The Medical Profession is a Conspiracy against Patients

I am a full-time practising doctor and yet sometimes I believe that the medical profession is not always completely honest with patients.

Now, I am not talking about the rubbish which alternative medicine practitioners are selling about how the medical establishment is out to rip patients off with unnecessary surgery and exorbitantly priced drugs. And neither is it true that doctors will gang up on patients and refuse to testify against other doctors when a medical mishap occurs. I believe that most doctors are honest professionals who are doing their best to try to help their patients to get better.

The truth is far worse. Sadly, most doctors do not realise the harm they often end up inflicting on their patients. They mean well, but because they become arrogant and brainwashed as they get older, they often end up doing a major disservice to their patients !

Arrogant ? Brainwashed ? Aren't these harsh words ? Aren't doctors supposed to be intelligent hard-nosed professionals who practise medicine based on hard-core scientific evidence ? How can they be brainwashed ? And by whom ?

Doctors set so much store by what they have been taught by their teachers that they tend to stop thinking like scientists. They do not ask questions or think critically , and will often continue to worship holy cows, even when they should know better. Old habits die hard in the medical profession, and the process of medical education inculcates an attitude of " do what you are told" in medical students and residents, who are taught to respect and obey professors and experts , rather than challenge old paradigms or think "out of the box".

This also explains why doctors become arrogant over time. They become set in their ways ; their attitudes harden; they feel they know everything there is too know about their specialty; and they refuse to consider evidence which does not fit in with their established beliefs. They will often even be disrespectful towards their patients because they do not value their opinions or insights.

For a man with a hammer, everything looks like a nail - and this is as true for doctors as anyone else. Thus, for a cardiac surgeon, every narrowing on an angiogram is an indication for bypass surgery - even though there is no proof that this helps the asymptomatic patient even one bit ! Why don't doctors learn from clinical experience ? This is because they fall victims to the fallacy of believing in the self-fulfilling prophecy that bypass surgery helps patients with a narrowing in their artery. Let's take 100 asymptomatic patients who go to a cardiac surgeon with a narrow coronary artery. He will advise surgery for all of them. Let's assume 50 take his advise and 50 don't. For the 50 on whom he does operate, the doctor is God. They will follow up religiously with him and sing his praises to the skies. The doctor will also believe that the reason these patients are now doing well is because of his surgical skills and that if he hadn't done the surgery, they might have died. Sadly, the surgeon has no way of following the other 50 patients who chose to ignore his advise. After 5 years, these 50 patients might be doing as well as the ones who were operated on - or even better, but the doctor has no way of comparing or finding out ! This is why these myths and misconceptions continue to be perpetuated for decades, even by well-meaning doctors !

In an excellent article, Launching the Century of the Patient, Gerd Gigerenzer and J. A. Muir Gray explain why many doctors do not understand the available medical evidence. They identify
seven “sins” which have contributed to this lack of knowledge: biased funding; biased reporting in medical journals; biased patient pamphlets; biased reporting in the media; conflicts of interest; defensive medicine; and medical curricula that fail to teach doctors how to comprehend health statistics.

As George Bernard Shaw wrote so eloquently in 1911 in The Doctor's Dilemma, " All professions are conspiracies against the laity" . This is as true today as it was then !