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Newsflash: People Are Weird
“Susan” is a very pleasant 51-year-old patient of mine – very tan, fit, and beautiful. She and her husband have done well, and they have multiple houses and boats and very nice cars and such. She started to feel poorly, and called her yoga instructor for advice (Recall that I run a concierge practice, so she pays big money to have me available to ask questions. But no – she calls her yoga instructor. Anyhoo…).
Her yoga instructor recommends a chiropractor who sees her, orders labs, and on follow up reviewed the 32-page lab report with her. It was all hormones, cortisol levels, inflammatory markers, and such – nearly all of which I’d never heard of. Performed by a lab I’ve never heard of. Just the estrogen report was four pages long, with groups and subgroups of estrogen varieties, which I’d never heard of. He started her on several organic all-natural hormone combinations which I’d never heard of. When she felt no better, he started her on iron for her fatigue. I asked, “He’s treating fatigue with iron?” She said, well, not exactly – he gave her capsules with frozen organic bovine liver. “Of course,” I say.
She shows me the dazzling multi-colored 32-page lab report, and her bag of supplements, vitamins, and hormones. I ask how she’s feeling, she says maybe a little better, but still lousy. I check one page worth of basic labs, and find her hemoglobin is high. So is her iron. So are her liver function tests. The doctors who are reading along are probably nodding their heads right about now…
I ask if anyone in her family ever had liver disease. She says her brother died of cirrhosis at 39 years old, but he drank a lot. I ask her if anyone ever mentioned hereditary hemochromatosis. She says she’s never heard of it. I tell her that I think she has it, and I’m sending her to a Hematologist, who will probably do periodic phlebotomy, and she’ll feel better soon. Her face lights up and says, “My Mom did that! I forgot!”
I just look at her. Finally I say, “Look. Your chiropractor is giving you the wrong drug. To treat a disease that you don’t have. And in doing so, he’s intensifying the disease that you do have. That’s like a trifecta of incompetence. If he was a doctor, I’d report him to the state boards. This is bonkers. Let me fix this. You’ll feel better soon. The liver damage you’ve sustained probably won’t get better, but we’ll try to prevent it from getting any worse. Please. Let me fix this.”
She frowned, and asked, “If I stop seeing him, can you refill all the hormones he gave me?”
Me: “You mean the ones that aren’t helping you? No. I won’t refill those.”
Her: “Ummm… I’ll talk it over with him on our next visit.”
Me: (pause) “Right. Ok. But please go see the specialist I’m sending you to, ok? Once your liver starts to fail with hemochromatosis, it can go bad very quickly. Don’t screw with this. Don’t die of something stupid.”
Her: “Ok, I’ll go see him. Thanks.”
“Mark” is a close friend and college teammate of mine who lives in Chicago. His neighborhood is a crime-ridden cesspool. Mark has voted Democrat his entire life. And he continues to do so.
I find both of these odd cases to be completely inexplicable. Neither “Susan” nor “Mark” are stupid. But neither case makes any sense at all. They ignore the obvious truth right in front of them, and do self-destructive things which make no sense whatsoever. And again, they are not stupid.
People are weird.
Lord, help us.
Published in General
Theory: Every doctor has a quack doctor inside that’s trying to get out. Some of them make sure that doesn’t happen.
Or perhaps some people manage to rationalize hurting people for profit. Like some “doctors” and some politicians.
Good question. Like you say, people are weird.
Some people don’t want to think they have “simple” problems.
I also wonder if “Susan” is religious? I’m thinking, regular attendee of the Church of Yoga.
Are you sure they’re not actually stupid? They might be “educated” (programmed, whatever) but that doesn’t necessarily mean they’re not stupid.
I love your stories about your patients. :) :)
People turn to alternative medicine for a lot of reasons. In fact, one could look at the entire illicit drug market as people turning to “alternative medicine.” People will try to solve their problems as cheaply and easily as possible. It doesn’t usually work. But I do sympathize with them.
However, I like working with real doctors, the old-fashioned decisive smart ones. My mom was borderline diabetic at one point, and her internist had had her on Metformin for several years. Her numbers never came down, but they didn’t go up either. So her doctor didn’t give it any more thought. But her health was declining. Of course, like most older patients today, she had several issues, so diagnosis was always a challenge. But when she had her first of three heart attacks within a short period of time, her cardiologist, a long-time friend of mine and someone I greatly admire, put her on insulin. He had an “Okay, enough of this medicine–let’s fix this” attitude. :) When I saw her the next day, I was shocked at how beautiful she looked. A complete transformation.
I really like that kind of doctor. :) “Enough already. Let’s solve this!” :) :) :)
I think it’s often a variation or corollary of the late (and much missed) Michael Crichton’s Gell-Mann Amnesia Effect.
(Update: I’m having trouble with that link, so try this link to the PDF here.)
For those who don’t know, Crichton described it thus (with minor abridgment):
The point is that we often tend to assume expertise in others on topics about which we know nothing. “Susan” knows nothing about medicine, and she is now confronted with what she believes to be two equally plausible experts on the topic. You may be more convincing regarding her liver disease (particularly given its correlation with her own recovered memories of her mother’s battle with a similar affliction), but there’s all that other stuff, the hormones and non-GMO supplements and seaweed wraps and whatever that her other medical expert has recommended… and you probably haven’t even offered her a laminated pie chart showing her estrone/estriol/estradiol balance so what the hell, doctor?! Of course she’s going to go talk to her trusted internist and/or chiropractor.
More serious point being, the “obvious” truth is obvious to you because you’re an expert. In Susan’s mind, her two experts don’t agree. What’s she to do?
I recommend astrology, but I’m medically non-conforming.
What?!?! You forgot the Bird of Truth!
When JFK, Jr.’s plane went down, my husband (who is an instrument-rated pilot and had owned the same plane) and I listened to the reporters interviewing “experts” about possible causes, what might have happened, etc. He kept up a constant stream of comments about this was wrong and that was wrong. I said, “You know, we need to remember this the next time we listen to reports about things we aren’t familiar with.” He agreed and said, “But we probably won’t.”
Another good one Dr. B. And so timely. Shared my experience with CTlaw on the talk tonight. Kind of embarassing. So getting a bad feeling in a private part in a shower. Ask to see my dermotoligist. In some pain. Very good experienced female M.D. who I have worked with for a few years. So its “lift up your pants and see what we got here.” Oh, yeah. Seen a few of these.” Pokes me with needle and says take Advil and will see you next week. The only thing I will miss about San Fran are the great docs. Maybe we can schedule appts. every six months.
Many doctors miss the hereditary hemochromatosis diagnosis.
My spouse is familiar because he lost 4 of his 5 maternal uncles to the disorder. Only when Mom’s brother #5 hit failing heart problems in his mid ’40’s did a doctor figure it out.
So your patient was quite lucky to have you.
When I lived in liberal Marin, many affluent people went to doctors, but the doctors acted much like the chiropractor you described.
Page after page of tests and test results. Real ailments were ignored, but supplements of this and that were ordered for the patient.
A family friend was being pressured to take his adult daughter with psych problems to one of these charlatans. He did not want to make the switch, but in Marin, which doctor you must go to was becoming a fad.
One of my friends who was a nurse finally called him to say, “Are you aware of how some of these ‘alternative doctors’ are putting people into the cemetery? You have been doing the right thing. Just stick to your guns no matter what friends are telling you. Continue having your daughter see the specialist she is seeing. She is making progress, and she won’t be doing that if you have her switch to any of these quacks.”
Both my friend the nurse and I were pleased when our friend relaxed and had his daughter stay with the usual physician.
So, blood-letting IS what she needed? Theodoric was right!
Steve Jobs most likely would have lived years longer if he just followed regular medical advice rather than “alternative” advice.
I see this as Dr. B’s point and the exasperated response to Henry’s question: “What’s she to do?” The ‘weirdness’ associated with ignoring an abundance of evidence, has little to do with either Dr. B’s expertise or the chiropractor’s bona fides (or lack thereof). Why continue and hold faith in what clearly isn’t working? What’s that old saying defining insanity?
It seems ‘Sarah’ already knows what she’s doing isn’t working – why else even show up at Dr. B’s rather expensive doorstep? But unwilling to adjust to Dr. B’s clear medical advice. I’m assuming ‘Mark’ must continually complain about the crime and his neighborhood conditions…he knows ‘something’ is broken, but is unwilling to change voting habits to fix it?
Aren’t these, and so many other instances, forms of cognitive dissonance in various degrees? Cognitive dissonance manifests itself through irrational adherence to some thought/dogma/idea, despite evidence to contrary. Is the weirdness Dr. B describes essentially the irrationality; the incoherent and contradictory logic driving their decision making?
Correct.
Hereditary hemochromatosis is the one disease you could actually treat successfully with leeches.
So those guys weren’t ALWAYS wrong…
My wife is very big on using any and every service we already paid for. If a hotel has gym and and a pool, then we are working out and swimming, even if we are just there for one night. If I kill an ant in the house, then we are calling the bug guy because we pay them monthly anyway. So, if we could afford a doctor with a concierge service, we would bother the hell out of him (well she would anyway).
I have never been to a chiropractor, but I always assumed they were there for spinal type issues. I didn’t know they could prescribe pills.
Chiropractors treat everything from allergies to breast cancer to heart disease, using everything from spinal adjustments to supplements to stuff you’ve never heard of.
I can sell you a coin to flip that is guaranteed to give the correct answer.
This is how I read a book. I find the part that I know most about. If the writer covers that well, I’ll give him/her a little “benefit of the doubt” on the rest.
Did ‘Susan’ wind up going to the haematolgist? Did she get better?
People are weird?
I think you are being kind Doc.
(refrains from mentioning the Darwinian selection process has been thwarted lately)
And then there’s The Weirdest People in the World. A good read, really.
I don’t know – I just saw her yesterday.
I made her an appt with the guy – I hope she goes. If she doesn’t, this won’t go well at all. It probably wasn’t the booze that killed her brother (although that probably didn’t help).
Rich people can be weird because they don’t have to worry about consequences.
We have a chiropractor who is excellent at what chiropractors are supposed to do. She fixed a pain in Andrew’s back that he had had for 30 years despite numerous doctor and other chiropractor visits. I had apparently damaged something while helping him put up 36 flags during a Flags Over Solivita holiday. Four days later, I could not lift my right arm without excruciating pain. She adjusted my shoulder area two days in a row. The first day was a vast improvement and after the second day I was pain free.
HOWEVER, she has also gotten into “wellness” and has all the potions and elixirs. And she does the tests with vials of “elements” sitting on your stomach to diagnose what you are sensitive to or deficient in. We just say “No, thanks” and have her stick to what she does best – adjustments.
I told her once that it was witch doctor stuff. To her credit (I guess) she just said, “Okay” and didn’t mention it again.
This thread reminded me of a routine that Aussie comedian Tim Minchin did some years back. Delivered in beat poem style, it addresses the foibles of alternative medicine adherence/worship. Enjoy, all.
https://www.youtube.com/watch?v=KtYkyB35zkk
For several years my physician was a former chiropractor who had gone straight and gotten his M.D. He had the annoying habit of diagnosing various abdominal aches and pains as being spinal issues. That itself wasn’t so bad, but it was annoying how he was always right. He didn’t diagnose everything as being a spinal issue, so sometimes kept his inner chiropractor in check. It has been 25 years or so since I last saw him. I don’t remember why I stopped. He died just a few months ago, and I see that his obituary makes no mention of his former life as a chiropractor.
I have never subscribed to the magic potion theory of health, which doesn’t mean I haven’t taken various poisons that have been prescribed for me.
Remember the old adage: the better the 4-wheel drive, the further you’ll get in the woods before you get stuck. When rich people get into trouble, it’s real trouble.
There are “true believers” and those who see growth potential for their business.
I meet with a group of ladies every Wednesday morning to say a rosary. We have a book that we pass around where we write our intentions.
The first 30 minutes of gathering is spent drinking coffee and catching up. I’m famous in that group (and other gatherings) for putting a time limit on ailments. We’re all of a certain age and I’ve learned that left unchecked that topic can last for hours.
Anywho, last week a woman (whose list of complaints is always long) was looking for an alternative doc to treat her gout. Her own doc had assured her that was not what she was suffering from.
How did she know it was gout? Because God had told her. (Long boring story followed. I think there was a dream and a healing mass involved, but I’d stopped listening)
The link appears not to work.