You Might Be an Altie, but...

Over at Respectful Insolence, Orac has given us an amusing run-down -- a la Jeff Foxworthy -- of "You Just Might be an Altie if..." It was cute. It was fun to read. There was little with which to disagree. However now it is time to return to our regularly scheduled life.

Although Orac correctly writes:

Alties are often militant and always highly suspicious of eeeviiilll "allopathic" medicine and doctors. Part and parcel of being an altie is an anti-intellectual and antiscientific attitude that does not allow a little thing like evidence to sway one from one's belief in the power of alternative medicine.

there are many people who show up in our offices with "altie-type" ideas who must be dealt with. Let me re-phrase that: We often see patients who, despite the fact that their understanding of medicine, pharmacology, physiology and anatomy, etc. may be incomplete or suboptimal, deserve to be treated with courtesy and respect. While Orac's litany is amusing, what he is actually doing (in good fun, of course) is defining a stereotype. Painting "alties" as objects of ridicule and derision puts us at risk of brushing them off as a group, thereby doing them a disservice as patients.

People don't walk into the office with the letters A-L-T-I-E stencilled on their foreheads. In practicality, there is a large middle ground of patients who consider themselves open-minded regarding science who nevertheless hold "alternative" ideas about various conditions and treatments, with varying degrees of tenacity. Because I have to deal with them -- granted not those quite so hard-core, who of course wouldn't be caught dead visiting an old allopathic doc like me -- on a regular basis, I would like to submit that certain strategies are perhaps more appropriate than blanket ridicule.

Of course the first step is education. The lady who comes in looking for a new doctor who discloses with pleasure her success with the passage of "gallstones" with "liver flushes" as part of a routine history is an example. Discussion of the physiology of bile and gallstones, perhaps along with some internet references about the analysis of said "gallstones," might be sufficient for one person. Another may remain unconvinced. Question: Is this patient-physician relationship doomed, or can an "agreement to disagree" work for both parties? How much negotiating should a given physician be expected to do regarding these issues? Should we simply refuse to accept as patients anyone who appears to be "rejecting science?" Remember, we don't always know what we think we know. What would we have thought twenty years ago of the patient who swore her ulcers were cured by a high-dose course of antibiotics? Back then, she'd have been an altie; today we've "discovered" H. Pylori.

Out in the real world, things are often not as cut and dried as the internet helps make them appear. Many people who do "liver flushes" also understand the need for pap smears, colon cancer screening and blood pressure control.

I believe this is a topic ripe for discussion: finding a middle ground with "alties" so as to provide them with competent, compassionate care in spite of the views they espouse -- to the extent they are willing to accept it, of course. Obviously I am not talking about the true extremists -- the blog fodder, that is. But if we could please take a step back from the wing-nut sensationalism and help find ways to persuade, educate, and above all care for these, some of our more difficult patients, I think we -- and our patients -- would find it rewarding.

(Yes, today is my birthday. Many thanks to all for the good wishes.)