Let’s Talk About Doctors
Why research and comprehension beat hope and fantasy every time
Before we discuss medical doctors specifically, let’s acknowledge one fundamental aspect of human psychology: our inevitable projection of our hopes and dreams onto someone or something. We do this all the time. In the USA people who rally behind a political candidate project all manner of qualities onto their beloved Great Leader despite all evidence to the contrary. In the UK a great many people idolize the Queen despite it being patently obvious she’s neither particularly intelligent nor an adequate role model (just ask her eldest son…). Name any country and you can also name the most prominent fantasy projections.
We do this because for most of our evolutionary history we existed in small hunter-gatherer groups in which cohesion was extremely important. It’s difficult to play follow-the-leader if one knows the leader is highly flawed; thus reality distortion becomes an essential attribute of our species, enabling us to overlook the blindingly obvious in favor of whatever imaginary construct we have inside our heads. It’s the same reason people believe in invisible magical creatures like gods, ghouls, and goblins. Our ability to discern real from imaginary is even at the best of times extremely tenuous and vanishes altogether when we’re afraid.
When we project our fantasies onto a person or an ideology we gain a sense of security. The illusion of a well-ordered world in which people know what they are doing is far more comforting than the terrifying reality that nearly everyone is mostly incompetent and most processes are poorly-designed and thus lead to entirely unintended outcomes, mostly bad ones. The more ignorant and simple-minded we are, the easier this projection is, which is why ideologies are most fervently held by those whose cognitive abilities are notably limited.
When it comes to matters of health we naturally deploy our fantasy-projection routine because otherwise our situation would be very disturbing indeed. No one wants to feel that their personal wellbeing is at risk, and no one wants to acknowledge the role of random chance that influences every life to some degree or another. We want certainty and we want safety. As doctors are presented to us as intercessors between us and disease we naturally want to believe they are supremely competent and will save us from whatever we fear.
Unfortunately, doctors are just like us: highly flawed and highly fallible human beings who aren’t granted super powers merely because they went through the mill of medical school and completed their internship. In fact, ironically, nearly all the training they receive is antithetical to the maintenance of good health because it focuses almost exclusively on disease.
Most people would be amazed to discover that doctors know little or nothing about proper experimental design and evidence-based reasoning. It’s not part of their training.
This is why medical doctors can write silly books about the evils of gluten or about why we should eat profoundly unhealthy diets in order to lose weight. Doctors are trained in a very limited way to play detective: they wait for us to show up with symptoms and they try to diagnose what is causing those symptoms. Very often, because human physiology is complex, they merely prescribe drugs that mask the symptoms and do nothing to ameliorate the underlying causes.
Doctors have also been demonstrated by many psychological studies to be people who have an abnormal fear of death. They are thus motivated by personal impulse as well as systemic organizational inducements to step in and take decisive action even when in reality they have little or no idea what they are doing. This is why doctors used to bleed patients to “rebalance the humors,” why doctors rushed to embrace lobotomies and tonsillectomies, why doctors are anxious to “control” the birth process, and why they until very recently handed out antibiotics like candy for viral infections, leading directly to today’s drug-resistant strains. It’s why doctors created the Prozac and Ritalin epidemics and why today the USA has an opioid crisis. Doctors need to do something, anything, regardless of the obvious consequences. It’s who they are.
Doctors don’t behave this way because they are ill-intentioned. For the most part, doctors genuinely mean well. Just as a witch-doctor genuinely means well when he performs a dance and burns body-parts taken from albino children in order to cure a curse. But good intentions don’t guarantee satisfactory outcomes.
In the recent SARS-COV-2 pandemic it’s now estimated that doctors killed around 70% of patients by rushing to place them in induced coma in order to intubate and artificially ventilate them. This is known to be a highly dangerous procedure but, like so many people, doctors were panicking. They wanted to do something, anything, in order to feel less powerless and overwhelmed. Doctors also deeply mistrust patients, which is why they ignored the much safer option of simply providing patients with nasal O2: doctors didn’t believe patients could be trusted not to dislodge the nasal clip.
Now that doctors have largely backed away from the induced coma routine, mortality per thousand infections has dropped precipitously. But few people want to acknowledge problems like this because they would shatter our much-desired belief in the infallibility of the medical system.
So we ignore reality in favor of myth, because it’s easier for our tiny ape-brains to cope with and it’s far more emotionally comforting.
It is, however, a strategy fraught with adverse real-world consequences.
When we look at childbirth we see overwhelming evidence of absurdity. Since 1927 the percentage of women giving birth in a medical facility has risen from nearly zero to around 97% depending on which OECD country we look at. As doctors will correctly point out, infant mortality has dropped during that period from around 500 per 100,000 births to around 7 per 100,000 births. Naturally doctors attribute this to the rise in women giving birth under “properly supervised conditions.”
Unfortunately for this narrative, when we look at the mortality rate for infants whose mothers opted for a home birth, we see precisely the same fall.
In other words, the fall in infant mortality has nothing to do with the mechanized hospital process and everything to do with modern sanitation, antibiotics, and improved diet.
In fact pregnancy and birth is highly stressful when conducted within the modern medical system and outcomes are now worse than home births.
In the USA, doctors routinely induce birth in order to adhere to arbitrary schedules, which results in premature delivery, which results in the world’s highest rate of C-sections (over 30% as of 2018 data). As a C-section is a major surgical procedure that jeopardizes the mother’s health and safety, it’s apparent that the madness of mechanized birth has gone far too far. In Europe, by contrast, the C-section rate is generally under 1% of births and is particularly low in France where home births and births in women-run clinics are increasingly promoted. France also has a lower incidence of infant mortality than the USA. It’s clear the US approach to birth is totally broken.
The purpose of all this is not to say that doctors are bad or universally incompetent. It’s simply to point out that they are ordinary people just like us. Their training is absurdly antiquated relative to the huge corpus of knowledge that has been developed over the last fifty years. Their reluctance to adopt improved techniques and technologies also results in massive harm to millions of patients.
By way of example most doctors still use forceps to assist difficult births, whereas a far superior vacuum option has been available for more than twenty years. The vacuum option has resulted in zero cranial deformations whereas cranial deformations are the norm with forceps. Likewise in the USA doctors routinely perform episiotomy on the mother on the ground that she “might” otherwise tear. OECD data shows that well over 99% of births are tear-free, whereas 100% of episiotomies result in potential bacterial infection and always leave residual scarring and nerve damage. Episiotomy is no different from breaking a patient’s leg in order to “save” them from a potential ankle sprain. And US doctors insist on using fetal heart rate monitors despite multiple studies that show (a) they slow down birth by inducing anxiety in the mother, and (b) doctors reliably misinterpret the data and rush to perform C-sections as a result.
Many women in the USA leave hospital after mechanized birth convinced their marvelous doctors “saved” them and their baby, which is precisely the same as believing that although the doctor shot you in the stomach (a perfectly standard procedure, you’re reliably informed) they then “saved” you by removing the bullet and stitching you up.
As anyone who speaks British slang will realize, in all these cases the patients were indeed “properly stitched up.”
Many of our examples here have been to illustrate how doctors treat a perfectly natural process as a disease and in consequence create all manner of harms for mother and child. But doctors aren’t limited to creating harm around the process of childbirth. Many doctors still perform spinal fusion surgery on patients with chronic back pain despite three decades worth of evidence that (a) spinal fusion does nothing to reduce chronic back pain, and (b) spinal fusion often makes things worse by placing greater stress on the remaining unfused vertebrae.
Again, the purpose of these examples is not to demonize doctors. In fact, it’s impossible not to feel very sorry for doctors. Despite all the knowledge amassed over the last century, we still know comparatively little about the human body and the many diseases to which it can be subject. Biochemistry is an extremely complex topic. Most doctors know very little about such complexities as their training is still based on a nineteenth-century outlook and approach. Nearly all the gains we’ve made in disease treatment over the last century have come not from improvements in medical practice but from pharmacology.
Doctors, in a very real sense, have remained trapped in a late-Victorian mindset. No wonder they are often anxious and turn to alcohol or narcotics for relief. Their patients expect miracles but they’ve been trained to hand out pills. Which, sadly, they do very poorly as most still refuse to use simple IT systems that automatically check for adverse drug-drug interactions. 30% of hospital deaths are estimated to be a direct result of doctors prescribing the wrong medications in consequence of being “too busy” or “too important” to run a basic computer program. No one knows what the non-hospital death rate through wrong prescription may be.
It should be abundantly clear by now that doctors are, like the rest of us, deeply human and therefore deeply fallible. If we want to be healthy it’s incumbent on us to undertake the necessary research (which does not mean looking online for hypochondria-inducing nonsense blogs) and then making adequate lifestyle decisions.
As more than half of all health care expenditure is now a direct consequence of people being too fat and too indolent, it’s clear doctors are increasingly overwhelmed by ailments that are totally unnecessary. How can we expect doctors to make good decisions on our behalf when most of us can’t even be bothered to make good decisions for ourselves?
And for those who do make more adequate lifestyle choices, it remains essential to conduct extensive research prior to consulting with one’s doctor. It’s unlikely your doctor has had any supplemental training since qualifying many years ago; most doctors merely receive detailing from drug company representatives. Your information may well be far more up-to-date than what’s inside your doctor’s head.
When we stop imagining our doctors are miracle workers and instead regard them in the same way we regard regular tradespeople, we get better outcomes. Know what’s wrong, understand what we need, consult with our doctor, and make the final decision ourselves.
There will always be those who can’t do these things, but for those of us who can it’s the only way to be relatively confident we’re not simply trusting to fantasy. And let’s be honest: what’s more important than our health? Do we really truly want to tell ourselves we “don’t have the time for all that” because we’d rather spend those hours watching Netflix or some pointless sporting event?
In the end we’re each of us individually responsible for our health and wellbeing. The sad thing is: so many of us are presently doing a truly abysmal job.