything and leave nothing to chance. Just because they have the education and the diploma on the wall does not put them inside my body. I am the one that knows is certain medical therapy is actually working for me. I think that we do put far to much trust in doctors, they don’t always know what is best for us. We need to be a bigger part of our own health care.

  2. once i went to a doctor for a yearly physical and at the end he asked if there was anything wrong that the physical did not cover – i mentioned that my legs hurt (as they tend to do – seems arthritis from years of sports, as they still do especially when it rains) – without even looking up at me he wrote and handed me a prescription. i stood dumbfounded. i asked what this was – he said take that, but if it is not helping then stop taking it immediately as it is not good for you. i said, so what if that happens?, then what? he wrote and handed me another prescription again without even looking up.

    i then proceeded to chastise him for this behavior and asked him – what if i stand all day on a concrete floor?, what if i need better shoes from a job where i walk all day? what if i play physical sports? shouldn’t you at least ask that before giving me a medication that is not good for me?!? – he finally looked up at me stunned. i tore up the prescriptions and tossed them in the trash and walked out. he never said a thing. i switched doctors immediately after that.

    a few years later i was talking to my then current doctor who was a D.O. so was good with body/joint pain etc – i mentioned that story about the prescription guy… this doctor who i consider a “good” doctor as he looked for reasons or cause of issues etc – he said “just like in all fields in every profession, there are people who graduate at the top of their field and those who barely squeak by – but after graduation they are all a “doctor” (or whatever profession)”

    those words really stuck with me – and now many years later i still think about that and in every day dealings with people for whatever the reason i consider that advice in whatever current situation, whether it be a doctor, plumber, building contractor etc… for so much of our lives we are told to just submit to authority – do what we are told. over time we lose objectiveness and if that person has a white coat, a police uniform, a contractors hat, a mechanic at the brake shop etc – we are conditioned to just stand stupid and feel we have to accept what they say. that ended for me all from that one talk to that “good” doctor.

    all these years later i still see it happen all around me, even my wife still feels she has to accept what she is being told without question – even down to the cashier at the local wal-mart. it’s been years but she’s getting better about it, and learning that we are not sheep and we have free will.

    i feel the economic issues facing our country have awoken the same feelings in many of our citizens – these people of supposed “authority” who have done nothing but screw everything up across the board – still want us to just shut up and do as we are told – while they make the decisions – hopefully our fellow citizens learn a valuable lesson from these past results to such blind obedience and what it has cost us – and hopefully we can correct before it takes an even bigger toll on our country our ourselves.

  3. What a breath of fresh air, I,ve been dealing with the medical industry for the past 12 years, my wife is a brittle diabetic and has been through what I wouldn,t wish on my worst enemy. Frustration is my middle name, just recently I had a nurse tell me “you know why the doctor gives you a hard time, you know too much”. You see I,ve done my homework and have all the right questions, unfortunatly they don,t have the answers. Egos how sad–thanks for the insite for awhile there I thought I was alone, God bless

  4. I have found that there are still some doctors out there who truly care. The Mennonite doctors I go to used to give (LARGE) discounts to patients who pay with cash and do not have insurance. Normally follow-up visits are at no charge.

    They didn’t make their money as doctors. They made their money as farmers, and worked as doctors to help serve the community.

    This was the standard until they were forced to sell the practice to a large “Health Company” that owns most of the medical centers in the area. The prices went up, cash discounts gone, free follow-up visits gone.

    The doctors are now encouraged to send patients for unneeded tests at the laboratory which is (SUPRISE!) owned by the same parent company.

    Make no mistake….”big company” health care scams their patients and the insurance companies…

    Look for small, independently owned family practices. That’s where the doctors are who still care.

  5. There’s nothing wrong in taking responsibility for our own health, but this article was a little too medical profession bashing and demeaning for my taste and not the caliber of writing I commonly see on this blog. To start the article off with the premise that uniforms represent authority and are used to to present superiority to those who aren’t wearing them is a little too far fetched for me. Is someone feeling inferior?

    This is a great blog with positive and useful information. I hope it stays that way.

    • notadoc –

      I understand and apprecate your comments. I think one of the great things about Guest Posts is many different perspectives on different topics can be shown – even some you (or I) may not agree with.

      OK notadoc – stick around – I think some good stuff is coming up – from me and others.

      Take care – Rourke

  6. In 1997 my wife was in a bad car wreck (the other driver was at fault). We didn’t know at the time that she had suffered nerve damage to her spine. Within days of the accident she started suffering from severe pain starting at her neck and traveling down her arm and leg. Month after month of doctors, pain pills, and other treatments failed to stop the cronic pain she was suffering with. In fact after a year and four different doctors a cause for her pain had yet to be pin-pointed. At some point I started doing research on her condition and possible causes and treatments. During this research on the web I came across cronic pain forums and to my shock…… suicide was an oft mentioned escape from the pain because the doctors could not seem to help these cronic pain sufferers. Also I met with considerable resistence from the doctors over my attempts to educate myself about my wifes condition and treatment options. After 14 months of this I was desperate to find help for my wife and met with her then doctor and demanded that he help me find her a doctor who could help her. He gave me 2 names and said that 1 doctor in particular was more aggressive in his treatments. We saw him and thank god we did. He ordered a test and after she went through it the x-rays showed the damage. when we talked about treatment options he was surprised at my level of knowledge and encouraged my involvement in the decisions of her treatment steps. In a shot time she received a medtronic inplant that blocks the pain signal from reaching the brain and it has worked like a dream.
    You must take control of your own treatment (you are your biggest advocate) and keep looking till you find help that you trust and believe in.

  7. Both of us like our dr, but apparently so do many others, for it’s difficult to get an appointment with him within what we consider to be a decent time frame, but depending on the medical situation, we might get worked in, so that’s nice. He does listen, closely most times, although perhaps him knowing I’m a nurse might make a difference (even if it’s been a few years since I’ve worked).

    He is quick to write prescriptions though; he prescribed statins to DH before the lipids profile was even done, based only on his age! I told him no way DH was taking those, unless his lipids were elevated enough that diet/lifestyle changes couldn’t touch, and then only if he took a CoQ10 along with the statin. I don’t think I came off as bossy, as much as a freaked out wife that didn’t want her hubby suffering side-effects unless it was medically necessary. He didn’t seem offended, in fact I believe he might have been a bit amused.

    Last time I sent DH in, the dr ordered a Vit D level, and the lab sheet even said to take X amount of Vit D to bring his levels up, which I thought was awesome because DH wouldn’t take the Vit D’s I was trying to get him to take.

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