Don’t Believe All Doctors: 3 Reasons
The healthcare system in the United States has a lot of problems. That’s not a controversial statement, according to a poll from last year that found 92% of Americans want changes, and 62% want either “major changes” or a complete redesign. By its very nature, though, healthcare solicits trust; it asks that patients believe what they’re told by the medical community and by medical professionals. This may be true now more than ever, with the massive push of COVID-19 vaccines that were developed at neck-break speed with a relatively new type of gene therapy technology.
But if it’s true that the healthcare system is riddled with problems, should people readily put their faith in that system? Reason would dictate “no.” Discretion is in order.
In fact, even in a good system, there are good reasons for not being all too trusting. Those reasons are called humans. The most important humans in the system that patients interact with are doctors. The purpose here is not to maliciously beat up on doctors, but to recommend wisdom to patients. Proverbs 14:15 says (and who can deny?), “The simple believes everything, but the prudent gives thought to his steps.” In that spirit, here are three considerations as to why patients would do well to not have blind faith in their doctors.
Doctors may have ulterior motives.
In an exchange between proponents on either side of the notorious controversy over the safety of vaccines, the issue was raised over whether physicians show enough compassion to those who are vaccine hesitant. One physician responded, “As physicians, we care about people. There’s compassion on the medical community’s side. We wouldn’t do this if we didn’t care.”
This response is to be expected. No physician is going to claim that he or she doesn’t have care or compassion. And for many, it may be true. But it’s an overstatement to claim, as though speaking on behalf of every physician’s heart, “We wouldn’t do this if we didn’t care.” There are plenty of other possible reasons for being a doctor. How about money? Respect? A sense of authority? Simple interest in the field? Presumably it’s most often a combination of motives.
Moreover, it ought to be remembered that doctors are just people, and medicine is their job. Anyone who works in some kind of job where they see customer after customer (or patient after patient) every day knows it’s easy to start treating people more like an item on the to-do list than a person—all the more when you’re overworked, as many physicians are. When people become items, it’s surely natural to slip into habits of convenience, like writing a quick prescription to treat symptoms, instead of carefully working to treat underlying causes.
Moreover still, physicians in private medical practices have financial incentives. Patients are customers, and the more services the practice provides, the greater the profit. That means the physician has an incentive to recommend optional services that the patient doesn’t necessarily need—meaning, the benefit to the patient is negligible.
In a survey of 435 emergency room physicians, “more than 85% admitted that in general, they call for too many tests, even if they know the results won’t really help them decide how to treat their patients,” and 97% “admitted to personally ordering unnecessary imaging tests.” To give another example of superfluous services being offered, a fairly common finding on prenatal ultrasounds is a white spot in the baby’s heart, which indicates calcification of the papillary muscle, and is usually of no significance, but does appear more often in children with Down’s Syndrome. Upon finding this, an obstetrician may recommend (if she hadn’t already) genetic testing for this chromosomal abnormality. If testing comes back negative, it essentially means the odds of Down’s Syndrome are nil. But the doctor can still offer additional testing, in case the parent is interested. As a patient, hearing this unsolicited offer of additional testing—practically pointless though it be—can seem like an upsell.
In response to a question about whether he himself trusts his own doctor, another physician in the aforementioned exchange said the following. “...As a young doctor, I think there’s a lot of distrust when it comes to physician recommendations. It sucks, because, you know, you spend decades training and learning and your heart is in this place where you want to, like, be of service to people, and then you’re not trusted.” Then he added, “But...you shouldn’t just blindly trust anyone’s opinion, your doctor or anyone.”
Indeed, personally frustrating though it may be, a physician’s years of training are not enough to earn the trust of the critically-minded. In fact, the natural incentive that doctors have to engender trust in the patient is, ironically, one more reason for patients to have a healthy dose of reservation. Since trusting the doctor means the patient is more likely to consume more services that the doctor recommends, it’s not unfitting to consider whether doctor recommendations are intended to serve the patient or to serve the bottom line.
Similarly, another thing to remember is that the more patients a physician sees, the greater the profit margin, so there’s a natural incentive to see as many as possible, which can end up decreasing the time and quality of care provided to each person.
All the incentives mentioned here are only natural incentives in private medical practices, to say nothing of intentional monetary rewards that medical executives may instate, which “always change doctor behavior” and can have “deadly consequences.”
None of this is to say that private medicine should be traded in for public medicine, since that comes with a whole host of its own problems, which are arguably much worse. But this is to say that patients ought to be mindful of the various motivations doctors may have for how they approach treatment. Compassion may be a motive, but whether it is, or whether it’s high on the list for a particular doctor, shouldn’t be assumed.
Let’s put it this way: if you would be skeptical of a car mechanic, you ought to be skeptical of a physician. In these professions there are similar incentives and similar opportunities to abuse the ignorance and agreeableness of a client. Yet, somehow, it seems there’s greater suspicion towards car mechanics than doctors. (And if you think, “Well, doctors have much more education,” I’ll remind you that that says nothing of their moral character.) There are good and bad in both professions, but none of them deserve unconditional trust.
Doctors are not above social pressure.
In an interview published in November, Dr. Stella Immanuel said her clinic had treated over 2,000 patients for COVID-19 and lost only three, who had refused treatment. How has this clinic done so well for their patients? Their standard regimen, said Immanuel, is a combination of familiar and readily-supplied medicines and vitamins (hydroxichloriquine, zitromycin, zinc, vitamin D, and vitamin C). It’s a safe, effective, available, and inexpensive treatment plan. But why has it not been the go-to treatment all across the country? Well, one clue is that a number of frontline doctors who have been successfully using and encouraging these kinds of treatments for many months now have often been censored for talking about it. Why? Undoubtedly, political reasons. And what is the effect of that? Legitimate doctors being shut down for talking about legitimate solutions undoubtedly has the effect of socializing other doctors to keep from considering those options, if they even hear about them. Those options are outside the range of acceptable dialogue. And indeed, most doctors seem to be toeing the line and parroting the official story that we’ve been hearing for months ad nauseam about masks, social distancing, lockdowns, and vaccines. Doctors, as anyone, are subject to social pressures and misinformation. The critical thinker, therefore, will take their doctor’s opinion into consideration, but will not take it as gospel.
Doctors are fallible and sometimes (maybe often) misinformed.
Physicians only know what they know—which means if medical school didn’t teach them something, and they haven’t taken the initiative to go learn it or to keep up to date with developments, there may be things they don’t know that they should know. A big example of this is nutrition. Our bodies have the amazing capacity to stay healthy and heal themselves in many cases if we simply consume the right foods—but this is apparently not an emphasis in medical school in the U.S., the proof of which is that the first resort of many physicians is a prescription instead of dietary advice. This makes it very easy for them to end up serving pharmaceutical companies more than patients (pharmaceutical companies which, it happens, have considerable influence on medical education in the U.S.). Indeed, perhaps much of what’s called “healthcare industry” might be more accurately described as the “medicine industry.” Given that, how can a reasonable person not want to check on everything the doctor recommends?
Furthermore—and this is the real kick in the pants—medical science is corrupted. In a 2015 article from the respected medical journal The Lancet, editor-in-chief Richard Horton wrote,
The case against science is straightforward: much of the scientific literature, perhaps half, may simply be untrue. Afflicted by studies with small sample sizes, tiny effects, invalid exploratory analyses, and flagrant conflicts of interest, together with an obsession for pursuing fashionable trends of dubious importance, science has taken a turn towards darkness.
You read right: half of scientific literature may be untrue, due to poor science practices and incentives. Pretty scathing. Horton doesn’t stop there:
The apparent endemicity of bad research behaviour is alarming. In their quest for telling a compelling story, scientists too often sculpt data to fit their preferred theory of the world. Or they retrofit hypotheses to fit their data. Journal editors deserve their fair share of criticism too. We aid and abet the worst behaviours. Our acquiescence to the impact factor fuels an unhealthy competition to win a place in a select few journals. Our love of ‘significance’ pollutes the literature with many a statistical fairy-tale. We reject important confirmations. Journals are not the only miscreants. Universities are in a perpetual struggle for money and talent, endpoints that foster reductive metrics, such as high-impact publication. National assessment procedures, such as the Research Excellence Framework, incentivise bad practices. And individual scientists, including their most senior leaders, do little to alter a research culture that occasionally veers close to misconduct.
All of this poses a real problem for the layperson: when we’re told something by the scientific community in general, or by the medical community specifically, how can we know what is true and what is not? For that matter, how can busy doctors—who may not have time to dig deep into all the research practices and the potential conflicts of interest in every new study that comes out—keep abreast of which developments are trustworthy? It’s presumably difficult enough to stay on top of the news about significant studies, let alone to evaluate whether those studies are a lie. So yes, your doctor is fallible—and may very well be misinformed.
Conclusion
A U.S. News article describing some of the problems with board certification for doctors concludes like this:
In the end, it's important to remember: There are actually very few incompetent providers, and the ways they are identified and mitigated do not derive from the board certification processes. Physicians are a unique and overall mission-driven group of individuals. In no other profession is the commitment to lifelong learning in order to serve any greater. Maybe that is evidence enough to have faith that physicians will take up the challenge as a professional body and govern themselves. Perhaps this assignment is actually an internal expectation rather than one that has to be thrust upon them. After all, we trust physicians with our lives.
This kind of adulation threatens the gag reflex. It’s especially unreasonable when applied to an entire profession, and even becomes laughable when you see that the article is itself written by an M.D. (A bit self-serving, isn’t it?) But, in practice, is this not how many people approach their doctor—with mindless acceptance of what they prescribe?
“After all, we trust physicians with our lives.” — I say, to whatever degree possible, we shouldn’t. People shouldn’t outsource their health. No one can care about your own health, day in and day out, as well as you can. Physicians should be a resource, but not a crutch. Everyone should take personal responsibility for their own life and their own health, and make an effort to be informed about what that entails, rather than blindly rely on whatever the doctor says. (Above all, this means eating well. Nutrition is the key to health, and since the body was made by God to function from what’s provided in nature, in most cases it’s only a failure to get proper natural sustenance that makes it necessary to resort to artificial means—and even then, when you focus on underlying causes instead of symptoms, the true resolution is often nutrition.)
So also, physicians should not feel entitled to their patients’ trust. They should earn it. The letters behind their names shouldn’t be enough to earn it; earning it should start with how well they can defend their treatment recommendations. The education leading up to that point is simply preparation. And patients shouldn’t settle for half-explanations or “just trust me”s. When patients are not so easily satisfied, that’s when the healthcare industry will get better.