A patient asked me the other day if I thought she was a crazy person for telling me she was going to disregard my advice on managing her high cholesterol and high blood pressure and go have a chat to her naturopath instead. I said no, that doesn’t offend me at all. Actually, it has nothing to do with me. I had explained to her the risks of untreated hypertension and hyperlipidemia and about how medications can help those, etc. etc. I had disclosed sufficient information for her to make an informed decision on her own health. She has a right to refuse treatment just as I had a duty to provide that information to her as her treating doctor. Medico-legally, I was in a defensible/safe area. Aside from that, though, did I think she was crazy for refusing well-advised medical opinion? Well, no. And this is what I told her.
You know, I believe in God. I believe in the Judeo-Christian version of God and in creationism. I’m comfortable in believing these stories that if you applied the scientific level of “proof” are actually quite laughable. So how do I get around holding such preposterous beliefs and still having some sort of pride in calling myself both a Christian and a scientist? I don’t apply the same level of proof or set of rules to all my beliefs. And yet, why do I believe the Christian and not the Islamic or Mosaic or Taoist or any other version of life philosophy? A whole heap of reasons! Probably because the country I grew up in had 99% of its population listed as catholic. Probably because my family is Christian. Probably because Christianity was all around me and the stories were told to me since I was very young. I was told from very early on also that the people who lived in my house were my siblings, my mum, etc. and I believed it. Even now I do not see the need to demand DNA-evidence to “prove” the story that these people are related to me. Similarly, I was told stories about God and Jesus and prophets, etc., and I am happy still to believe them. But what has all this got to do with my initial story about the lady who wanted to see the naturopath?
I’ve been trained in Western Medicine. I have a system in my mind with which I approach illness and human functioning. Briefly, I studied anatomy and physiology and pathophysiology so I believe 1) The body has these organ systems working together to make the body function in the environment, 2) The body is trying to stay “alive” and function properly as it’s default, 3) When the body is failing at functioning, it is because of an illness, 5) Illness is brought about by microscopic processes, be it errors in naturally-occurring processes or external microscopic organisms bringing about this change. That’s it. That’s essentially the Western Medicine model of disease. When we approach illness, we are trying to restore the body’s function to its default. We give medications or we perform surgery to try to restore this balance somehow. We may also advise modifications in diet, physical activities, exposure to the external environment, etc. The “treatments” we recommend are based on scientific evidence that they have some effect on illness.
I am comfortable with the model of medicine I have been trained in. I am comfortable with the level of scientific evidence it demands. Because I’m both comfortable in this system and believe in the scientific method and the stringency demanded of the “treatments” in Western Medicine, I find it hard to accept other models of medicine. Is that a bad thing? That is akin to asking ‘Is it bad that I’m a Christian and not a Jew?’ No; it isn’t a bad thing. It’s what I’m comfortable with, what I know and understand, and the alternative is unknown to me. Alternative models of medicine are to me as foreign as Zoroastrianism. Because these things are largely unknown to me, I lack knowledge and exposure to them, and –importantly– I lack belief in them, it’s better that I stick to the kind of medicine and the kind of religion I know and believe.
Now, back to the point of scientific evidence. The model of medicine I practice in, Western Medicine, what I simply call medicine, has a few postulates that to me are important. For example, it demands that the positive effect of treatments be reproducible, that side-effects are minimal and predictable, that treatment is better than no treatment (and by a significant margin), and that the treatment has been tested many times over for safety. The treatments supported by other models of medicine may lack some of these stringent criteria in favour for other priorities (e.g. that it is derived from ‘natural’ products, etc.). As I said, to me (and for the majority of my patients), the level of scientific evidence that Western Medicine demands is all-important. But if others are happy with an alternative model of medicine and alternative levels of evidence that they demand of their treatment, then I can only respect that in the same way I see it as my duty to respect other people’s religious, cultural, and other beliefs.
For example, I have patients who tell me, against widely-accepted scientific evidence, that they don’t believe that smoking is bad because their relative smoked until the age of 100 and died of causes unrelated to smoking. This person requires a study of only one person who is significant to them to make their conclusions. Or they may tell me that their friend down the road told them that sunscreen causes skin cancer, and that is why they refuse to wear it. This person, again, requires only anecdotal “evidence”. Or they may tell me that blood-pressure-lowering or cholesterol-lowering drugs cause more harm than good, but the arsenic-containing but “natural” compound sold by their naturopath is the best thing for it. This person believes that a product being “natural” means it’s automatically safer and more beneficial than one that has been rigorously scientifically tested. What can I say to these people? Well, usually nothing that will change their minds if they don’t believe in the model of medicine I have been instructed in. But what I usually do is explain to them in Western Medicine and scientific terms why I believe the treatment Western Medicine suggests is appropriate, what the risks are of not treating it this way, and then ask them what else they wish to know about this particular treatment. After that, it’s up to the individual patient to make their own choices. And no, I don’t think of them as crazy for ignoring my advice :)
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