Thursday, June 2, 2011

Medical Arrogance and the Effects of Prejudice

One of the most fascinating stories I have run across about medical arrogance is actually a story about doctors turning on one of their own.

In 1847, Dr. Ignaz Semmelweis figured out that if the doctors and students at his hospital washed their hands, it would decrease the spread of disease. This was revolutionary, because at the time, doctors believed that illnesses were caused by a 'disruption of the four humors', with the common 'treatments' being bloodletting, enemas, and cupping. Based on his discovery, he was able to drop mortality at his hospital from childbed fever by 90%. But his theories were rejected by the medical community. Other doctors believed there was simply no way they could be the cause of disease spread.

What absolutely strikes me is Dr. Semmelweis's reaction to the rejection. From Wikipedia:
Beginning from 1861 Semmelweis suffered from various nervous complaints. He suffered from severe depression and became excessively absentminded. Paintings from 1857 to 1864 show a progression of aging. He turned every conversation to the topic of childbed fever.*

After a number of unfavorable foreign reviews of his 1861 book, Semmelweis lashed out against his critics in series of Open Letters. They were addressed to various prominent European obstetricians, including Sp├Ąth, Scanzoni, Siebold, and to "all obstetricians". They were full of bitterness, desperation, and fury and were "highly polemical and superlatively offensive" at times denouncing his critics as irresponsible murderers or ignoramuses. He also called upon Siebold to arrange a meeting of German obstetricians somewhere in Germany to provide a forum for discussions on puerperal fever where he would stay "until all have been converted to his theory."
*Emphasis mine, because wow... that sounds.... hauntingly familiar.

This wasn't a guy who was chronically ill. This was just a doctor going up against other doctors. And it was the act of their rejection in the face of clear evidence that drove him to that behavior. Simply not being believed, he became obsessive about the topic. This leads me to the conclusion that it's not being sick that drives us crazy, it's the disbelief of others that drives us crazy.

And with so many articles out there warning patients about the evils of obsessive thinking about our disease... I wonder what kind of revolution in care could happen it doctors simply expresses a willingness to believe in their patients.

Because that's largely what a medical education does: teaches doctors not to trust their patients. I saw a friend of mine go through med school, and when he became a resident, he constantly felt like he had no clue what was going on, despite his education. It's just all so HUGE. Doctors know their patients haven't gone through this, so obviously any of our observations are... suspect.

Studies on prejudice in psychology show that when people are treated with suspicion, they become depressed and unable to view themselves as in control of their lives:
"Our results show that perceptions of unfair treatment, like other chronic stressors, are psychologically burdensome... Many... suffer emotionally because they are unable to view themselves as efficacious and competent actors when treated with suspicion and confronted with dehumanizing interactions."
Keith VM et al (2009). DOI 10.1007/s11199-009-9706-5
Now, I had to take this quote out of context, because there haven't been any studies on prejudice towards patients as patients. All the studies are on race, gender, and visible disabilities. But the results are consistent. People feel depressed, angry, isolated, and suffer a loss of self-esteem if they feel the deck is stacked against them. Currently, however, patients get blamed for these reactions.

This needs to change.

I know this change is not something that will come easily. I have Semmelweis experience to warn me. I'll be seriously surprised if it happens in my lifetime. But he was eventually vindicated, even if he wasn't able to know that satisfaction.

Someday... *sigh*

[Update - July 15, 2011:]
This talk from TED by Tim Hartford provides other examples.

4 comments:

  1. This is an awesome, awesome post. Thank you for writing it. I really think you're on to something here.

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  2. You are so very right! I hope someone will do thourough research on this topic and kick start the same kind of change dr. Semmelweis did.

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  3. Fascinating post! I have experienced this prejudice for many years now while being treated for my chronic illnesses. And what I found even more eye opening for me is the trial and error approach mentioned in Ted ideas video. This is what the approach has been to rheumatoid arthritis treatment all along. Unfortunately it extensively limited to trial and error through drug application. This is due to the God complex that does exist among almost all of our medical professionals today. And because so many drugs do have consequences, I have been one of the unfortunate ones to have bad allergies to many of these drugs. This has left me out in the dark wondering on my own like you. My heart goes out to you in your personal quest for treatment(s). It truly does.

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  4. *Thumbsup* Now if we could only get the doctors who need to hear this to consider it.

    Thankfully there are some fabulously wonderful doctors out there, but just like the barrel of proverbial apples... A single one is enough to spoil a lot of lives...

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