You lost me at "everyone should receive childhood vaccines." You need to research the truth on that one. Turtles All the Way Down, Vaxxed vs Unvaxxed; let the Science Speak, etc. I appreciate the overall theme of your piece though.
Came here to comment that your view of the patient-Doctor relationship is, unfortunately, a utopian fantasy for the vast majority of us. Looking at the comments that view is apparently widely held. How can this be fixed?
If I am I have just exposed my pathologic self-loathing.
I guess it's a reasonable questions. I think I would not consider someone who is a clinician and speaks publicly as a hobby a celeb. Part of the definition for me is that your paycheck depends on what you say.
Sounds reasonable. There are many doctors who definitely fit that role through book sales and podcasts etc. An oncology colleague of mine has almost 90 followers on X and he probably isn't a celebrity doctor.
Perhaps people follow famous doctors advice or read their books because it is damn near impossible to see a doctor with health insurance in the United States. Kaiser’s motto is: “We care…if you fuckin make us” . And it is the motto of every US based health coverage company
I understand and agree with a lot of what you say Dr. Cifu. It frustrates me to no end when I hear the broad advice given with no discussion into the nuances and subtleties that are so critical to understanding the given advice. I believe this is the unfortunate result of the businessification of medicine. We have transitioned from a model that actually rewarded making quality of life improvements, and replaced it with the quantity of life metrics that are easily billable and marketable.
I see so many times the doctor and patient shackled by corporate limitations on the simple act of being human to know we got this one wrong. The hope of finding a solution in a hospital or doctor's office has been replaced with the fear of the bills and surviving said ailment. When one considers the ever rising costs of Healthcare against the paltry wage increases of the average wage-worker, is it any wonder that we increasingly see people willing to listen to celebrities? After all, we are a nation built on risk. What more lucrative gamble is there than paying the monthly cable bill, taking the advice of said celebrities, and possibly avoiding the tens of thousands, sometimes hundreds of thousands of dollars in debt from a chronically billable illness?
I think doctors have a major responsibility in having strongly contested debates in a public forum, where the nuances can be analyzed in layman's terms, and the public can glean information that is useful to them. We would simultaneously create a better-informed public that would hopefully translate to a healthier public.
This is very informative and very well said. I can tell just by the way you express yourself as a very intelligent person. Thanks for this, it was a good read and became more aware.
Dr. Cifu, Even though I don't agree with some of what you've said in this post, it's great that you've taken the time to read our comments. In all the columns you've posted before, especially those in which you spoke from the heart about how some interactions with patients had affected you, or your own experience as a patient, I have seen the caring and compassion in you. You've been a pleasure to read, esp when, like many of your followers, I have had too many less than optimal interactions with doctors.
While I agree with most of your points, I think we need to be aware of the reasons why people are flocking to the celeb physicians. Sure, fancy production, savvy social media teams, and brand endorsements will attract many. But surely, it is also the disappearance of a real, ongoing, trust- and respect-based relationship between patients and physicians that is at play. That requires time, communication skills, empathy, thoughtfulness and awareness of the context of an individual's health. In our current system - those are increasingly absent.
How many doctors would love to practice clinical medicine that is not limited to 15 minutes per patient.... the opportunity to have close personal attention and care, along with the time to establish knowledge and trust between individuals.... ? Good doctors drive and dream of this kind of profession. Our healthcare system works against it.
Those of us who can afford concierge doctors get that kind of medical care. However, It pushes against the bioethical principle of “justice....that people should have access to equitable medical care.
Just like our justice system, medical care produces different outcomes for those who can afford special treatment.
From my experience as a health professional most MD’s simply don’t have the time to really delve into all facets of their patient’s lives and health. The medical model considers the patient in parts versus looking at the whole and the time/energy it would take to help patients overcome their resistance to change just isn’t available.
I’m curious why the author feels threatened (that’s how it reads) by other doctors/health practitioners providing opinions on “their” patient. This feels less about the patient and more about the doctor’s ego which sadly I see as one of the major barriers we face in our system.
Sadly most GP’s lack significant knowledge/training in the lifestyle determinants of health and most of their solutions lie in some sort of prescription or referral...yet these physicians seem to have a lot to say about this, that and everything and are quick the shame/criticize other forms of help that the public are seeking.
“Evidence-based” care does not only include RCT trials...and it is impossible for one person to be an expert in it all.
So while I agree that writing books for the masses is likely more about fame, fortune and ego...I don’t see an issue with the public looking for inside-out solutions for living well that don’t need the “approval” of their all-knowing MD.
The profession as a whole took a massive downturn during COVID. There was a vanishingly small cohort of docs who spoke up about masks, lockdowns, social distancing and the vaxxines and those who did were castigated, censured and sometimes, expelled from their positions. Where was everyone else? Hiding, saving themselves. Utter cowardice.
I’m a stoic and a libertarian. I don’t worry about what I can’t control. And it’s a free country. I try to avoid paternalism as best as I can.
That said, yeah it’s annoying when people swear by their vitamin D, or Strauss Heart Drops, or (thankfully rarely) chelation; while resisting a statin after their 3rd MI with an LDL of 4 (about 150 in American).
Interesting point about celeb docs hawking one-size-fits-all miracle solutions to the gen pop, based on the flimsiest of evidence, when we need to question whether even the results (and average effects) of the very largest and best RCTs might apply to Mrs. Smith sitting across from us, on a case by case basis.
Considering all the new titles out there, your dentist will be a happy man. I'm a sucker for these books. In my defense there are fascinating concepts for the layman in these books--gut/brain connection, fecal transplant procedures, health span vs lifespan.
You lost me at "everyone should receive childhood vaccines." You need to research the truth on that one. Turtles All the Way Down, Vaxxed vs Unvaxxed; let the Science Speak, etc. I appreciate the overall theme of your piece though.
Adam, I may just steal your post, replacing celebrity "doctor" and "physician" with celebrity "economist." :)
Came here to comment that your view of the patient-Doctor relationship is, unfortunately, a utopian fantasy for the vast majority of us. Looking at the comments that view is apparently widely held. How can this be fixed?
You have 25k followers on X and many readers and fans. Could you be considered a celebrity doctor?
If I am I have just exposed my pathologic self-loathing.
I guess it's a reasonable questions. I think I would not consider someone who is a clinician and speaks publicly as a hobby a celeb. Part of the definition for me is that your paycheck depends on what you say.
Thoughts?
Sounds reasonable. There are many doctors who definitely fit that role through book sales and podcasts etc. An oncology colleague of mine has almost 90 followers on X and he probably isn't a celebrity doctor.
I am totally going to use this citation style and call it Cifu.
What is the style?
Perhaps people follow famous doctors advice or read their books because it is damn near impossible to see a doctor with health insurance in the United States. Kaiser’s motto is: “We care…if you fuckin make us” . And it is the motto of every US based health coverage company
I understand and agree with a lot of what you say Dr. Cifu. It frustrates me to no end when I hear the broad advice given with no discussion into the nuances and subtleties that are so critical to understanding the given advice. I believe this is the unfortunate result of the businessification of medicine. We have transitioned from a model that actually rewarded making quality of life improvements, and replaced it with the quantity of life metrics that are easily billable and marketable.
I see so many times the doctor and patient shackled by corporate limitations on the simple act of being human to know we got this one wrong. The hope of finding a solution in a hospital or doctor's office has been replaced with the fear of the bills and surviving said ailment. When one considers the ever rising costs of Healthcare against the paltry wage increases of the average wage-worker, is it any wonder that we increasingly see people willing to listen to celebrities? After all, we are a nation built on risk. What more lucrative gamble is there than paying the monthly cable bill, taking the advice of said celebrities, and possibly avoiding the tens of thousands, sometimes hundreds of thousands of dollars in debt from a chronically billable illness?
I think doctors have a major responsibility in having strongly contested debates in a public forum, where the nuances can be analyzed in layman's terms, and the public can glean information that is useful to them. We would simultaneously create a better-informed public that would hopefully translate to a healthier public.
This is very informative and very well said. I can tell just by the way you express yourself as a very intelligent person. Thanks for this, it was a good read and became more aware.
Dr. Cifu, Even though I don't agree with some of what you've said in this post, it's great that you've taken the time to read our comments. In all the columns you've posted before, especially those in which you spoke from the heart about how some interactions with patients had affected you, or your own experience as a patient, I have seen the caring and compassion in you. You've been a pleasure to read, esp when, like many of your followers, I have had too many less than optimal interactions with doctors.
Thank you so much Marilyn. I really appreciate that. I get a ton out of reading the comments. Especially when people really disagree with me!
I would also like to say:
The majority, while male, are not actually all that attractive. ...🤔... But ...which ones were you referring to??? I might wanna go buy their book.
I gotta go check them out, then decide. Jk! 😆😆😆
I was glad to see footnote one as I agree with you it sounds delicious.
In the grand scheme of things however this sort of self-promotion seems to pale in comparison to our pharmaceutical industry
Dear Dr. Cifu,
While I agree with most of your points, I think we need to be aware of the reasons why people are flocking to the celeb physicians. Sure, fancy production, savvy social media teams, and brand endorsements will attract many. But surely, it is also the disappearance of a real, ongoing, trust- and respect-based relationship between patients and physicians that is at play. That requires time, communication skills, empathy, thoughtfulness and awareness of the context of an individual's health. In our current system - those are increasingly absent.
How many doctors would love to practice clinical medicine that is not limited to 15 minutes per patient.... the opportunity to have close personal attention and care, along with the time to establish knowledge and trust between individuals.... ? Good doctors drive and dream of this kind of profession. Our healthcare system works against it.
Those of us who can afford concierge doctors get that kind of medical care. However, It pushes against the bioethical principle of “justice....that people should have access to equitable medical care.
Just like our justice system, medical care produces different outcomes for those who can afford special treatment.
From my experience as a health professional most MD’s simply don’t have the time to really delve into all facets of their patient’s lives and health. The medical model considers the patient in parts versus looking at the whole and the time/energy it would take to help patients overcome their resistance to change just isn’t available.
I’m curious why the author feels threatened (that’s how it reads) by other doctors/health practitioners providing opinions on “their” patient. This feels less about the patient and more about the doctor’s ego which sadly I see as one of the major barriers we face in our system.
Sadly most GP’s lack significant knowledge/training in the lifestyle determinants of health and most of their solutions lie in some sort of prescription or referral...yet these physicians seem to have a lot to say about this, that and everything and are quick the shame/criticize other forms of help that the public are seeking.
“Evidence-based” care does not only include RCT trials...and it is impossible for one person to be an expert in it all.
So while I agree that writing books for the masses is likely more about fame, fortune and ego...I don’t see an issue with the public looking for inside-out solutions for living well that don’t need the “approval” of their all-knowing MD.
The profession as a whole took a massive downturn during COVID. There was a vanishingly small cohort of docs who spoke up about masks, lockdowns, social distancing and the vaxxines and those who did were castigated, censured and sometimes, expelled from their positions. Where was everyone else? Hiding, saving themselves. Utter cowardice.
I’m a stoic and a libertarian. I don’t worry about what I can’t control. And it’s a free country. I try to avoid paternalism as best as I can.
That said, yeah it’s annoying when people swear by their vitamin D, or Strauss Heart Drops, or (thankfully rarely) chelation; while resisting a statin after their 3rd MI with an LDL of 4 (about 150 in American).
Interesting point about celeb docs hawking one-size-fits-all miracle solutions to the gen pop, based on the flimsiest of evidence, when we need to question whether even the results (and average effects) of the very largest and best RCTs might apply to Mrs. Smith sitting across from us, on a case by case basis.
Considering all the new titles out there, your dentist will be a happy man. I'm a sucker for these books. In my defense there are fascinating concepts for the layman in these books--gut/brain connection, fecal transplant procedures, health span vs lifespan.