Your story is excellent and so spot on! I taught clinician patient communication skills at Kaiser Permamente Southern California. We have used actors as patients for years and your findings are consistent with mine. And I agree these skills can improve with awareness by the clinician of how he/she are perceived by the patient or an observer. And I agree, sadly that there is less and less time for true patient physcian communication. So much is lost in not having a trusting relationship with your physician. The system is broken, and I fear that it may be beyond repair as long as reducing the cost of health care is the main driver of the system.
You’re almost there! Next, think more deeply about “evidence based medicine” and you’ll realize most of it is just as much a corrupt scam as the EMR systems that came with it…
Forgive the lengthy excerpt, but I just wrote about this:
“the current crop of medical robots did not forthrightly announce their intention to rule the world. They were subtle and took control with devious lies. The greatest of these was the concept known as Evidence Based Medicine. I went to med school in the heyday of Evidence Based Medicine; it was our mantra, and you couldn’t throw a surgical sponge without hitting someone spouting off about its countless holy attributes. Hand in hand with Evidence Based Medicine was the concept of the Guideline. This was an authoritative document, penned by the experts in the field, incorporating all the aforesaid Evidence, telling doctors exactly how to treat any particular condition. The one-two punch of Evidence and Guideline were sold as a way to discard the superstitious practices of old and to incorporate only those treatments proven to work via rigorous research and clinical evidence. Sounds good, right? Long time readers doubtless recall the many horrors inflicted in ignorance by doctors of the past. What’s wrong with requiring studies be done before a treatment is approved? Unfortunately, it was all lies. Evidence Based Medicine uses faulty evidence, practices bad medicine, and is anything but based. Our practice-determining Guidelines are cringey groupthink. Combined, they were used to strip the human touch from medical practice. The machines, in short, are already in charge.
Imagine, if you will, an Evidence Based Guideline encouraging pediatricians to get toddlers to chain smoke Lucky Strikes. Unthinkable, you say? Well, what if I showed you a rigorous study, funded by the cigarette companies, following toddlers who smoke for two whole months? Not one single case of lung cancer detected in those entire 8 weeks! Cigarettes are clearly as safe as water – safer still, considering no child has ever drowned in a tobacconist’s. Meanwhile, detailed questionnaires given to the toddlers’ daycare centers reveal a significant improvement in mood and focus alongside a notable decrease in overeating. The science is clear. Within a few months of the study’s publication, the American Academy of Pediatrics, shortly after unveiling its new sponsorship agreement with Marlboro, publishes its practice guideline encouraging the placement of Pall Malls in every pediatrician’s waiting room, with handouts provided to all parents on the benefits of smoking alongside their children.
Too fanciful to believe? Well, return to reality and consider just a few highlights from the Evidence Based Hit Parade of the past few years:
- Forced masking of toddlers and closing down of all childhood activities for years, causing untold mental and developmental harm, over a disease that posed zero risk to children
- Castrating and mutilating children, then pumping them full of hormones for life, in order to perpetuate the outrageous delusion that they were born in the wrong body
- Using powerful, addictive, and harmful psychiatric drugs to zombify millions of five-year-old boys into sitting still and shutting up every single day of their lives
- Prescribing even more brain altering, soul-destroying drugs with lifelong, irreversible side-effects to any kid who voices doubts about the famed joys of adolescence
- Prescribing yet more mind-altering, hormone-manipulating drugs (are you starting to notice a pattern?) to millions of teen girls without any warning of the deadly dangers
- Blatantly discriminating against medical school applicants for their race and sex
- Calling for the censorship, and the de-licensing, of any doctor who spoke out against any of the above
I could go on. All the above insanity – whether related to COVID, trans madness, ADHD, DEI, or ‘mental health’ – was enthusiastically embraced by the Evidence Based Medicine community, and in some cases remains *the* standard of care promulgated by prominent medical guideline makers, like the contemptible AAP, to this day.
A system is what it does. Evidence Based Medicine, I think we now all understand, has precisely zero to do with getting medicine to base itself on evidence, and absolutely everything to do with getting medicine to be run without dissent by a corrupt, anti-human establishment.“
This is why I’m a proponent of two things. 1) concierge type medicine, and 2) alternative medicine.
People need to support their health through lifestyle, and it’s far more important to their longevity and wellbeing than seeing a doctor. In fact, usually better. I hate to say it, but so much of medicine is utterly destructive.
Look no further than 1) cancer treatments, 2) so-called cholesterol therapies. Then proceed to proton pump inhibitors and while you’re at it, bisphosphonates.
Yet ask a doctor about the importance of K2 MK4 and you’ll get a blank stare most of the time. And when it comes to thyroid, well, fuggedaboutit. I believe there is a ton of iatrogenic atrial fibrillation because of ignorance and stupidity regarding thyroid supplementation.
And the worst is this: the feeling engendered in patients is learned helplessness. I must go to the doctor and get a prescription or a procedure.
Nobody is taught to have agency. That’s what alt health is about. Agency. Sure there are some bad supplements and bad people out there, but on the whole, the damage done by alt health is a tiny 1% of the damage done by bad medicine.
I have been one of those physicians. However, I would make a distinction between the doctor who is aware, in this case, of the job loss hint, and those who are not. A good number of us have to consciously decide whether we want to "open the door" due to the time constraints Dr. Rai alludes to above. Once you open the door, it cannot be closed, and, as with harms vs. benefits in any intervention, you must prioritize how you manage your day. Is it here with 1 patient x 10-15 min for consoling, or 2-3 patients x 5 min each, increasing or decreasing a dose of med?
As you say, I think we all start our careers on a spectrum from great listeners to decent listeners of such hints. But I also think over time, due to the system itself, most of us get worse at it, and that is the overriding problem.
Doctor to bathroom time-Did you give 30ml/kg of fluid for the missed sepsis that had strep throat-Doctor to order time-admit time-stroke TPA in 5 minutes before the patient got here-Did you watch the Bariac Sensitivity Training Video-Did you get all 5 on your Press Gainey, many more metrics too numerous to count———————-WELCOME TO THE ER by the way.
Your story is excellent and so spot on! I taught clinician patient communication skills at Kaiser Permamente Southern California. We have used actors as patients for years and your findings are consistent with mine. And I agree these skills can improve with awareness by the clinician of how he/she are perceived by the patient or an observer. And I agree, sadly that there is less and less time for true patient physcian communication. So much is lost in not having a trusting relationship with your physician. The system is broken, and I fear that it may be beyond repair as long as reducing the cost of health care is the main driver of the system.
Thanks Andrew! I know I’m a better clinician because of patient-actors and educators like you.
There is A LOT to repair but I’m still hopeful we can. We need to keep raising our patient voices and clearly communicating what better looks like.
You’re almost there! Next, think more deeply about “evidence based medicine” and you’ll realize most of it is just as much a corrupt scam as the EMR systems that came with it…
Forgive the lengthy excerpt, but I just wrote about this:
“the current crop of medical robots did not forthrightly announce their intention to rule the world. They were subtle and took control with devious lies. The greatest of these was the concept known as Evidence Based Medicine. I went to med school in the heyday of Evidence Based Medicine; it was our mantra, and you couldn’t throw a surgical sponge without hitting someone spouting off about its countless holy attributes. Hand in hand with Evidence Based Medicine was the concept of the Guideline. This was an authoritative document, penned by the experts in the field, incorporating all the aforesaid Evidence, telling doctors exactly how to treat any particular condition. The one-two punch of Evidence and Guideline were sold as a way to discard the superstitious practices of old and to incorporate only those treatments proven to work via rigorous research and clinical evidence. Sounds good, right? Long time readers doubtless recall the many horrors inflicted in ignorance by doctors of the past. What’s wrong with requiring studies be done before a treatment is approved? Unfortunately, it was all lies. Evidence Based Medicine uses faulty evidence, practices bad medicine, and is anything but based. Our practice-determining Guidelines are cringey groupthink. Combined, they were used to strip the human touch from medical practice. The machines, in short, are already in charge.
Imagine, if you will, an Evidence Based Guideline encouraging pediatricians to get toddlers to chain smoke Lucky Strikes. Unthinkable, you say? Well, what if I showed you a rigorous study, funded by the cigarette companies, following toddlers who smoke for two whole months? Not one single case of lung cancer detected in those entire 8 weeks! Cigarettes are clearly as safe as water – safer still, considering no child has ever drowned in a tobacconist’s. Meanwhile, detailed questionnaires given to the toddlers’ daycare centers reveal a significant improvement in mood and focus alongside a notable decrease in overeating. The science is clear. Within a few months of the study’s publication, the American Academy of Pediatrics, shortly after unveiling its new sponsorship agreement with Marlboro, publishes its practice guideline encouraging the placement of Pall Malls in every pediatrician’s waiting room, with handouts provided to all parents on the benefits of smoking alongside their children.
Too fanciful to believe? Well, return to reality and consider just a few highlights from the Evidence Based Hit Parade of the past few years:
- Forced masking of toddlers and closing down of all childhood activities for years, causing untold mental and developmental harm, over a disease that posed zero risk to children
- Castrating and mutilating children, then pumping them full of hormones for life, in order to perpetuate the outrageous delusion that they were born in the wrong body
- Using powerful, addictive, and harmful psychiatric drugs to zombify millions of five-year-old boys into sitting still and shutting up every single day of their lives
- Prescribing even more brain altering, soul-destroying drugs with lifelong, irreversible side-effects to any kid who voices doubts about the famed joys of adolescence
- Prescribing yet more mind-altering, hormone-manipulating drugs (are you starting to notice a pattern?) to millions of teen girls without any warning of the deadly dangers
- Blatantly discriminating against medical school applicants for their race and sex
- Calling for the censorship, and the de-licensing, of any doctor who spoke out against any of the above
I could go on. All the above insanity – whether related to COVID, trans madness, ADHD, DEI, or ‘mental health’ – was enthusiastically embraced by the Evidence Based Medicine community, and in some cases remains *the* standard of care promulgated by prominent medical guideline makers, like the contemptible AAP, to this day.
A system is what it does. Evidence Based Medicine, I think we now all understand, has precisely zero to do with getting medicine to base itself on evidence, and absolutely everything to do with getting medicine to be run without dissent by a corrupt, anti-human establishment.“
The stirring conclusion here:
https://gaty.substack.com/p/the-three-wise-men-walk-into-a-doctors
This is why I’m a proponent of two things. 1) concierge type medicine, and 2) alternative medicine.
People need to support their health through lifestyle, and it’s far more important to their longevity and wellbeing than seeing a doctor. In fact, usually better. I hate to say it, but so much of medicine is utterly destructive.
Look no further than 1) cancer treatments, 2) so-called cholesterol therapies. Then proceed to proton pump inhibitors and while you’re at it, bisphosphonates.
Yet ask a doctor about the importance of K2 MK4 and you’ll get a blank stare most of the time. And when it comes to thyroid, well, fuggedaboutit. I believe there is a ton of iatrogenic atrial fibrillation because of ignorance and stupidity regarding thyroid supplementation.
And the worst is this: the feeling engendered in patients is learned helplessness. I must go to the doctor and get a prescription or a procedure.
Nobody is taught to have agency. That’s what alt health is about. Agency. Sure there are some bad supplements and bad people out there, but on the whole, the damage done by alt health is a tiny 1% of the damage done by bad medicine.
I have been one of those physicians. However, I would make a distinction between the doctor who is aware, in this case, of the job loss hint, and those who are not. A good number of us have to consciously decide whether we want to "open the door" due to the time constraints Dr. Rai alludes to above. Once you open the door, it cannot be closed, and, as with harms vs. benefits in any intervention, you must prioritize how you manage your day. Is it here with 1 patient x 10-15 min for consoling, or 2-3 patients x 5 min each, increasing or decreasing a dose of med?
As you say, I think we all start our careers on a spectrum from great listeners to decent listeners of such hints. But I also think over time, due to the system itself, most of us get worse at it, and that is the overriding problem.
Doctor to bathroom time-Did you give 30ml/kg of fluid for the missed sepsis that had strep throat-Doctor to order time-admit time-stroke TPA in 5 minutes before the patient got here-Did you watch the Bariac Sensitivity Training Video-Did you get all 5 on your Press Gainey, many more metrics too numerous to count———————-WELCOME TO THE ER by the way.