Who Do You Think You Are, A Doctor?
Remember the scene in the movie Knocked Up, where the obstetrician is telling Allison she can’t have an epidural? Greatest scene ever. I know for a fact that at least three of my most loyal and beloved readers won’t get this cultural reference, so I’ll quote it for you:
Setting: Labor room, Allison (Katherine Heigle) about to have a baby, Seth Rogen’s character, the father, is there, along with the nurse, Deb, and the obstetrician, played by Ken Jeong, who is actually a real doctor.
Allison:”Oh this really hurts.”
Jeong: “I see we’re well on our way.”
Allison: “I want the… I want the epidural. Okay?”
Rogen: “Give it to her now.”
Jeong: “Ok Allison. We’re past the point of an epidural. Okay? The cervix is fully dilated.”
Allison: “No seriously, I want an epidural…”
Jeong: “We can’t give you the epidural.”
Allsion: “I’ll make sure it doesn’t come out! I’ll stop pushing!’
Jeong: “We’re gonna just have to do this the all-natural way, okay? The way you wanted to do it.”
Allison: “This is messed up. Something’s wrong in there.”
Jeong. “Oh, no, no. I mean, granted, gynecology’s only a hobby of mine, but it sounds to me like she’s crowning. Is that right, Deb?”
Actually, there a few scenes in the movie in which Ken Jeong’s character hilariously says things that doctors would love to say on occasion but never do. They are variations on the theme of “Who’s the doctor here?” This post is not a yearning for the old, paternalistic way medicine used to be practiced, but every time I see these scenes I remember similar discussions with patients who are trying to play doctor.
This rant started because a colleague pointed out a piece by Tom Nichols at The Federalist entitled “The Death of Expertise”. (Thanks Jess Geerling!) http://thefederalist.com/2014/01/17/the-death-of-expertise/. Here’s how he introduces the topic:
“I fear we are witnessing the “death of expertise”: a Google-fueled, Wikipedia-based, blog-sodden collapse of any division between professionals and laymen, students and teachers, knowers and wonderers – in other words, between those of any achievement in an area and those with none at all. By this, I do not mean the death of actual expertise, the knowledge of specific things that sets some people apart from others in various areas. There will always be doctors, lawyers, engineers, and other specialists in various fields. Rather, what I fear has died is any acknowledgement of expertise as anything that should alter our thoughts or change the way we live.”
I’ll ignore the blog-sodden comment. Here’s the thing. Information is readily available. Access to the greatest minds in every field is more accessible than it’s ever been. Information, however, even from thought leaders, is useless unless it is processed appropriately in the right context. For example, imagine that I, arguably an “expert” in the field of anesthesia, decide to go consult a lawyer on a possible real estate purchase. This lawyer would presumably be an “expert” in the field of real estate law. I could play my visit two ways: I could go to her (it’s a her. It’s my blog.) and say “Here’s this building I was thinking of investing in, but it has several zoning regulations, what do you think…” and then do what she says. Which is what I would do, since I know zilch about real estate. Or, I could go to her and say “I’ve spent all day on the internet and I’ve discovered that in zone 3 in this state the statute of limitations on blah blah…” If she then patiently explains zoning laws to me, I could come back with “Are you sure, because realestaterus.com says that according to article 33 of amendment 501 of the zoning regulation…”. But I’m not going to do that, right? Because she is the expert, and I am not. It doesn’t mean I’m inferior to her, or somehow in her debt, or that I should feel bad about myself because I don’t know anything about zoning. Nor should I feel attacked or threatened by her superior education and skill in law. I subjugate myself to her in this particular area.
Patients are in a difficult spot. They feel vulnerable, threatened, fearful of pain and unfamiliar circumstances. Especially in anesthesia, which is a black box to most folks. In medicine, patients must subjugate themselves, within reason, to an expert. So many people feel threatened by this. The source of this feeling is distrust. I’ll admit to feeling the same way about my mechanic. But I know less about cars than I know about real estate law. I can, and should, look at the information that’s available that I can understand, but ultimately I must trust. May we doctors be forever worthy of yours.