What is Wrong with the Doctor’s Office?

Dan Petrovitch

Sunday, February 23rd, 2014

Essay #5: Medicine and Medical Ethics

I always feel uncomfortable while paying a visit to the doctor’s office. I never end up asking most of the medical questions that I originally intend to, and I rarely express any of the concerns or anxieties that sometimes crop up throughout the year, during the indefinite intervals that separate these half-hearted check-ups. Here’s another confession: I am never completely honest with my doc. For example, I tell her the truth about my diet, my exercise habits, and my sleeping patterns, but I lie to her about my sex life and my consumption of any mind-altering substances, such as caffeine, tobacco, or alcohol. Yet I am fully aware of the modern, legally binding Hippocratic Oath, and I am supremely confident in the miraculous healing powers of properly applied medicine.

So, to state the obvious and natural question, wherein lies the problem? Why don’t I just trust my doctor, in order to learn as much as possible, in order to optimize the best resource available on my unique quest towards superior well-being? These questions are forged into existence by the inherent paradoxes of our current medical/pharmaceutical complex. Medicine is a unique, contentious, and incredibly influential field because it shakily straddles the gap between purely personal and purely professional spheres.

In a sense, one’s health is the most intimate and private aspect of his or her life. The degree to which a person’s parts function and interact is often messy, embarrassing, painful, or tragic; poor health can be the the limiting factor of someone’s dreams, or of their career, or of their physical, social, reproductive, and sexual experience as a human being. However, despite the stakes, we rarely take responsibility for our own health, instead choosing to blindly trust an over-payed legion of allegedly qualified professionals and their artillery of verifiably greedy corporations to look after it. We allow the doctors and the pill companies to determine our fates by actively muting our own voices in the debate over our own health; we forfeit our own votes on some of the most important personal questions of our lives. Why?

Just because our health care system offers the required privacy doesn’t mean that it offers the equally necessary libertarian comfort of personal and discrete choice. The unfortunate state of modern medicine is just as Juliann Garey of The New York Times presents it: “Perhaps the most notable of these efforts–and so far the only one of its kind–is the narrative medicine program at [the C.U.M.C.], which starts with the premise that there is a disconnect between health care and patients and that health care workers need to start listening to what their patients are telling them, and not just looking at what’s written on their charts.” Although doctors and nurses hold the most qualified opinions about the medically factual, on paper details of a given patient’s situation, only the patient can really hold any valid opinion on the actuality of their experience: the fear, the pain, the symptoms, the side effects of treatment, and the heavy, lonely weight of a grim diagnosis or a cold prognosis.

What we need is a medical community that recognizes and properly respects the consequences of arbitrarily blending this dichotomy of personal versus non-personal problem versus solution. We desperately need self-aware doctors who understand their roles as foreign entities, paid to carefully cross private and personal boundaries in order to cure their patients. And, even more desperately, we need self-aware doctors who fully comprehend their responsibility as the gatekeepers to the world of prescription drugs. A good doctor is obliged to protect his patients from the myriad of evils that undoubtedly reside in such a potent realm: for example, the doctor who over-diagnoses countless unprepared nine and ten year old boys with ADD and ADHD, and then prescribes them  unhealthy, excessive daily doses of amphetamines, should lose his job. But the doctor who selfishly refuses to prescribe the correct drugs in the correct situation should likewise lose his job. The philosophical leap that we need our medical community to make is the one that asserts every situation as the correct situation, as long as it involves a rational, mature adult, making a highly informed and fundamentally individual decision about which chemicals to introduce into the soup of his/her brain chemistry. As a medical patient, as a paying customer, and as a sovereign human being, you ought to confidently possess the right to this choice. And the degree to which you consider this to be a radical proposition is indicative of the degree to which you treat yourself as both a product of and a slave to the novel, unproven, and unfairly strict socio-medical paradigm of our time.