kelpforestdweller:

fox-bright:

I’m seeing some “doctors think more logically than you do” and “doctors don’t make judgments based on their emotions” and “you should 100% trust your doctor” stuff going around right now, and it kind of scares the shit out of me.

Absolutely you should be able to trust your doctor.  Absolutely you should hope that they’re looking at you as dispassionately as possible when considering your privileges, and as mercifully as possible when considering your needs. And if you get four doctors telling you the same thing, probably you should listen to them.  If you’re told you need PT, if you’re told you should consider the merits of this medication or that one, you should take it into consideration. You should be able to work with your doctor toward your best health outcome, regardless of if you like them very much.

But doctors are people.  And people are capable of all sorts of bullshit.  People get tired.  People mix things up. People are prisoners of their prejudices, unless they are constantly fighting them.  And to fight them they’d have to a)recognize them and b)realize that they’re wrong things to believe, and frankly most people are just not capable of that on any constant basis.

And even if we’re not talking about the forcible sterilization of Native American women and of women in prison, even if we’re not talking about the Tuskegee Syphilis Experiment, even if we’re not talking about all the ways that doctors in the US have manipulated and abused the communities they were supposed to be serving, just on an individual level falling to the belief that a)your doctor knows everything and b) your doctor really, really cares about you?  That can be very dangerous.

So let me tell you a little story.

My mother and her twin sister were born in Anaheim, CA, in 1960.  They were born with what today would be recognized as acute asthma, and they spent their first twenty years very, very sick a great deal of the time.  Constantly in and out of the hospital.  Both their parents were smokers (it was the Sixties! The years of asthma cigarettes were barely past, and lots of people still believed in ‘smoking for your health’) and it was California before the unleaded fuel laws, before pollution regulations of any sort.  My mother and her twin both nearly died on many occasions, their lungs slamming shut like books.

So my grandma, she took them to a lot of doctors.  But even before the days of big insurance, that wasn’t cheap, and the family was poor. So when after a decade or so she found a doctor with a big smile, a doctor who was locally renowned for the survival rates of his asthma patients, a doctor who obviously really, really knew what he was doing, that’s the one she stuck with.

And she didn’t much question him, when he said that my mother’s asthma and my aunt’s asthma were different kinds, and that they needed to each take a different kind of medicine, and that Grandma needed to be very, very careful not to mix them up.

You see…Mom and my auntie, they were identical twins.  That is, genetic clones.  Exactly the same in so very many ways.

And this was before ethics boards, this was before medicine and research had any expectation of or regulation for informed consent.  The doctor told you what to do, and you did it, and that was that.

And my mother, and my mother’s twin, were only half-white.

Do you see where this is going?

This wasn’t a hundred years ago.  This was by this point the mid-Seventies. Bell-bottoms and disco, Bowie was Ziggy Stardust and the Thin White Duke, the first series of Star Trek had already been off the air for several years. This was only a minute ago, you guys.  When you walk into a vintage store, you see clothing that’s older than what this doctor did to my family.

You’ve probably been through middle school science.  You know that when doing an experiment you need your control
group–the one that doesn’t change–and your experimental, right? The one that gets some new condition or stressor?

And the doctor flipped a coin, or chose some other way at random, and he gave my mother the control. That is, Mom lucked out and got the medicine that was already known to him to work pretty well.

And my auntie, my doomed, beautiful auntie, was made into an experiment.

When my mother describes those years, she says that her sister “looked like a burn victim.”  Auntie’s skin sloughed off in sheets.  She got cataracts, her hair fell out in chunks, she couldn’t be out in the sunlight.  She developed all sorts of interesting food allergies (who the fuck is allergic to red #40, to the point of anaphylaxis?), her bone density suffered, and basically if you want to imagine a nasty side-effect there’s a fair chance she had it.

And the doctor? He wrote a fucking paper.  Maybe several. And he never told Grandma what he was doing.  And he never told his test subjects what he was doing.  And he was a pioneer, he saved lives, he pushed the knowledge of asthma forward by a lot, I’m sure. But he didn’t ask. He didn’t see any reason to. Mom and my Auntie were half Filipino.  White, Protestant Grandma dared to marry a Filipino-American man, and a Catholic besides!  She couldn’t be trusted with any serious decision.

And so my aunt suffered all sorts of unpleasant repercussions of that treatment for the rest of her life, until she died at a mere 52 years old.

What I am saying is, doctors are people. That is all they are.  People with their prejudices and their greed, people with their soft hearts and their emotional exhaustion.  They’re not somehow special or more or better than anyone else is. They’re just people who have been to a bit more schooling than the average Jane.  You want to tell me that architects are somehow more logical in their life decisions than someone else?  That lawyers are less likely to be prejudiced? That entomologists are more trustworthy than, say, artists, if we’re talking about anything other than bugs?

I’ve known doctors who were excellent human beings. But that wasn’t because they were doctors, it was a sideline to that fact.  Some people certainly become doctors because they have good hearts.  But let’s be honest–most of them do it for the money.  And while there’s nothing wrong with choosing a career for the lifestyle it’s going to provide you, doing so doesn’t make you a better person.

They’re just PEOPLE. And people have so very, very many flaws.

i would dare to say that decent doctors are decent despite being doctors.

i don’t know what it is exactly but something in medical school changes you. it’s brutalizing, desensitizing.

i don’t know when they teach you that you know best, that your patients will lie to you and are not to be trusted, that the lives of POC and women and disabled and trans people (god help we who fall in a venn diagram) do not have worth, that you must never apologize or consider that a patient might know anything whatsoever about medicine or even their own body.

i saw it change my sister. she was always this way inclined, i think, but there used to be more gentleness. now she talks to me like a doctor. dispassionate, intrusive interrogation, unreciprocated.

i have met a lot of doctors and i’ve come across a lot more shitty ones than decent ones. and i no longer trust the ones who seem decent at first. they are given too much power and all but no accountability. and if you want both decent AND competent…

thanks for saying this. it’s so important.