Musings of a Dinosaur

A Family Doctor in solo private practice; I may be going the way of the dinosaur, but I'm not dead yet.

Sunday, March 04, 2007

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.)


At Sun Mar 04, 03:43:00 PM, Blogger jmb said...

Usually a lurker, but Medblog Addict sent me over to say Happy Birthday to you. She's not giving me a bum steer, is she?
Good post by the way.
I worked in a hospital pharmacy with 30 people, half of whom swore by echinacea for preventing colds. No scientific proof of efficacy has ever been provided but these scientifically trained people gobbled it down.
After a long career in pharmacy, my answer, when I'm asked about it, is take that herbal remedy if you think it helps, provided it does no harm, does not interact with anything else you're taking (so check with your doctor) and you do not avoid scientifically proven treatment. After all it's your money and who can discount the placebo effect?
Obviously, your "alties" are much more serious and difficult to deal with.
Back to lurking

At Sun Mar 04, 04:44:00 PM, Anonymous Anonymous said...

Echinacea is actually a cousin of ragweed, so allergy sufferers may induce cold-like symptoms in themselves by taking this supplement. Of course, the interpretation of the symptoms is that they had a cold with less severe symptoms, thanks to the echinacea.

At Sun Mar 04, 09:39:00 PM, Anonymous Anonymous said...

I had an orthopedic patient who came to me with osteoarthritis in her knee. She's also a 'reiki' healer. She claims she can put her hand inside a person and take out whatever is hurting them. I had to bite my tongue to keep from saying, "Why don't you stick your hand in your own knee then and fix it?" Instead, I took the time to educate her on the disease and what she could do to help alleviate her symtoms in a more, ah, traditional sense. Did she listen? Probably not.

IMHO, people use alternative medicine sometimes because they hope it will all go away if they just take the right herb. I'm talking about people who KNOW there's something serious going on but are in denial. 'I know this big, hard, mysterious lump in my abdomen will go away if I just drink green tea three times a day.' These are the ones who make me want to bang my head against the wall. The alties who get regular check-ups by their docs are fine with me. At least they have one foot in reality.

At Mon Mar 05, 11:58:00 AM, Blogger RedSpiral said...

I don't understand the disdain between the two methods... acupuncture has been around for centuries, far, far longer than allopathy -- the trick would be to get allopathic physicians to coordinate efforts with a few respected alternative practitioners in the area. They do not have to be separate from each other!

I am glad you wrote this, I am an 'altie' I guess, I prefer to go the gentlest route possible. I'm not opposed to allopathic medicine at all, it has it's place and has been there for me many times. However, I think there is a lot more to healing than 'quit smoking and lose weight', which is the best preventative that allopathy seems to offer.

For example, I'm seeing an OB/GYN for my prenatal care, AND a homebirth midwife. My OB/GYN will look for problems and my midwife will help me to prevent it. They know each other and have a relationship, and I have a longstanding relationship with my OB/GYN which allows me to say to him "I will be a difficult patient, but not because I do not respect you, but because my health care is in MY hands." I'm the patient who question everything, researches everything (using published data/studies from reputable sources, not personal websites of people who think they know.... jeez as a doula I hate that, too!). I'm not 'compliant', I'm an active participant. I won't always agree, and I expect him to be okay with that, because I have *tremendous* respect for him and I know his suggestions will be his best guess at what is best for me.

See this is the trouble when patients want more from health care... they go to the internet to find out what they think they are missing, and they get exposed to all these 'crazy' ideas like Reiki (the practitioners of which do not 'put their hands into' anyone, or anything, it's an energy healing method involving no touch whatsoever), acupuncture, supplements, herbs, etc.

Being adversarial doesn't help anyone, it just patronizes the patient, dismisses htem and drives their belief that 'allopathy is evil' even further. :( It's a sad loss for everyone, IMO.

At Mon Mar 05, 12:24:00 PM, Blogger Lynn Price said...

"She's also a 'reiki' healer. She claims she can put her hand inside a person and take out whatever is hurting them."

Oh, this just hurts the brain. For the record, I'm a reiki master, and I can tell you that the person espousing these claims needs to be lashed to the nearest flagpole. Reiki offers no such guarantees. It's a form of relaxation. My book website talks all about it in terms that are educational.

People that make guarantees and outrageous claims do a huge disservice to those who practice alternatives ("alties" - hadn't heard that before) and give the whole "industry" a bad name. I've encountered plenty whack jobs in the coures of researching for my book and agree with so much of the sentiment described above.

People have gravitated to alternative medicine for any number of reasons and not just becasue they hope their affliction will go away. There's a reason they're led in this direction; possibly a bad experience with allopathic medicine, were told there was nothing more science could offer them. Sure there are the nut jobs who believe that howling at the moon will rid them of their warts. But you have nut jobs everywhere.

#1Dinosaur makes a compassionate suggestion that there's middle ground to be had between docs and alties, and I agree. This is exactly what my book(shamless plug) is about - finding that middle ground.

Like most docs, I'm very leery of those who turn away from allopathic medicine because it's simply ignorant. Likewise, I'm impatient with docs who refuse to acknowledge that they don't know everything. There is a definite correlation between the mind, spirit, and the body - an integration, if you will. How many of you docs have seen a positive or negative outcome that left you scratching your head? For all intents and purposes the patient should have either died or got better - all the elements were there for either outcome. Yet in spite of all your best, the patient surprised you? Personally I believe that the spirit, the mind comes into serious play, and the research I did with hundreds of cases and doc interviews only served to solidify my opinion. Like Dinosaur says, we don't know everything - most of all the power of the human spirit.

Rather than go overboard to one side or the other, there's a third option; integrative medicine. It's the idea of integrating alternative healing modalities with allopathic medicine. Beth Israel Hospital in New York has a huge clinic donated to this very idea. So does Arizona State University. My cover designer's daughter is getting her fellowship in Integrative Medicine. It's not science fiction or fantasy. It's acknowleging the idea that there's more to us than meets the microsope.

This is such a great topic, and I'm sure I'll recieve some flak from my post. Let me just say that in the course of my research, I went into this book of mine an ardent disbeliever of alternative medicine. It wasn't until I had enough weird things happen to me with Reiki that I decided there's a lot more at play to us corporeal beings than just what we see on an x-ray.

At Fri Mar 09, 05:54:00 PM, Anonymous Anonymous said...

well said Dr D

what is a 'blog fodder'?

Patients and Physicians have to be continuously educated.

Personally, I think that our education system should devote much more time teaching about health and our bodies. It would be beneficial to the general public, the healthcare community, the govt......maybe you could do a blog on that subject.

At Fri Mar 09, 05:55:00 PM, Anonymous Anonymous said...

dr d

i read your other blog and left you a comment there. thank you for the link.

At Mon Apr 16, 08:44:00 PM, Blogger Unknown said...

I am really enjoying your blog. I don't agree with everything that you say, but I truly appreciate the honesty and your perspective.
I am a CFer and a double lung transplant patient. In my day, I have rocked the see-saw between alternative medicine and western medicine. I have written a piece about my experiences. I especially thought you would appreciate example 2!
I'm going to link you on my blog and will certainly be checking in! Thanks!
Sick Girl Speaks/Tiffany


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