I wonder about the difference in perspectives on medicine having been a doc trained during the pandemic. I see a frame shift in my generation, a sense of humility. I inherit patients from older doctors and see a different practice style, and ideal of manipulating people’s physiology to control disease, to treat sensations.
I was trained during a time where we realized medicine is largely helpless. I began my residency during normal times, watched a global pandemic decimate the healthcare system, kill off a portion of the population while researchers desperately scrambled to find any viable treatments. Physicians made up medicine on the fly, nurses desperately proned and suctioned secretions from patient’s airways. None of it seemed to help. The patients would just die despite your best efforts. Then, even when we found amazing viable treatments, a large portion of the population, unfortunately listening to quacks like Alex Jones and Donald Trump, declined our best evidence based interventions.
Doctors of the prior generation often blanket checked labs on all patients, listened to every patient’s heart and lungs, palpated their abdomens. They did these intensely thorough physical exams to find hidden pathology, palpated every prostate that walked in the door, felt for every breast lump, did a hernia exam on every adolescent boy. What we have found based off that mentality, through extensive population level studies, is that sometimes patients who came and saw us, patients who were poked and prodded, actually died faster than the patients we left alone. Our interventions for prostate cancer often caused incontinence, erectile dysfunction, and even killed people who were never going to have any problems from their prostate cancer. We tested the thyroid of everyone who walked in the office, and we found that the younger population rarely if ever benefited from treatment when they didn’t have symptoms and the older population actually died faster because of our treatment.
I have watched a prescription opioid crisis create a whole population of patients whose pain is worse than had they never been started on the medications. I have watched patients come in emaciated, anxious and sleepless because they were prescribed amphetamines for their very normal, very not-pathologic difficulty concentrating in life. I have seen recovered alcoholics pride in their sobriety be decimated when they learn that the clonazepam their doctor put them on for anxiety is, in reality, just alcohol in pill form.
I believe we have created a population of patients who believe sensations need treatment, that existence alone is enough to need medications, that we can prevent every disease. The reality is that it is always an odds game, always weighing probabilities of risks and benefits. And after seeing a portion of the population die from a slight mutation in a common virus, I think I respect our limitations in medicine.
Avoid us. We will poke and prod you and test you and “treat” you until we have caused more harm than good. The most fundamental tenet to the hippocratic oath is “do no harm”. The reality is that there is no way to do no harm. I wish Hippocrates had gone with my high school economics teacher’s motto: “TANSTAAFL” an acronym for “They’re ain’t no such thing as a free lunch”. I tell my patients this all the time when I am trying to talk them out of unnecessary lab testing, unnecessary physical exam maneuvers. Anything I do comes with a cost. I listen to your heart and we lose a few seconds where I could be talking about tobacco cessation or healthy diet with you. Or worse, I hear a murmur that never would’ve caused you trouble and now I’m getting an ultrasound of your heart to evaluate that and I find a mildly dilated thoracic aorta and now I put you on beta blockers which slow your heart rate to a point where you lose your ability to hike up your favorite trail and I do annual monitoring of your aneurysm because that’s what the guidelines say to do and it costs you hundreds of dollars a year, money which you could be spending on a dietician, or a physical therapist, or going to a show with your family, or taking your partner out for a lovely date.
Don’t just avoid doctors. Avoid all of us. “Alternative medicine” practitioners are no better. Naturopaths, chiropractors, functional medicine, homeopaths, will poke and prod you, empty your pockets, convince you of pathology that has no basis in reality such as “being out of alignment” and bring you back in for repeat “treatments”. Avoid all of us unless you need us.
Nothing I do is benign. Nothing I do is without risk. Doctors are not gods. There is a 100% mortality rate to this existence. Don’t fix it if it’s not broken. TANSTAAFL.