Doctors Are Great, Except When They Aren't

White coat hypertension is a phenomena/condition that is now common enough to have a name in the medical community. Doctors found that the blood pressure of patients were at higher levels when taken in a medical setting versus somewhere the patient is more comfortable. I suffer from this condition.

In other words, doctors make me so nervous my blood pressure goes up. Let's explore why!

Pictured: Is this not enough on its own?

Before starting this tirade against principles of the medical profession, I want to say that a lot of doctors are awesome at their job and that doctors aren't evil people. I also owe my life to a lot of doctors being skilled. Lastly, some of the trauma may also come from having a rough-and-tumble childhood; I had to go to the ER every year of my life (at least once) until I was 14. So a lot of formative memories with pain plus doctors.

But this isn't me being mad about a doctor super gluing their thumb to my forehead that one time. It's an observation that medical school and practice leads to certain principles being instilled in doctors. And those principles can drive me up the wall.

1. Occam's Razor

This is a principle that can be helpful in getting a diagnosis. For those unfamiliar, the principle values simple explanations over more complex ones. This isn't a bad rule of thumb, but can quickly lead to under-treatment and misdiagnosis for more complex conditions when applied broadly. For instance, my wife and I have a friend who has a myriad of health conditions including Rheumatoid Arthritis and Bipolar Disorder. It took her years to find a doctor that would take her seriously. And she was in excruciating pain the entire time she was looking.

You can Occam's Razor a person's life away if you don't watch it.

2. I Don't Know

There is a pressure to diagnose patients, regardless of whether you have a full picture or not. Sometimes this is necessary to think about how to start treatment. However, once a doctor has assigned a diagnosis, everyone else involved in caring for the patient will start to see treatment and symptoms through that lens.

I have another friend who spent some time in the psych ward. He told me that he had been diagnosed with something like 7 different conditions; all comorbid. After listening to his tale, something became obvious. Instead of the doctors admitting that they were not sure about what was going on, they threw the book of diagnoses at him.

Another time, after my first trip to the psych ward, I had a doctor illustrate a flippancy in assigning diagnoses, even saying that "you can have 99 diagnoses, it's fine and ends up where it ends up" (or something along those lines). For those who have to live with those labels, particularly with mental health, incorrect diagnoses can become a cage people are trapped in. This can lead to dehumanization and labeling (this effect has even been documented).

Medical school can leave the impression that the body is a known quantity. It's not. There are large parts that we simply don't know (or, we have an idea how things work but do not know why things occur). But, in my experience, doctors hate *not* having an answer and would rather have a wrong one than nothing.

Pictured: Something you will have a hard time getting many doctors to admit.

3. Extreme Risk Aversion

Doctors do not like risk. And, given that they play with human life, this seems fair. However, this also prevents some people from getting the care they need and slows the speed of research.

I've mentioned I am non-binary before. To best reflect my gender, I will be getting a non-standard bottom surgery. The exact procedure has been done for years now. However, it took me quite some time to find a surgeon that would be willing to actually do it. Indeed, doctors are so risk averse that I will be the first person in the NYC/tri-state area to get it. I'm thankful that someone was willing to step up to the plate (after a bit of convincing), but I was having to look at other options (including going across or out of the country) in order to find someone willing to try.

Another place where this can be seen is the lack of willingness for procedures deemed "unnecessary". For instance, I have a magnet implanted in my left hand. No doctor would have put it in, even though what I wanted implanted is biosafe and designed for this purpose. Instead, I had to go to elsewhere, outside of the medical profession.

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I think the most frustrating piece of all of this is that I can see exactly where these principles are coming from. And in many instances they make sense. But the overapplication of these principles lead to human lives being impacted negatively. And that's hard to swallow.

So if you are a doctor reading this, remember what you learned in med school. Just remember the logical effects of your actions that stay with the patient, even after you leave the room to check on someone else.