In tinkering about on my desktop I thought about an avoidable tragedy in medicine. Off topic in one way but relevant in others. I read the terrible saga of the young girl Martha Mills being comprehensively failed by medicine and who died with sepsis after an accident on her bicycle. Merope Mills, her mother cites four all-too-often found attitudes of even senior doctors/consultants. They are 1) arrogance (how dare you question me?), 2) coasting (carrying on with futile activity without questioning if one is right to do so), 3) laziness (refusal to engage with other, more modern concepts and keeping on with their own less understood diagnoses from older guidelines) and 4) fear ( especially in more junior doctors who are frightened of the seniors power to stunt careers). One sees it everywhere, not less than in the thyroid field, where new knowledge has supplanted (or should I say, SHOULD supplant) older thinking. BTW I didn't realise that Weetman has won prizes for his contributions to thyroiology.
Lessons on arrogance in medicine: In tinkering... - Thyroid UK
Lessons on arrogance in medicine
Thanks for posting this, things have not changed, nor likely to be with the present BTA top dogs. Oh, and Weetman should return any prizes he’s been awarded for contributions to thyroidology - tell them he was only somatising.
🤣🤣🤣
“4) fear ( especially in more junior doctors who are frightened of the seniors power to stunt careers)”
Agree with all, and especially the above. There may be an exception to point 4, in my experience anyway. I have often found a junior male (usually White) arrogance far exceeds the fear, and their appetite for risk much higher. For example, I even had such a Junior prescribe and support my health journey when the GP, Senior Consultant would not, this Senior also being the lead of that particular clinic.
I often have wondered as well how much of a difference it makes to risk taking or more aptly ‘clinical judgement’ when the medical professional lives in ‘research towns’ as I call them (loosely this I define as major universities cities such as London, or Edinburgh etc. where involvement and exposure to research is in abundance), and of course lived experience.
I am not absolutely certain I get precisely your meaning HealthStarDust, my brain not well at the moment. BUT I live where research etc should be upfront. City with all sorts of recognition for its research and pioneering medicine. This is actually the present centre of the Universe for ‘top’ endocrinologists, who write the guidelines etc without any reference to the research of the last thirty years. It’s extremely unhelpful living here.
Your right. Having thought about it, it probably does not apply to thyroid diseases one bit.
I just replied to another post this morning about similar medical arrogance. With hindsight (and getting on a bit) I have come to the view that there is no such thing that is of use to us through ‘hero doctors’. We just need someone with a genuine interest in what they are doing. However if they ever had sight of this, they lose it with their incredible salaries (often allowing them to work very part-time) career structures and the unquestioned trust of their (mostly it would seem) unquestioning patients. It’s not all their fault. I mean 7 minutes for a consultation about something as important as a patients health is a downright lack of human rights. However privately paying for your health care is also disillusioning. Some real attention to detail from both government and doctors would be useful.
I very much agree this is a human rights issue. Have you seen the posts by jimh111 recent traumas? I very much think the situation epitomises a breach of human rights and equality. Would be quite something if Good Law got involved!
Could not agree more. If only!
We need a class action like they do in the American movies!
We do but look how difficult it is to get people to just sign a petition. A lot of it is down to the nature of the illness. When we are ill we are too distracted to get involved and when we are better there is just so much personal stuff to catch up on. ‘They’ get off easy with this illness.
Also, arTistapple it will happen. Eventually. Progress is also, but there are more revolutionaries than ever before and sooner or later will take a huge interest when they are heavily affected by it.
How old or recent are the awards?
I just can't get how medical science, can even be considered a science with its head stuck in the sand. Science is ever evolving isn't it.
Yes, but think of this parallel. Mammals evolved when the dinosaurs ruled the earth, so they had to be small and kept out of sight. When the asteroid struck, the dinosaurs died but the mammals came out of their burrows to take their place. Good ideas in science often go the same way: put forward but not accepted by the opinion-formers who were then dominating how things work (wrongly). When these retire or die, the way is clear for the new work to find its proper place. But a new thought: the mammals then allege the dinosaurs never existed: convenient to justify their new dominance , which eventually leads to hubris and arrogance all over again.
Yep! We need the shiner grey hair 🦕 to die first!
This is a great list of issues! Would be very interesting to see what would happen if this was presented to a group of medics at a training session 🤣
Although maybe not that interesting because I think they have well rehearsed excuses and reasoning for all of it. I'm sure they are actually trained to behave this way, so it's kind of an "I was only following orders" situation of banal evil.
The way I think of these things myself is that doctors are flowchart following entities, not illness addressing entities. It is just not their job to address your illness in a meaningful way. It is their job to go through the steps. And those steps have been figured out by that set of unseen committees with strangely little accountability, referencing or transparency that we sometimes discuss.
And of course as long as they follow the steps correctly they can never be accused of anything or get in trouble. Whereas if they tread off the path to help you outside their instructions they *could* get in trouble if anything goes wrong or it attracts attention.
I was thinking similar on your recent post about improving the consistency of blood tests. I've found that doctors don't care at all about the accuracy of blood tests, they just care about box ticking if their flowchart indicated they should order a test.
The most extreme example of this I have personally experienced was a blood test report that came back saying the sample had been spoiled so the test hadn't been done. The doctor treated this result completely as if it had been a 'normal' test result, and as if we could put that matter to bed. They even said specific sentences like "Okay, we've got the answer to that question" "We can rule that out now". I tried to point out that we'd just received no information from the request, and if we wanted to know we'd need to order a new test and do it again. But as so often it was like talking to a brick wall and the doctor almost didn't understand my words.
I've experienced similar many times when they create a setup where the test just can't be done successfully. Saying "You can go down to pblebotomy and get the blood for this test done on your way out", and I ask if that test isn't supposed to be done fasting or first thing in the morning or whatever (not for thyroid tests where they will deny these things, but for tests where their own guidelines tell them to take the blood that way), and they will then kind of reluctantly admit that I'm right and I shouldn't get the blood taken today.
But I just don't think it is a concern of theirs whether any given measurement is taken accurately. For them, if it is written down on the sheet it is completely accurate and true, no matter what dodgy circumstances the test was taken. Very unlike in a scientific situation where people care deeply how measurements are taken.
To indulge myself a little and ramble on... I experience the same with pulse and blood measure tests frequently. It is a particular annoyance of mine because it is so easy to be measured quickly with a cuff, but to take the test correctly the patient should be relaxed, not bustling about getting hot and sweaty finding the appointment room, worrying where to put their coat, etc.
Anyway... A friend had taken part in a clinical trial where pulse and blood pressure were relevant. And guess what... Those measures were taken in a separate room well away from the reception area and administering other bits of the intervention. She was left to sit on a couch alone in a peaceful room with plants and a window, and told to relax for 15 or 20 minutes before they were taken. Which of course is the correct way to take these tests, and how they are probably always taken in research settings. Meaning all the normal ranges and other guidelines are based on these best practice measures. Then in clinical settings they are always rushed out under way less ideal conditions.
Banality. That’s an excellent description. Our taxes pay a lot for this banality. I used to make a point of not overusing my GP services. I always thought I would leave them for people who needed them. However it’s their actual problem by not diagnosing me and treating me properly that I had a rush of time spent there (all wasted). Now it’s back to scratch. I avoid as much as possible. Even a phone call to get my prescription sorted/reviewed makes me ridiculously stressed.
"Banality of evil" is a term from the philosopher Hanhah Arendt. She uses it in her analysis of the trial of a Nazi party member who worked on logistics for the Holocaust. She is amazed by how ordinary he seems, and how he just drifted into a life where he did these terrible atrocities. His concerns were things like getting ahead in his career, and he just didn't give much thought to politics or the meaning of what he was doing.
I was going to say that I had mangled quoting her words, but actually now I'm explaining it I realise it is very close. She was discussing how evil can happen without the person doing it seeming evil, and she was interested in things like, at what moment does that evil actually happen. Which is similar to what we're talking about here. She would have intended her work to be used in other times and places to look at other kinds of evil acts. I often say that I think the things doctors do to us would be very much considered abuse if they were done by a loved one, and I think seeing it that way can make it easier to cope with, and recover after a brush with doctors. Philosophy like this could give us another way to understand the traumas we've suffered so can probably be useful, too.
That’s a great reference (holocaust) and without checking, it’s ringing bells for me. I like your idea of using the scenario of abuse by a loved one as some sort of measure. That’s going to be useful for me. I can’t help thinking that our medics get away with far too much because of our innate trust in them. You know that saying “Big boys don’t cry”? It’s an extension of that. We lay ourselves out and open to them and they basically ridicule us. Excluding the forum, where is is there to take our stuff? I know they are overrun etc but this has been cried many times in my lifetime. There just feels like something is very fundamentally wrong.
I often wonder how things could possibly change, what it would take for doctors to become attentive and do what we expect them to be doing. But it is really hard to imagine it, because so much is wrong at every level.
One big issue I think is that doctors are not trained to put the patient at the centre, and to have respect for them. They treat patients more like a broken photocopier that is a problem in their path.
Years ago I was talking about this with another forum member when we met in person. Her job was as a legal advocate for people seeking asylum, and before I got sick I worked doing social research. Both are jobs where the people we work with are absolutely front and centre to the work, and their voices and experiences are the most important part. For me, my training went very deeply into how to listen and prioritise other people's voices, and there are big arguments in the field about how to do so. It's a big enough issue that people can work their whole lives just on that topic, and have huge disagreements with other experts on the best approach to take, etc.
I'm sure that doctors have none of this kind of training, and what they do get is a brief lip service to what it means to listen. They are not experts in that topic by any means.
But there are also so many reasons why it would be hard to fit that into their skill set. One of the biggest ones coming out of my discussion with that forum member is that doctors are given so little time with the patient, and see huge numbers of people per day with often no continuity of a relationship with the same person. In my own work I had the luxury to usually spend hours with my research participants, and in one study where I saw over 100 people it was considered a huge number and took me many months to visit them all.
In medicine they talk about things like compassion fatigue. And that concept is a really knotty one. In a perfect world, I would want a doctor to experience that compassion. So how could you re-build the whole system from the ground up to make sure they weren't fatigued and exhausted by it?
Another little tidbit I think doctors aren't trained in is how to deal emotionally with the horrors they might experience, and even the smaller difficulties you hear them complain so crudely about, like patients who are dirty and smelly or who can't communicate well. Whenever I've had to discuss death or serious consequences with doctors, they've always been more scared than I am, and very unprepared for it. Again, I don't think they get the training like, say, a counsellor would have in how to deal with their own difficult feelings. And of course if you compare with counselling, there are also support structures for therapists that allow them to offload the feelings brought up in sessions, which I'm sure doctors don't have. But they also don't seem to get training in the mean in of death, and to come to terms with death and terrible outcomes. They seem to just view death the way someone you would meet on the bus would. As in, just in a common sense way, without the benefit of all the work in philosophy, psychology, spirituality, etc, that would be a big help.
And because they are not trained to address hard topics, it's actually not surprising that they tend to use manipulative strategies instead, like how to shut the patient up, dismiss their concerns, get them out of their office quickly, etc. That's exactly how a child would react if they were plunked into a hard situation without sufficient training and support.
Anyway... I could rattle on for ages about these kinds of things. Even the few little things I've mentioned here about lack of training and support would be so expensive to address. Not only would doctors need tons more training than they currently have, it would also take more time to do everything, and there would be new support jobs created to help them. I wouldn't be surprised if it took double the number of hours, which would mean double the people being paid. Not only the price but one thing I worry about is - are there even enough potential candidates in the world to train as doctors in the world I'm envisaging? The NHS already poaches staff from overseas. Although I also think if doctoring was better a lot of time wasting could be eliminated, and maybe much more nuanced triaging systems, so that often you are seeing a more junior person with less training, or a person who is not a doctor but has a role more like an explainer /patient support expert. Personally I also think many times I have seen a consultant they just haven't offered anything, and I hate to think how much they were paid for my appointment, when I would have been better off seeing someone with less training and seniority who actually wanted to help.
I can’t find anything to disagree with in this last post. It all needs such a shake up, right to the roots. After three or four visits to A&E I was given over to a Nurse Practitioner. She explained that what I was getting was palpitations and not atrial fibrillation. That explanation was worth its weight in gold. Doctor’s arrogance comes from them being perceived to be top of the food chain. I would say hand us over to someone trained/educated to someone who wants to help too. The only problem I would add to that is that doctors are already out of the loop with patients and this would create an even further distance. They really need to spend some of their time learning a bit about empathy and listening.
I did have a GP for about twenty years whom I liked. We would have what I thought was a proper communication BUT he never once suggested hypothyroidism. I brought it up myself only once. He said “Oh you don’t want to be going down that road” or something very like. He retired without telling me (another GP did the same) it’s obviously not important to keep patients informed of anything! Anyway he went to a job in the University teaching students about communicating with patients. So there you go, in the end he could not communicate as well as he thought he could and neither could he diagnose hypothyroidism. 10 out of ten.
The story about your nice GP is so heartbreaking, but also sounds really familiar. I think I've heard similar many times on the forum, a GP who seems good but actually isn't doing what they should be for you.
That response to you mentioning hypothyroid is so interesting!! It is almost like a poem, so much is going on!
It shows one of the magical thinking things doctors often have.... That if they don't diagnose and treat something then it kind of doesn't exist and you can avoid "going down that road". To me it suggests a distaste for hypothyroid patients, too. As if he's doing you a favour by not letting you become one of them 😅
Recently I have wondered whether he knew/suspected what a shambles endocrinology is. I live where a cabal of the VIP endos practice. It was probably about 10 years ago so I think they were all still practising here. No T3 is prescribed here at all. The statistics prove it. I read your bio by the way. You have had it very tough indeed. You have had a hell of a fight. Absolutely brilliant you are here.
I wrote a while ago about the GP and I having a "discussion" about my blood pressure. She measured it using the wrist cuff, but I told her for some reason they always give a low reading for me. Sure enough the reading was 140/70. My home readings were around 170/90. She told me I was doing it wrong (I trained as a nurse last century), then my monitor was faulty. I asked her to try the upper arm blood monitor and she did. Reading was 175/95.
Guess what the only reading in my notes read? Yup, 140/70. It also added that I was irritable! I proved her wrong so it was my fault!
I was watching the news this morning whereby a young girl dislocated her hip during a rugby game... she died of sepsis 16 days later having been labelled as a needy or difficult patient after telling the medical staff that she was in pain... awful.
I certainly am familiar and know ‘neediness’. There are many episodes in this illness which make me feel that way. Is there not something in this kind of ‘behaviour’ which sets of a response in the mindset of bullies? Fear of feeling around people experiencing ‘neediness’ as you cant cope with the inadequacy it brings out in yourself. Anyway apparently there are many doctors practising who can’t deal with it and this is probably a big contributor to their callousness. It’s probably not impossible to weed these people out at pre Uni interview but I guess they are only looking at results and career prospects (push) at that level; not compassion and being able to work with patients. Hey patients are the last things on their mind other than being the forerunner in their dread of their jobs it seems.
After some poor person is dead it’s too late to retrain
Today there's an article in the Sunday Times which goes even further into the internal bickering and face-saving that goes on in the NHS. And how we (women especially) are seen as demanding zombies, aka units of medicine, rather than human beings with our own anxieties. NHS medicine is bound to be hide-bound and self protective because of the back-covering and blame-rotating ethos. I was once a civil servant of sorts for a while, and know the business of making sure the next person up the line was shafted, and not me. It's a frame of mind that is self-protective.
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