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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
I was thinking Andorians.
I’ve told this before, but in 1979 a newspaper reporter came out to interview me for a story on the acid rain monitoring network of which we were a part. He asked good questions and the result was a 2-page spread with photos, all well done.
Around this same time I also was interviewed by some local public radio and TV journalists. The latter were especially ditzy. I never watched or listened to any of what they put on the air, but my wife did and confirmed some of my suspicions about where they were going with the topic.
Anyhow, over 30 years later I happened to meet that newspaper reporter again, when he was retired and I was about to retire. He remembered the story he had done on acid rain, because (he told me) it was the first science story he had done. He had done a lot of work beforehand to study the issue before coming out to do the interview. It was a surprise to me to learn it had been his first science story.
So it can be done, but work schedules and deadlines don’t always permit. Best to get as much education as you can before getting to that stage.
Hartmann, it no longer does for me, either. I can’t explain that, as I copied the link verbatim, and tested it. Thank you for catching it. I’ll update the original comment.
Here is a link to a PDF of the speech. I think it’s quite a good speech.
Yup.
A study showed that of the people who get medicines prescribed only about half of them ever get them filled. Of those who get them filled about half actually take them as prescribed.
So, 25% of people who go to an expert for advice actually follow the advice where medicines are concerned, and it doesn’t seem to matter whether the medicines are vitally important, such as is the case for diabetes or organ transplant, or not.
Speaking of weird, people who pay for and go to the trouble of seeking expert medical advice and then actually follow it turn out to be the outliers.
This may be true, but it feels like the percentage cited is somewhat misleading. Many (most?) prescriptions are elective in some way or another. In other words, most health problems are far from life threatening (and most are fairly mild), so a failure to take the medicine is far from a catastrophe. For example, my one son was prescribed an antibiotic for acne (which we filled), but it would in no way have been that big of a deal had we not and just continued to try over the counter stuff. How many painkiller prescriptions are written following surgeries that the patient is told, “fill this if you have extreme pain”? It would seem like a lot. No doubt the percentage of people who need the medicine but fail to get/take it is high, but I’d be willing to wager that the percentage of prescription filling/use for medicine that is needed is much higher than 25%. FWIW.
Very true. I write quite a few prescriptions where I tell the pt not to take it unless this or that happens. Saves me a phone call later.
–John Derbyshire
The patient’s behavior seems both understandable and explicable. Many patients, when confronted with the possibility of a serious and potentially lethal or at a minimum debilitating genetic disease engage in rather massive denial. This patient seems to typify that phenomenon.
This phenomenon is most pronounced in disorders that have no effective treatment, such as Huntington’s Chorea, but occurs in more treatable disorders like Hemochromatosis. The recourse to a yoga instructor or a chiropractor who practices wildly alternative medicine, seems to me to reflect an attempt to reject the possible diagnosis and search for some much more benign explanation outside of allopathic medicine to explain symptoms, which can be both intimidating or frightening (a term like “hemochromatosis” sounds dire) to explain mild chronic symptoms in someone who has been in superb health. Imagine the shock of being told that you, a very healthy and active middle aged person anticipating a long and healthy and very high quality life, have an inherited disorder that may be lethal, as it might have killed your brother, and mother? How willing would you be to immediately accept such a (potentially lethal and incurable, even though treatable) diagnosis? Would you not want some more benign alternative explanation?
The patient’s attribution of her brother’s death from liver failure to alcoholism, seems to be a defensive reaction, and may even be correct, but he had a 50% likelihood of having hemochromatosis if indeed his mother did and his father was a carrier, which would be the case if his sister, Dr. Bastiat’s patient, does have hemochromatosis. The patient may indeed have recognized, perhaps intuitively, her predicament, but was unable to deal with it rationally if at all. From Dr. Bastiat’s description, it seems very likely that Hemochromatosis is the diagnosis. Hemochromatosis tends to have symptomatic onset in women after menopause, when women no longer lose blood to monthly menstrual periods.
Perhaps the patient’s inclination toward denial might have been offset to some degree, and the likelihood of her actually seeing the hematologist increased, by informing the patient more extensively of what the disorder is and how it is treated. Perhaps not.
But I would have been inclined to explain the genetics of the disease, (that genetic testing could affirm or refute the diagnosis), the a priori odds of her having the diagnosis, how it occurs, how it affects multiple organs (liver, pancreas, kidneys, adrenals, heart, pituitary, thyroid, gonads) and can induce congestive heart failure, liver failure, diabetes, pituitary insufficiency, adrenal failure, hypothyroidism, hypogonadism, any of which may cause some of the symptoms she reported. I would have tried to explain to her how the treatment works, how very effective it is, and how it might benefit others (blood donation) while keeping her healthy.
Then I would have called the Hematologist and explained the circumstances to him or her, and the perspective of the patient, and tried to establish some repoir between them, and likewise with Cardiologist, Endocrinologist, and Liver Specialist.
As you probably presumed, I did all that. Spent 20 minutes going over all the details with her. I just left that part out of my post to stay on point.
No, that doesn’t appear to be the case. I can attest to the tendency of a lot of people to ignore even vitally important advice, as in the original post.
Psychologists found that if patients had a good understanding of why the medications were necessary the compliance improved, so taking time to explain and try to make sure patients understand helps a bit.
Like I said, I don’t doubt that the number is large. But do you really think that when someone needs a medication that 3 out of every 4 of those people never take the meds? That seems way too high to me.
But I’m no doctor, nor do I play one online (ok, sometimes I do). I’ll let you and Dr. B fight it out.
Doesn’t seem too high at all to me. :)
For a million reasons, everyone I know is like this. They just don’t like prescription medications. I really don’t know why.
They have chemicals in them!
Ew, ew, ew.
Their bodies are MADE OF chemicals!
And some water. (Which in a way is another chemical.)
Both Susan and Mark are loathe to admit they were spectacularly wrong.
Which for me makes the power of her denial impressive indeed. At least I would characterize it as denial, which may not be correct. Perhaps something else is going on. Maybe she just has no confidence in allopathic medicine. Doug Kimball has an enlightening comment on this thread of the horrific errors his father was subjected to by allopathic physicians. But an interesting case, and a hard nut to crack. I have diagnosed a number of patients with hemochromatosis (usually in the setting of diabetes with elevated liver function tests, check a ferritin and find it very high, and do genetic testing; I have even found some compound heterozygotes that are affected) and haven’t had any that doubt the diagnosis as this lady appears to be doing.
Maybe she’ll wait for her yoga instructor to agree.
¯\_(ツ)_/¯
Well, it is unnatural to take medicines for chronic conditions. With a good well, fertile soil, and with a minimum of steel for tools you can survive and even live well. You can at least supply for your own needs.
You’ll never be able to make your own medicines. And being reliant on, say, insulin or blood pressure pills or HIV medicines, or anti-rejection medicines ties you to a particular environment and society and supply chain. You really are shackled by it. You can’t live as a hermit in the woods, you have to take a sufficient supply with you on trips, and if manufacturing or transportation breaks down you’re in trouble.
And you never get a day off from your medicine-taking routine. Denial removes the shackles.
Then once you’re dead, the shackles are REALLY off.
Yes, there’s a healing at death, and the double amputee will walk again, too.
I don’t like my daily meds either. However, they do prolong my life. Once I retire I am going to try to walk to lower weight and lower doses.
I don’t mind prescription medicines in the slightest. We are all going to die. Anything that helps me get more done between now and then is GOOD. Better living through chemistry, baby!
That’s not what the ancient Egyptians believe in.
The ancient Egyptians don’t believe in much of anything these days.
My kids would say that an ancient Egyptian is any Egyptian over 40 years old…
The only good thing about ancient Egyptians was how they walked.
Are you Catholic? I would have guess that you were not Catholic. I know there are some other Christian denominations that pray the rosary.