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Quacks versus doctors

If doctors were better trained to treat their patients as human beings, maybe fewer patients would end up in the hands of quacks

I was reading an article in the Guardian today by Rose Shapiro. In it, she condemns alternative medicine, pointing out that its quackery enabled a man like Karadic to hide his identity very effectively, and another quack to possibly kill her patient Dawn Page (see yesterday's story on detox diets).

Shapiro is a sceptic, and of course she is also trying to publicise a book she's written against alternative medicine. But one thing she doesn't mention is that people so often turn to alternative medicine because regular medicine lets them down.

Why do so many doctors have so little in the way of interpersonal skills? Why do so many treat their patients like they were a collection of symptoms rather than a human being? No wonder there is a vast yawning gap, just waiting to be filled by every crystal-swinger in town. What doctors need is more training in how to deal with their patients. 

My friend C, a nursing matron, last year had the worst kind of medical experience, as her mother suffered and died of oesophageal cancer over a period of 15 months. From start to finish, the indifferent attitude of the consultants, which bordered on the callous, was an added level of distress. Without preparation, without a 'sorry', they bluntly informed her mother of her incurable medical condition and the severity of the operation she would have to undergo, then left her to weep. C was outraged, despite 25 years of working in medicine. The only positive thing that came out of it was that her mother died in a hospice, in a calm and quiet atmosphere, and where doctors, incidentally, are notable by their absence.

In my experience, not many of us have come across a caring, sharing consultant. At the peak of their profession, they are often pulled early out of the student body and are never taught how to interact with patients. 

My experience of family doctors, back in the 1970s, was also parlous. As a child, I was terrifed of Dr S, who was the old-school type of doctor who stood for no bloody nonsense from children, and pulled me about like a puppet. I never went to see him unless I was desperate. The cure for my bad periods, he told me, was pregnancy. Aside from the fact that I didn't want children either then or later, I was 15 years old. He put me on a high-dose contraceptive, which did help my bad periods, but also led ultimately to the uterine fibroids that plagued me for years.

The cure for the fibroids, incidentally? Acupuncture - a treatment which Shapiro lumps in with others in suggesting there is no evidence for its efficacy. A single session of acupuncture and my fibroid pain was gone - and this was something that for two years had laid me out flat, despite every effort of the allopathic medical establishment. 

The problem with doctors is that too many of them are close-minded, regurgitating only what they have been taught. And it begins even before their training. It is no surprise to anyone who went to university to hear that medical studients are often complete wankers. The worst kind of privileged class, they are almost universally the comfy middle-class sons and daughters of other doctors, or lawyers. Many, in the UK, have been to single-sex public schools, with all the class differences that this inculcates. Their understanding of the lives of the majority of the working-class populace (who will become their patients) is almost non-existent.

Nor, when I was at college, did many of them appear to have gone into medicine to help people. There were, of course, exceptions, but most admitted quite readily that they were doing it for the money and the status. Frankly, it's not a good start. 

Working on such poor subjects, the training then doesn't help matters. I'm not saying that it shouldn't be - of necessity - medically based, but doctors, particularly general practitioners, deal very often with social problems - obesity and diabetes caused by poor diet, health problems caused by smoking, health problems caused by poor housing, depression caused by living in difficult circumstances.

I spoke last year with a GP who practised in the low-income Elephant and Castle area of London, a place known for high crime, drug use, poor housing, pollution and all the rest of the joys the inner city has to offer.

"So," I said. "Let me guess. You see what? Drug addiction, borderline malnutrition, diabetes, smoking-related diseases, TB, bronchitis caused by damp housing?"

"Bang on," she replied grimly.

The bronchitis and emphysema were particularly noteworthy, she said, due to the area's 'project' housing of the 1970s, and of course drugs were always a problem - though a substantial proportion were prescription drugs - ie: drugs that had been prescribed by doctors.

Nothing in this woman's training (and she was a dedicated, intelligent doctor) had equipped her to deal with her patients' real problems and many of them were beyond her power to solve. She had patients with a low IQ, or poor literacy, patients who couldn't read the instructions on the medication, patients who didn't know how to feel themselves adequately. Dealing with them was something she had to learn as she went along and she often felt beleagured. Above all, she felt that what she had learned as a doctor was not what she had been taught as a doctor. She had had to learn to take account of the whole patient and their circumstances, not simply the symptoms.

Perhaps if doctors were taught better how to deal with their patients, it wouldn't drive so many of those who can afford to choose into the arms of the alternative community, where at least they feel that their voice can be heard. And if the quacks can learn to treat their patients like people, why can't the general medical profession?

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