Chapter 12: “An Undertaker’s Dozen”
Thirteen doctor failings that can kill you.
Chapter Summary:
Based on what I have observed over 30 years’ of medical practice and in discussing these issues at well over 500 monthly mortality and morbidity conferences with fellow physicians, the thirteen things listed here arise as the most serious problems that can spell a lethal outcome for you, the patient. I list and describe them briefly. In one respect they all seem so self-evident. It is a wonder they ever happen. But they do and they are not a failure so much of a doctor’s intelligence, rather they result from too little time with a patient, poor communication, the handcuffing of the doctor by insurance number crunchers and all the other issues talked about in this book. Read these lethal practices each and every time you pay a visit to your doctor and do not be afraid to ask questions about them whenever you have any doubts. This could save your life.
I've given you some positive indicators of a good doctor. Now, let's look at an incompetent doctor and some of the bad habits that are ingrained in his daily practice. I emphasize again that these faults are not due to a poor education or a lack of scientific knowledge. They are caused by laziness, callousness, greed and similar character deficiencies. They cannot be discovered by certifying examinations or licensing boards, but you can pick them up simply by following the general principles established in this book, and by observing your doctor's behavior closely.
Each of the following thirteen bad habits can be lethal. Most of them are easy to detect if you look for them and ask a few pertinent questions. Let's take them one at a time—be sure you review them before and after each visit to your doctor.
1. Treating symptoms, not diseases
I am sure you know that pain is a symptom of some underlying disease. It just doesn't happen without a reason. You also know that painkillers do not remove the cause of the pain. Relieving the pain without looking for its cause creates a potentially dangerous situation. That's why the instructions on the aspirin bottle warn: “If pain persists, see your doctor.”
Most of the aches, pains and feelings of illness that affect you are symptoms of an underlying derangement called a disease. The disease may be simple and short-lived. If detected early, it is easily cured or at least controlled to the point of minimizing damage. Some illnesses, which we call latent, cause no symptoms for a long time. Left undetected, they can cause serious damage without your being even slightly aware of their existence. Cancer, in all its horrible species, is a perfect example.
Under no circumstances should a physician persevere in treating symptoms without a thorough search for the underlying disease. To do so is a completely irresponsible act and leaves you no better off than if you had sought relief by purchasing a nonprescription drug. In fact you're worse off. At least when you tried your own treatment, instinct told you not to persevere beyond a certain point.
That's why you finally decided to see a doctor. By treating symptoms only, your doctor is putting his seal of approval on your illness. He's telling you the symptoms mean nothing serious and will go away with the prescription he has given you.
He is also compounding the problem because the drugs he uses are usually more potent than those you can get on your own, and these can cause their own problems. You could end up worse off with an incompetent doctor than if you had continued treating yourself!
You can easily figure out if your physician is treating symptoms only. Just bear in mind some of the principles you have learned already, especially: Good doctors are good teachers. A good doctor works hard.
Let's take an example. Suppose you visit your doctor because you have had diarrhea for four weeks. The cause may be simple and innocuous, such as an irritable bowel. But the diarrhea could also be a warning sign of cancer or a serious form of colitis. An incompetent physician is liable to give you an incomplete examination, rush you through an abbreviated history and prescribe a medication to stop the diarrhea. Or, at best, he may get one X-ray of your intestine, find that it's normal, and then give you a simple medication to eliminate the symptoms.
A good doctor works hard. Diagnosis almost never comes easy. It takes time, effort, and perseverance. A good doctor will question you at length about the diarrhea. When did it start? Is it getting worse? How many bowel movements a day? Do they contain blood or mucous? Have your bowel movements been at all formed or are they loose and watery? Any abdominal cramps associated with the diarrhea? Any other associated symptoms? Any weight loss? Have you ever had similar symptoms in the past? Any colitis or intestinal cancer in your family? And on and on.
This line of questioning may take fifteen minutes or so and may be repeated during subsequent visits, differing in details as more information becomes available.
Next, your doctor will carry out a thorough physical examination emphasizing, but not limited to, the digestive system.
At the end of the interview and examination, a good doctor will sit with you and explain his thought process. This is the teaching part of good medicine. He may not have arrived at a diagnosis. But he has some ideas, some clues that he must follow. He may give you a list of possible explanations for your diarrhea. This approach, called the differential diagnosis, leads to certain appropriate tests.
A competent physician will then outline these tests—X-rays and other special examinations that he recommends to help him arrive at a more specific diagnosis. He is looking for the underlying cause—the disease responsible for your diarrhea. He will explain the nature, risks, and costs of these examinations and, if you've agreed to have them, he will make an appointment for you and ask you to return later for a second evaluation. While waiting for the results of these tests, it is proper for your doctor to start you on a drug in an effort to control your uncomfortable symptoms until he can make his diagnosis. This is not the same as if he were treating only your symptoms.
There is nothing mysterious about the diagnostic process carried out by the conscientious physician and you should feel a part of it. It takes time and effort. It involves an interview, an examination, a discussion, a scheduling of special tests and a reevaluation.
|