The Practice of Adversarial Medicine

Hippocratic-oathby Anniel   8/15/14
“Never trust your patients, they always lie to their doctors.”House, M.D., played on TV by Hugh Laurie.  •  The Hippocratic Oath, the older version of which reads: “First Do No Harm”, is regularly trampled by doctors like Ezekiel Emanuel, the President’s Medical Advisor, and others who have brazenly called for doctors not to take the Hippocratic Oath too seriously. The oath, like the Constitution, appears to be hopelessly outdated to them. Emanuel says doctors need to be more conscious of the social and financial aspects of medical treatment. Death Panels would be one of his specialties.

The most destructive of all forms of medicine, is what what I choose to call “Adversarial Medicine.” After watching an episode of House, M.D. with other parents at a Ronald McDonald House, we laughed at the assertion that patient’s lie to their doctors. Our thought was, “Why would we do that?”

Well, there are doctors who believe that patients do lie. And some of them are teaching physicians passing on the tradition. Our family’s first encounter with the approach was shocking to us, and what follows is a sample of how such physicians work: The doctor meets the patient for the first time, shakes his or her hand, asks, “What can I do for you?” Then proceeds to aggressively challenge what the patient says, calls his or her symptoms silly, and/or does a cursory exam while not paying attention to the patient at all. If a parent and child are involved the parent may be marginalized completely by sneering references to their assertions about the child. If a parent claims knowledge of a family illness, he or she may be told, “This isn’t about you.” And Munchausen’s Syndrome by Proxy can rear its ugly head at any time.

This approach places the patient and/or parent in a defensive and angry position, making it difficult to convey the full extent of the problems, which sometimes feels like that’s what the doctor wants. Plus one wonders if the whole thing is an ego or power trip.

The case of Justina Pelletier is an example of physicians and hospitals who allow such medical over reach, and shows the arrogance that adds fuel to such conflicts. How any medical person involved in such a case can live with themselves is a mystery.

My family has been afflicted by genetic illnesses for at least five generations, so I am well aware of medical issues. My paternal grandmother brought pesky disorders to our gene pool, which followed through to my father, his brother and three half-sisters, then to me and at least one brother. Now both of my daughters and two grandsons are afflicted. It has been a long journey discovering all of the permutations of these conditions, and a large part of that journey has been discovering the strengths and weaknesses of the American medical establishment. For a patient to be treated as a fool or a liar is a terrible injustice that creates untold emotional havoc.

Americans tend to think in terms of our “great” doctors and medical care. We think all doctors are intelligent, caring, kind, and self-sacrificing, and many of them are just that. But many are mediocre at best, and some of them are horrible. They probably have their own bell curve. Depending upon your need, it might be just the luck of the draw which you will get.

My husband frequently reminds me that if you go to a doctor for a relatively minor problem and he hands you a prescription that cures you, then you think he’s a great doctor. It is only when your problem is serious or even rare and hard to diagnose that you may find him to be less than stellar.

I don’t wish to come across as overly pessimistic about the future, but even without the specter of ObamaCare hanging over our heads, real changes need to be made in what passes for medical care in many facilities.

A Teaching Physician I know well told me a few years ago that the doctors currently being trained are, for the most part, not very good. He thinks we are reaping the results of students who were reared on “self esteem” by parents who coddled them, never demanded much of them, and always told them they were smart and wonderful. They also attended schools where they were never held to any rigorous standards so they came away believing they could do no wrong. Now the student doctors also have unions controlling the terms of their training and limiting how many hours they can work. So if a resident walks off in the middle of a surgery? Hey, his hours are up, what’s the big deal? Call someone else to come in and scrub.

You may not think such things happen, but they do. Once our daughter had a rather minor surgery scheduled at 6:30 A.M. It was supposed to take about two or three hours, but complications developed and her operation lasted until 10:30 P.M. She turned out to be the only patient for the day, and the residents did have to change out in mid-surgery.

Affirmative action is alive and well, too, so instructors can be accused of racism, sexism, the whole gamut of victimology if they try to discipline a resident or fellow. It takes a strong Teaching Physician to stand up to the pressures put on them.

My Teaching Physician friend says we will look back soon and realize that the “golden age” of American medicine has passed. Now, especially with ObamaCare in the mix, I fear he is right.

Maybe we should turn the tables and not trust the adversarial doctors because they always lie to their patients. Be very careful if you meet such an adversary and be prepared to fight for your rights.

We can always pray ObamaCare finally collapses and something better arises from the rubble. • (1677 views)

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10 Responses to The Practice of Adversarial Medicine

  1. Timothy Lane says:

    Since avant-garde physicians increasingly are comfortable dealing out death instead of life (which is why I consider the movie Coma to be no longer fiction), I have suggested that we switch the Hippocratic Oath to another named after their more recent inspiration: the Mengelaic Oath.

    • Rosalys says:

      I have suggested that we switch the Hippocratic Oath to another…

      How about the Hypocritical Oath.

      • Timothy Lane says:

        You do recognize the significance of the name Mengele, don’t you? I can’t think of any worse name. (Even more appropriate would be the German doctor in charge of the euthanasia program, but he isn’t well known, as indicated by the fact that I don’t recall the name.)

        • Kung Fu Zu Kung Fu Zu says:

          Philipp Bouhler and Karl Brandt were in charge of the euthanasia program which targeted the mentally ill and handicapped.

          The program was started some years before WWII broke out and can be seen as something of a practice run for the final solution.

          Sounds like something not to far from Death Panels which have heard about, except in addition to the handicapped, there will be lots of old people who will be sacrificed for the good of the party, uh, I mean country.

          All that is missing is the right type of doctors who will follow the examples of Bouhler and Brandt.

          • Timothy Lane says:

            I’ve thought for some time that liberals owe some sort of retroactive apology for executing Wilhelm Frick at Nuremberg, since the euthanasia program was most likely the main reason for his death sentence.

        • Rosalys says:

          Yes, I know about “Doctor” Mengele and it is probably a more descriptive name. I just thought Hypocritical Oath was a nice play on words.

          • Timothy Lane says:

            As an incorrigible punster myself (the traditional command about such people is “do not incorrige”), I certainly can’t quibble about that. But comparing liberal notions of Mengele just seems so appropriate.

  2. We, too, have been down that road of abusive medicine — doctors who had confused “telling the truth” with being as brutal and caustic as possible. I realized early on the my husband was not only fighting cancer, but he was also fighting the medical community. Now, almost 5 years down the road, it appears that we’ve won the battle; we were fortunate in being able to go to another city, another hospital and another doctor. God is good.

  3. Rosalys says:

    You must remember (as a friend told me recently) that 50% of doctors were in the bottom half of their class!

  4. Brad Nelson Brad Nelson says:

    A Teaching Physician I know well told me a few years ago that the doctors currently being trained are, for the most part, not very good. He thinks we are reaping the results of students who were reared on “self esteem” by parents who coddled them, never demanded much of them, and always told them they were smart and wonderful.

    I absolutely believe this will be an increasing culture-wide phenomenon. It’s inevitable.

    Affirmative action is alive and well, too, so instructors can be accused of racism, sexism, the whole gamut of victimology if they try to discipline a resident or fellow. It takes a strong Teaching Physician to stand up to the pressures put on them.

    Yep. Instead of merit it matters what your skin color is. And I thought we were the victors over the Nazis in WWII and put that behind us. They have just popped up elsewhere.

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