Wednesday, September 24, 2014

Having Respect for Limitations – in Medicine and in Life

Recently, I heard the story of a bright and ambitious young woman who aspired to be a physician. She finished pre-med in college but, as she started to get to know more doctors, she found that many were addicted to alcohol or drugs or just plain angry. She decided that she didn’t want that kind of life and went on to a different career.

In an earlier blog post I talked about some of the stresses on doctors today. ”The vast majority of physicians are sincere, caring people who are doing their best to treat too many patients in too little time. … Doctors work impossible hours; they are harassed and talked down to by insurance providers; and they must protect themselves (at great cost) against lawsuits for malpractice.”

What I see in the way medicine is practiced in the United States today is a lack of respect for limitations, both of the individual medical practitioner and of the field of medicine itself. As more and more patients are stuffed into doctors’ schedules, communication is limited, treatment is standardized, and subtle nuances are overlooked. All of this sets the stage for medical errors that arise, not from incompetence or a lack of caring, but from too little time for listening attentively and framing a careful response to the patient’s situation.

In addition to schedule constraints, physicians are limited by their individual education and experience. Diagnosis is too often guided by what tests are available and commonly applied rather than by the patient’s own medical history (which the doctor may not have had much time to review). In some cases, unfortunately, doctors’ training has predisposed them to believe that the solutions offered by modern medicine are always to be preferred and that if modern medicine doesn’t offer a solution to the patient’s problem, there is no solution. This school of thought often involves a blanket rejection of all supplements, traditional remedies, and alternative treatments.

When I was in my late forties, juggling a career and graduate classes, I tore something in the back of my shoulder. It was quite painful and, as the weather got colder, it got worse until I was having trouble sleeping. My doctor recommended over the counter anti-inflammatory remedies and then a course of therapy with a clinic run by the local hospital but none of it helped. After about six months of this, with no other option but surgery, I decided to try acupuncture. My doctor was scornful, “All that does is stimulate endorphins.” Over a couple of months, the injury healed; after that, I did stretching myself to restore normal movement in my shoulder. My doctor was so impressed that she later sent at least one other patient to the same acupuncturist.

I have enormous respect for modern medicine, which has probably saved my life a number of times, but modern medicine doesn’t always work and doesn’t have much to offer in some areas. Most athletes will tell you that there is little to be done for any but the worst soft tissue injuries. Rest, Ice, Compression, Elevation are what doctors and trainers alike will recommend; the body just needs time to heal itself. Another weak area is the wide range of food allergies and sensitivities and other digestive disorders termed “irritable bowel syndrome.” Doctors can’t do much about these so they don’t give them much attention, but for affected patients these conditions can lead to long term malnutrition.

Fortunately, there are remedies out there. Acupuncture and massage can accelerate the healing of soft tissue injuries; probiotics and enzyme supplements benefit many people with ill-defined digestive disorders. Unfortunately, most doctors won’t have anything to do with these therapies because they are not part of the standard canon taught in American medical schools. Doctors may also be motivated by fear of a malpractice lawsuit if harm comes to the patient.

A lack of respect for limitations, both the human limitations of doctors and the practical limitations of medical science, creates hardship for both doctors and patients. We need to find an approach to medical care that is more respectful of the individual and more open to therapies outside the conventional realm of medical care.

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