On algorithms. February 21, 2008Posted by phledge in black bile, fat, medical school, yellow bile.
Tonight I picked my husband up from work (we’re almost done with the truck but for right now I cart him around if I want to have the car during the day) and he was jonesing for a baked potato from Wendy’s with bacon on it. When we asked for said item in the drive-through, the charming young male voice emerging from the speakers at the restaurant told us that they did not put bacon on their baked potatoes. Mr Phledge asked if we could just get a side order of bacon, and again we were denied. So–brilliant devotee of bacon that I am–I asked for a spicy chicken sandwich with bacon on it. Behold! A spicy chicken sandwich with bacon, coming up! We rolled our eyes and also ordered a plain baked potato. Either the tender sprig gave in to complicity, or he didn’t figure it out, but up came the potato on the ordering screen. Mr Phledge and I laughed the whole way home.
What does this have to do with medicine?
If you have not done so, I do so strongly recommend reading How Doctors Think, by Jerome Groopman, MD. Within its very layperson-friendly pages you will see that your doctors are being trained much like this young Wendy’s employee: via algorithm. If something doesn’t fit within a given construct–such as, oh, I don’t know, healthy fat people, or doctors who refuse to accept kickbacks from Big Pharma, or manipulation that actually does more than help a backache, or GLBT patients wanting children, or people who enjoy smoking enough to not want to quit–there’s a little lightbulb that pops in their heads. The cognitive dissonance between what should be (according to their faculty, who took it from their faculty, who took it from maybe say Aristotle) and what actually is breaks their widdle $250,000 brains. And I tell you what:
It’s hard to say no.
By and large, my professors have earned nothing but my respect. I am being taught by some amazing clinicians and basic science faculty who are committed to teaching us how to think outside the box and on the fly. I also believe that they are doing what they feel is best for my education and my future patients. Having said that, there are some people that I really admire that espouse some concepts that I find abhorrent and inconsistent with current knowledge. One particularly well-liked professor announced, during a sports physical training session, that if an obese child presented him- or herself for a sports physical we should defer to their primary care physician for further workup or, if we actually were the PCP, do a cardiac workup and not clear the child for activity participation until the child lost weight. I smell shame there, and yet it’s so very difficult for me to gather up the courage–and the legitimate resources–to challenge this physician. An otherwise agreeable instructor spent more than half of an hour-long class on eating disorders harping on the dangers of obesity, and declared that our obese patients were killing themselves, and their quality of life was obviously diminished. I sit and listen to this. It’s not that I believe it, but I will be tested on it, and when the examination asks me what causes type II diabetes I answer obesity. I do a little mini-rant to those few classmates who will listen to me, but in a group of almost 140 students, it’s a small percentage of people who will go on to question the authority, question the research, question the answers. And that’s a crying shame, because education really is not all about unanswered questions, and more about unquestioned answers. The Socratic method, I fear, died a long time ago. And the guy at the Wendy’s drive-through confirmed that suspicion for me tonight.
The baked potato, I’m told, was excellent.