Pruritus Emeritus

Arguing with doctors


 

In these pandemic times, there is much discussion about public skepticism toward scientists and doctors. Many decry this distrust. They think people should accept what experts advise. After all, experts work hard to learn accurate facts to promote the public’s best interests.

Dr. Alan Rockoff, now semiretired, after 40 years of practice in Brookline, Mass. He served on the clinical faculty at Tufts University, Boston, and taught senior medical students and other trainees for 30 years.

Dr. Alan Rockoff

Those who disagree and justify their reluctance – to be vaccinated against COVID-19, for instance – are unrepentant. First of all, they are not so sure experts are public spirited. Perhaps doctors have something to gain from illness and approve vaccines for political reasons, or assign certain diagnoses to get higher reimbursement.

In this contentious climate, peculiar treatments and unproved “cures” are claimed to deserve more respect than so-called experts are willing to grant them: hydroxychloroquine, bleach, and so on.

From my perspective, what is notable about such public disputes with medical experts is not that they exist but that they are public. In private, people have always argued with doctors. Most of those arguments don’t reach public notice. They are not interesting enough.

For instance, as I think back over the years, I can recall:

  • A man who preferred to treat his eczema using topical yogurt. And not just any yogurt: only low-fat, plain Market Basket. He had tried them all.
  • The woman with perioral scarring. She had let an unlicensed practitioner apply a painful acid on her face – he never told her what the acid was, and she hadn’t asked – as she lay on a neighbor’s living room floor to have her “skin cancer” treated.
  • The man with an obvious melanoma on his chest. He did not want to treat it, because his faith healer in Milwaukee, whom he had never met in person, assured him that “it’s all taken care of.”

I could go on.

I cite these examples only because they are striking. They are far from unique.

People argue with doctors for the same reason they argue with anybody – because they think they know better. They may have heard otherwise from a friend, a magazine article, a blog, a different kind of practitioner.

Many such disagreements are never spoken out loud, because people who expect to argue usually don’t show up at their doctors’ offices. They either stay home or see a different kind of healer. If they do visit a doctor whose point of view differs from their own, most keep disagreements to themselves, because few people relish in-person confrontation. Instead they go home and ignore medical advice there.

Even when overt disagreements do erupt at a medical visit, the doctor can often find a way to convince the patient to reconsider, or somehow deflect the clash. The physician has to at least try to convince a patient who thinks his melanoma has “been taken care of” to have it removed. Whereas if someone really prefers low-fat yogurt to topical steroids, there is no need to win the argument. If the patient decides at some point that his eczema is out of control, he can call and request a prescription. He usually won’t.

For dermatologists, medical arguments rarely involve stakes high enough to force the doctor to try changing patients’ minds or discharging them from the practice. Had I stayed in my original field of pediatrics, I would have confronted patients who refused to vaccinate their children. I would have had to negotiate a compromise – vaccinate “more slowly” – or else part ways with the family.

I always advised medical students, when they found themselves argued with, to separate patients’ needs from their own egos. Being challenged in a small room can be challenging. Still, what matters is how the patient fares, not how the doctor feels.

Public disputes with scientists during the COVID-19 pandemic strike me as being motivated by the same factors behind private disputes in physicians’ offices: skepticism, resentment, suspicion, and – often underlying all these – fear.

Public disputes carried out over social media allow for posturing and aggression. A tweet is a better medium behind which to cloak opinions in the mantle of a noble cause, such as personal freedom. It is also easier to express derision and hostility toward opponents, expert or otherwise, from behind the screen of a Twitter handle.

Fortunately, in everyday medical practice, in-your-face disputes don’t happen very often.

You do remember them, though.

Dr. Rockoff, who wrote the Dermatology News column “Under My Skin,” is now semiretired, after 40 years of practice in Brookline, Mass. He served on the clinical faculty at Tufts University, Boston, and taught senior medical students and other trainees for 30 years. His second book, “Act Like a Doctor, Think Like a Patient,” is available at online. Write to him at [email protected]

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