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Two types of doctors

Posted Nov 18 2008 12:14am

Just like biologists classify people ( for example, lumpers and splitters) , I have come to the conclusion that there are two groups of doctors - I call one the "worry-makers" and the other the "reassurers". Let me explain.

Many patients come to doctors with minor self-limited problems which get better on their own , or do not need medical intervention. For example, as an infertility specialist, I often see young couples who have been trying to have a baby for only a few months, but who are concerned that they may have fertility issues because they have not yet conceived. It's sometimes family pressures which precipitate the visit; or the fact that a friend who got married after them is already pregnant.

I have to explain to them that Nature takes time to make a baby - and that 90% of fertile couples take up to 12 months to conceive . I also tell them that it's " much more fun making a baby in your bedroom" - and that they should not come to me until they have exhausted simpler options. I refuse to do any tests for them - and just educate them about the fertile time and what they can do to maximise their chances of conception.

However, other gynecologists and infertility specialists take a diametrically opposite approach. They will test the husband and the wife - and often these tests do show minor abnormalities ( for example, a small fibroid in the wall of the uterus on ultrasound scanning) which are of no clinical importance. They then do further tests to evaluate these abnormalities , thus creating a vicious cycle of tests and anxiety. Some will even do surgery to "treat" these "problems". If the patient does get pregnant ( and often this is inspite of the doctor rather than because of him !), the doctor is happy to take all the credit. This is a clever thing to do , because these "success stories" promptly refer lots of other patients to the doctor, creating a positive virtuous cycle for the doctor !

Reassurers are often Simplifiers. They explain the basics of how the body works to the patient, so the patient is empowered to manage their own problem and make their own decisions. The Worry-makers are often Complicators. They use jargon and talk above the patient's head, in order to intimidate them and ensure unquestioning compliance to the doctor's orders.

In the final analysis, doctors get the patients they deserve - and patients get the doctors they deserve. For example, a patient who wants a "full-body checkup " done, will not be happy with a Reassurer ! On the other hand, well-informed patients will refuse to be bullied by the pressure tactics adopted by the Worry-makers. They will do their homework and get a second opinion, so they can make their own decisions.

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