I Didn’t Know You Were a Doctor, Tell Me More!
My daughter had her 18 month check-up yesterday, and I finally realized that all the little things about her (really, quite good) pediatrician’s office that bothered me have one common root cause. The doctors are scared of the parents.
Individually, everything that bothered me at appointments, starting at the “meet the pediatrician” before my daughter was even born, struck me as weird quirks of individual doctors. Or perhaps a lapse in knowledge or training. But this was one of the premier pediatricians in the state. In a wealthy area, with many prominent clients (children of professional athletes, for example). I was really starting to question the medical establishment as a whole. If this supposedly awesome office was so out of date, so “wrong”, how bad must it be at other practices?
Some examples? Homeopathy was recommended at our very first appointment (my husband had to hold me back from hormone Hulk raging the place to the ground); starting the vaccine conversation with “so let’s talk about the acceptable alternative schedules” rather than “here’s our schedule”; being told at the 18 month appointment that “I understand if you feel the need to turn her forward since she’s so big, but let’s talk about how to do that safely”, and “You’re still breastfeeding, don’t feel bullied into continuing to do that, there are no benefits other than snuggle time at this point anyway”. The moment I said “Dude, homeopathy is fake” or “Aria is rear-facing until forever, as per recommendations” and “give her every shot you can as soon as you can” I could see them relax. I saw them go from defensive mode to doctor mode.
Now, before I go farther let me say I realize my opinion here is coming from a place of super-duper privilege, and I’m sounding really elitist. I get that, I do. But I’m educated, I’m very familiar with AAP, CDC and WHO recommendations. I understand what is generally considered standard of care. And my fear is that parents who aren’t similarly educated will take these scared statements from physicians as permission to do potentially dangerous things (not vaccinate, turn kids around too early, etc). All the focus on “do your own research” and “be your own advocate” are all well and good when applied to the right issue. Absolutely, read about the risks and benefits of different options your doctor presents you with. Do certain treatment options better mesh with your lifestyle? Do certain side effects interfere with your life? Those are things to research. When doctors encourage you to become educated, these are the choices they’re talking about. They don’t expect you to become an epidemiologist and figure out if vaccines are a secret government conspiracy. In fact, most family practice doctors would admit that they themselves aren’t experts on vaccines. They know the recommendations, and they’re trained to deal with reactions, but epidemiology and the bio-chemistry of vaccines is NOT their specialty. With issues such as vaccination, it’s not just your doctor you think you’re being smarter than, it’s all of medicine. And not just in the United States where “oh noes Big Pharma”, it’s the entire medical establishment all across the world.
I have a degree in Astrophysics. Sometimes that makes me feel really smart. I’ll fact check the Big Bang Theory for you all day long. But I leave medicine to doctors, and the medical organizations dedicated to finding the care models that best serve patients. Do they get things wrong sometimes? Does the influence of our for-profit healthcare model get in the way of new advances? Absolutely. But no one googling through sites like Natural News or the Drudge Report is all of a sudden going to be smarter than the collective knowledge of the medical field. How egotistical must you be to think that your 12 hours spent chatting with Dr. Google makes you an expert?
People rail about how doctors aren’t up to date, or don’t fully support certain recommendations (that’s what made me want to write this, right?) but it’s because they’re bullied by parents who feel empowered by doing their own “research” (that word does not mean what you think it means) and are afraid to do their job. When they have to start every appointment putting out sympathetic feelers to decide how crazy a parent is, they’re not able to do their job. What if I didn’t understand carseat safety, and thought my doctor saying “it’s ok” to turn around meant I was supposed to? The push for empowered patients has gone too far. If you know everything, why even bother seeing the doctor? So you can put them in their place? It’s absurd.
Do your reading, ask questions, become informed, but for the sake of parents who are really trying to learn from their doctors, stop bullying doctors into being afraid of patients. Let them do their jobs, and seriously, from now on, unless you have a PhD in Chemistry, no more talk of how you researched vaccines. Because you didn’t.
Featured Image courtesy of Flickr user jfcherry
“…vaccines are a secret government conspiracy.”
This one also makes me want to HULKSMASH. I mean, seriously?
And also the whole anti-intellectual basis of the anti-vax movement — the belief that the average person’s opinion is just as good as the opinion of people trained in the field, of those who have spent decades studying these very issues.
Well said! I can’t imagine what it’s like to be a pediatrician these days. The first thing I said to mine was like, “It’s OK, we are pro-vaccine,” and then we were cool. 🙂
I encountered a similarly nervous public health nurse who was giving my son his vaccines. I don’t remember which one, but they had run out of the single shot, preservative free vaccine dose. They had vials that contained more than one dose and thimerosol as a preservative. I had to reassure her repeatedly that I understood what that meant, that I understand the basics of thimerosol and how quickly it leaves the body, that I understood it was the same vaccine and protection, and that I did not want to come back another day.
Yet doctors are human too and a 2nd opinion when you feel uncomfortable should never be discounted. Case in point: our family GP decided our 20 month old daughter’s symptoms warrented a diabetes test – which freaked us out and sent us running for an appointment with the very expensive and difficult to catch paed. One quick visit later we had both an adenoid diagnosis and the correct antibiotics. Now we have the ENT pushing for an adenoid op on her (at 23 months) as it *might* resolve the issues. I’m for it but my partner is concerned that it’s a surgery under general anesthetic with no guarantee that will resolve the issue: is he in the wrong for questioning the ENT or am I in the wrong for unquestioningly accepting the diagnosis? I honestly don’t know. [btw our compromise is another 2nd medical opinion that won’t be paid for by medical aid – definitely a case of using our middle-class privilege.]
The problem is separating issues like vaccines, where there’s an established medical consensus no matter which [real] doctor you ask, from more subjective issues of diagnoses. Genuine patient/parent empowerment – where dialogue is key (on both sides) and questioning a medical diagnosis doesn’t get seen as disrespecting the entire canon of thought – should be encouraged and not discounted.
Neopare: That’s a really good point.
Remember that the more rare a condition, the more doubt you should have of a diagnosis of that condition, per Bayes’ theorem. Prior probability is relevant. The more rare something is, the more false positives you will get to true positives!
So questioning diagnoses is not only reasonable, but very rational in many situations.
neopare, I completely 100% agree with you, and I should have been more clear in my post. Odd diagnoses, especially from a family practice doctor or pediatrician instead of a specialist should definitely be discussed at length, and people should take advantage of 2nd opinions. It’s a weird double edged sword. In cases like yours patients need to be ready to fight to get the information they need. It’s worth noting that in that case, it’s not questioning the entire medical establishment, it’s questioning that one doctor. With individual diagnoses, that makes sense. With something like vaccination (unless you’re one of that small percentage that has issues), it’s not just your doctor, it’s everybody!
Also, if you’re not comfortable with the recommendation of doctor A, the smart thing is to find another doctor, preferably a specialist, that you feel more confident about. The smart thing is not to start reading crazy-ass rumors on the interweb or fool yourself into believing you’re some sort of medical authority.
I have experienced exactly this when the topic of vaccines came up during the first mtg with our pediatrician. I live in a neighborhood full of middle class liberals, and I look like an artist, so when I exploded with pro-vaccine talk you should have seen the look of relief and glee on our practitioner’s face.
It’s scary to hear that the antivax nonsense has this much mindspace. I sure we are just presented with a brochure explaining the 12-year schedule, and told by the doctor when to show up and which vaccines would be done when. We could have said no, sure, but it would have been entirely up to us to do so.
I agree with most of what you’re saying, and I don’t like how combative patients who know EVERYTHING make my doctor hesitate when patients who have genuine questions ask them. All of my doctors have been wonderful about explaining decisions in my family’s medical care (“a study shows that. . .so. . .” or “we don’t really do that anymore because. . .”) once they realized that I honestly was deferring to them as the medical experts.
It must be so frustrating to devote a decade of your life to education before even getting to start practicing and having a patient who has spent 20 minutes talking to a neighbor about using X,Y or Z herb as a “cure” think that their knowledge is the equivalent of yours.
At the same time, I don’t necessarily listen to my doctor about things I consider parenting advice, such as infant sleep or feeding schedules.
My wife’s doctor is delightful. Once she realized that we were reasonable, she felt free to make jokes, like telling my wife that she should start smoking if she wanted to have a small baby, and when she mentioned that drinking was frowned upon, and I pointed to the recent study in Denmark(?) she said “well, if we were in Europe I’d tell you you could have a half glass of wine a night.”
Our doctors are great about that. I asked about spacing out vaccinations because it seemed like the combo shots were a lot to give a tiny baby body all at once, and I was prepared to bring her back for them at week long intervals so she could get them reasonably on time still. The pediatrician explained it really well. She said to imagine the immune system as an army, and that everything new calls in the whole army. Then the parts that aren’t needed can “go home”. (It sounds a little patronizing now but it didn’t when she explained it.) So separating them actually makes the body work harder because the whole immune system is activated every time. I would never have known that if she wasn’t respectfully strong about it. They also have a whole packet debunking Dr Sears’ alternate vax schedule (which is probably what she thought I was going on).