I can’t find the source of this quote. Maybe philosopher Bertrand Russell, but I’m not sure. Once, when asked how he’d respond if given evidence that went totally against something he’d believed for years, he answered,
“I would change my mind, of course. What, sir, would you do?”
It’s too bad the same can’t be said for the medical profession.
When presented with information that’s not in synch with what doctors learn during training, it seems a majority of physicians stop thinking altogether. Of course, a change of mind is possible eventually. A doctor may see an article or overhear a colleague saying “Did you hear the latest on…” and a glimmer of new thought is sparked. The entombed brain cracks opens to let in a little light.
A single reality tunnel
The entire medical profession seems to have a single reality tunnel and, inside it, a healthy hostility toward change. Sometimes there’s a shift in beliefs (bleeding patients with leeches doesn’t work for everything) while other times deeply held beliefs seem ossified (homeopathy is nonsense). Since the 19th century, psychologists have referred to this as “herd mentality” and it’s never viewed in a positive light.
You’d be surprised how many people have suffered needlessly or died as a result of the medical profession’s herd mentality. In the 19th century, Hungarian physician Ignaz Semmelweiss realized the high infection and mortality rate among women who had just delivered babies was being caused by physicians not washing their hands before delivery. When he proposed compulsory hand washing, he was summarily drummed out of the profession and later died in an insane asylum.
In the middle of the 20th century, the AMA’s official stance was that cigarettes were a harmless pleasure, not associated with heart or lung disease, but actually good for you because they reduced stress.
It’s a shame that access to medical information on the internet has actually further narrowed the tunnel vision of many physicians. Just watch your doc’s facial expression or body language when you begin a sentence with, “But doctor, I read on the internet that…” See the look of dismay when you hand her a few pages of reading material.
Why does this rigid thinking occur? It’s because in medical education, young physicians succeed by being obedient. A medical textbook is gospel, the wisdom of professors written in stone. Any out-of-the-box thinking (“Why not try chiropractic?”) is mightily discouraged.
The med school price of a controversial opinion might be a poor letter of recommendation that ends a young doctor’s chance for a particularly desirable residency. (“He’s a good student, but prone to some unusual and unscientific opinions” can kill a career.)
Want to experience some of this narrow-mindedness?
Be a patient with chronic symptoms and normal lab tests and be told there’s nothing wrong with you. Go online and read about some of the conditions contemptuously called “fad diagnoses.” Over the years these have included candida (yeast) overgrowth, chronic fatigue syndrome, fibromyalgia, leaky gut syndrome, chronic Lyme disease, multiple chemical sensitivity syndrome, adrenal fatigue, subclinical hypothyroidism, toxic mold syndrome, electromagnetic field sensitivity, hypoglycemia, and others.
Perhaps you’ll read an article and think, “Hmmm…this sounds like what I’ve got.” You may even buy a book on it. But what will truly sabotage your case with your physician is to have learned about it from an alternative practitioner–your chiropractor, nutritionist, or naturopath. Maybe you even had some tests done, paying out of pocket: Lyme antibodies, stool for candida, lactulose/mannitol ratio for leaky gut.
Present this evidence to your doctor and her face hardens. You sense the negativism, hostility even. She tosses down the paperwork with barely disguised contempt. You know immediately the book you’ve purchased for her will go unread. “I’ve never heard of any of this. These tests you paid for are meaningless. We never use them. Can’t you just stay off the internet?” And then, the coup de grace, “I realize you’re really tired of feeling poorly, but I think a lot of this is depression. Here (handing you a business card), why don’t you make an appointment with this psychiatrist.”
For example
Let’s take the controversial diagnosis “leaky gut” (intestinal hyperpermeability) to give you an idea what you’re up against. In leaky gut, an overly porous/permeable intestinal wall leaks large molecules of food and triggers an immune reaction that causes a variety of seemingly unrelated symptoms. I’ll devote a whole Health Tip to leaky gut syndrome in the future.
Here’s Wikipedia, in an article likely written by Stephen Barrett, MD, of Quackwatch. Leaky gut is called “a dishonest ploy designed to make money from the sale of supposed remedies for it.” On the other hand, an apparently open-minded gastroenterologist on WebMD says “We don’t know a lot, but we know it exists.”
However, if you Google “intestinal hyperpermeability” an immense article in the conventional medical journal Gut from 2006 goes into detail about the physiology, testing, and treatment. A 2003 article from East African Medical Journal concludes “The occurrence of increased gastrointestinal permeability is probably vastly underestimated.”
Now picture your doctor with a rivet in the back of her neck, unable to look to the left or to the right, just rigidly straight ahead. Her narrow-mindedness, her utter lack of intellectual curiosity–her total commitment to a single belief system–is very costly to your health and well-being.
Change is possible
If there’s a dim light at the end of this tunnel thinking, it’s that physicians can eventually change their minds. It was tough for Louis Pasteur to sell the idea that germs caused disease. It took the advertising power of Big Pharma, which had developed mediocre drugs for fibromyalgia, to convince many (but not most) physicians that fibro actually existed.
Today patients with stomach ulcers are prescribed antibiotics to kill off Helicobacter bacteria, but the scientists who discovered the bacterium’s role in ulcers had an uphill battle convincing doctors that ulcers weren’t caused by stress. You’d be even more shocked to learn how difficult it was to convince physicians to recommend folic acid during pregnancy to prevent spina bifida. The connection between low folate levels and spina bifida had been known for years, but then, as now, nutritional supplements were regarded with suspicion by doctors who had been taught in med school that the US diet was the best in the world and that vitamins were a waste of money. How many babies were born with spina bifida unnecessarily because of the rivets in the neck of the medical profession?
Yes, change is possible. Pregnant women receive folic acid to offset fetal growth deformity. The AMA stopped encouraging cigarettes for relaxation more than 50 years ago. But if you’re chronically unwell and not getting help, don’t hold your breath waiting for a shift in medical thinking.
Rather, do some internet research on functional medicine and integrative medicine. Many websites have a Find a Physician tab. Of course you’ll need to do your homework when you select one of these physicians as well. It takes real work to be a patient.
Be well,
David Edelberg, MD
I totally agree with this article. As a person who started experiencing skipped heart beats some 40 years, I mentioned to a few cardiologists that I felt that there was a link between the skipped heart beats and my diet. I even offered to eat the foods that I knew would bring the skipped beats on (onions, capsicums,…)while wearing a 24 hour heart monitor to provide evidence of this. They were “not interested” in this and assured me that “food does not trigger skipped heartbeats”. Fast forward 25 years and, yes, it’s medically accepted that certain foods can trigger skipped heart beats due to vagus nerve stimulation.., but, no-one would listen to me.
ian
I am fortunate to have found a doctor who is openminded and willing to listen to my complaints. A decade or so ago a doctor I was seeing then became angry with me because I declined HRT. I’ve been through a few doozies. There is notably an othopedic clinic in these parts that routinely refers patients to a chiropractor prior to considering knee or hip surgery. Now that is progress. By the way, I also have an excellent chiropractor.
SuzieQue
Great post, as always, Dr E, but encourage your patients to examine their internet research findings with a gimlet eye. BTW, The initial quote may or may not have been uttered by John Maynard Keynes, but has also been attributed to others as disparate as Churchill and the Dalai Lama.
Carol S (gimlet-eyed medical librarian)
@Jim, I on the other hand do not sympathize with physicians who think their passing med school entitles them to stop learning, even when it comes to information supplied by their patients. Of course you always have to separate the wheat from the chaff researching one’s medical/health situation on the Internet. And no, taking Dr. Oz’s latest “miracle” treatment to your doctor is not an acceptable approach. But there are many good, non-confusing sources of medical information out there that could have a meaningful and positive impact on one’s health. I am a personal testament to that.
MP
I thought docs had continuing medical education requirements. If they don’t, something is wrong!
Jim
Jim Morrin
This article is an excellent reality check. I have experienced just what you have written. Thank goodness I have medical knowledge….Critical Care RN for 28 years….and body self-awareness….. which enables me to research and make integrated medical choices. For others this is what happens. The MD is the décider and one can go elsewhere if they don’t like it……which also happened to me. So I chose to find a physcian who would listen and respects my knowledge and opinions. This article has validated what all patients should expect from their physicians. Thank you for writing it.
Kathryn Donahue
Physician tunnel vision can absolutely be detrimental to your health even with more main stream accepted chronic diagnoses. My experience as a parent to a chronically ill child with very mainstream diagnoses confirms how narrow minded and difficult it is to change a physician’s perspective once they have a thought in their head. Physicians are notorious for using the gaslighting technique when something does not fit their original thought. Some gems I have heard over the years include “your child does not actually ever have to drink fluids- no one ever does. He gets plenty through soup,” “it is totally normal to lose 2 pounds overnight in a 22 lb child.”
Liz
Dr. E.
I think you are far too hard on your medical colleagues. This resistance to “new information” has been part of the American way of thinking for many years. In disciplines as varied as physics, economics, psychology, and even economics, radically new ideas are routinely dismissed and their adherents ridiculed.
And now we have elected a president who seems able to deny whatever information he finds inconvenient or personally unacceptable. I don’t like the idea of climate change and so therefore, it does not exist.
What was is that Pogo said some fifty years ago: “We have met the enemy and he is us.”
I think I am just going to lie down now.
Dan Krause
I myself have had the experience of several doctors telling me that I just need to accept my autoimmune disease and that it might get worse. I kept getting sinus infections, could not sleep, was overweight, had swollen joints, constant muscle aches and serious fatigue. After much research and seeing a naprapath, I changed my supplements and diet. My weight has dropped significantly, I sleep better, and I feel better. As a matter of fact, my medicine dosage has been lowered 3 times so far and my autoimmune disease is on the remission track. My regular doctor is amazed and is now starting to think that certain foods might be an issue for some people. Mind you this is the same doctor 2 years ago that told me that food has no role in my disease. I believe that doctors are trained ‘by the book’ and anything outside of their training is not taken seriously. I am grateful to have done the research to understand my disease as well as find the right foods and supplements to help myself heal. Dr. Edelberg is spot on with this article!
Chris Zapp
As someone that suffers from Lipedema, Lymphedema (caused after an anesthesiologist missed my femoral artery and stuck my lymph nodes) and Ehlers-Danhols, I know all to well this attitude. “Lose weight” is usually the answer – um no — my arm is bending too far back.
Now I need a new ACL and the only answer I’m given is to get knee replacements. I don’t have knee pain (in spite of what the x-rays show), I have knee instability.
Sadly, a lot of the doctors that preach open-mindedness are still very closed minded when it comes to certain issues
Paula Sims
I sympathize with physicians who must address the concerns of patients who, with little or no medical education, dive into the internet for answers. Without some framework from which to hang all the information out there, an inquiring patient can become hopelessly confused. Medical dogma may be wrong-headed from year to year, but it may be safer than wandering through the Internet echo chamber and latching on to the idea de jure. (Homeopathy is still believed by many) Medical progress is littered with bad theories that were eventually rejected. People need to be remind themselves that Medicine is a practice and a science.
Jim Morrin