Comments on: Rationing vs. evidence

By: dx

dx — Mon, 28 Sep 2009 23:36:39 +0000

Anon – the question, as I understand it, is whether or not I could ever know the the proper course of treatment better than my physician. As it happens, I once developed a fistula and told my personal primary care physician it was a fistula. He told me it was not a fistula and that we would be not be treating it as such; because I believed doctors always know best, I let him convince me it was not a fistula. Sometime later, after I saw a second doctor, I learned that it was in fact a fistula and that my primary care physician had always been wrong. The problem was that my PCP had never seen a fistula before; this would be analogous to a plumber who had never seen a broken toilet before. In this case, I did in fact know more about the pathology and treatment of my disease than he did. That is one example; I could list more, but this should suffice.

By: anon

anon — Mon, 28 Sep 2009 23:18:46 +0000

Excellent reply, and much appreciated.

I have no doubt that, as you say, there is substantial value to the knowledge of information that a chronic illness patient can bring to the table — in fact, I’d go as far as saying that you know more about your illness than many medical professionals in other fields (say, a psychiatrist specializing in bipolar disease or a infectious disease specialist who researches the Ebola virus). However, I strongly disagree with the proposition that you can possibly know more than your personal primary care physician.

Let’s say that I live in a house which has a chronically broken toilet. I know what sounds it makes before it’s going to quit, I know how to jiggle it in a certain way to convince it to work, perhaps I’ve even watched the plumber fix it. Given my substantial experience with my broken toilet, does this give me as much expertise in the domain of toilet repair as my plumber? I don’t think so.

By: dx

dx — Mon, 28 Sep 2009 13:06:24 +0000

Anon – I certainly didn’t intend to imply that I had formal medical training training. Such training is not the only way one can learn useful facts about medicine. It’s a common and understandable mistake to assume otherwise, but in many cases patients with a history of chronic illness end up learning a good deal about their disease, it’s symptoms, and appropriate treatments. In fact, after 15 years of Crohn’s disease, I know as much or more than many people who can claim formal medical training. The challenge for someone like me is getting those sorts of people to recognize the value of the knowledge I bring to the table. Too often, they simply refuse.

By: anon

anon — Mon, 28 Sep 2009 08:22:44 +0000

Just a quick post but, I’d like a bit of clarification on your post — in particular, I was struck by your quote — “where I knew the proper course of treatment, but was powerless to get my physician to follow it.” — it seems to imply that you have formal medical training, which doesn’t seem to be present in your biography.

By: Kevin

Kevin — Wed, 23 Sep 2009 14:03:23 +0000

Thanks for the comments. fyi – Begley has historically been in the corner of evidence and comparative effectiveness research:
http://www.newsweek.com/id/187006

Kevin