She's a character, she has opinions.

Doctors oughta doctor.

with 2 comments

Dr. Rob’s post A Letter to Patients With Chronic Disease made quite a stir since it was posted in mid-July. People love it, people hate it, and personally I can’t believe I’m watching classic derailing techniques like the tone argument and victim blaming play out in this space.

When I read the Letter there were parts I liked and parts I disliked. (Dare I say, parts that offended me?) I very much like that Dr. Rob admits that doctors can be scared by patients with chronic disease: “I am talking about your understanding of a fact that everyone else seems to miss, a fact that many doctors hide from: we are normal, fallible people who happen to doctor for a job. We are not special. … Then there is the fact that you also possess something that is usually our domain: knowledge.  You know more about your disease than many of us do – most of us do.” From the perspective of a patient with chronic disease, I find that refreshing to hear. I can work with a doctor like that. I feel like just from that simple admittance that this doctor is going to be open to learning about my disease and helping me the best he is able.

But then we get down to the advice portion of the post. I’m on-board with building a relationship of trust with my doctor. I think that’s a great idea. I think he makes some great points about forming a core team of doctors, not avoiding doctors’ appointments, not putting up with bad doctors, and even forgiving doctors for things. (I expect my doctor to review my file, I don’t expect him or her to be infallible.) And, like Dr. Rob, I agree that relationships are built by both people involved. But Dr. Rob seems to forget that a little bit in his points 1 and 2:

“Don’t come on too strong – yes, you have to advocate for yourself, but remember that doctors are used to being in control.  All of the other patients come into the room with immediate respect, but your understanding has torn down the doctor-god illusion.  That’s a good thing in the long-run, but few doctors want to be greeted with that reality from the start.”

“‘Show respect – I say this one carefully, because there are certainly some doctors who don’t treat patients with respect – especially ones like you with chronic disease.  These doctors should be avoided.  But most of us are not like that; we really want to help people and try to treat them well.  But we have worked very hard to earn our position; it was not bestowed by fiat or family tree.”

I’m going to say this carefully: Respect is earned. I approach every doctor as I do every person, with common courtesy. Whether or not you earn my respect is based not on your medical degree but on our interactions.

It seems here that Dr. Rob is saying that if patients are treated poorly by their doctors it’s because they didn’t treat their doctors well enough. In the comments to a follow-up post, Dr. Rob makes this clear: “You say that I am implying that the patient bears blame for their bad treatment by doctors. To quote: ‘You’re saying that if a patient isn’t *nice enough*, she won’t get good treatment.’ Well…actually yes, that IS what I am saying to some degree. How patients treat doctors DOES affect their quality of treatment. That’s human nature: we treat people better if they treat us well.” [Link]

Remember I mentioned the tone argument? In brief, for those who aren’t familiar with it and don’t want to click the link (though I suggest you do), the tone argument is where one person objects to another person’s argument based on its tone, as in “if you weren’t so angry maybe I’d listen to you.” Or, as the graphic at the link says “I’m offended that you’re offended!” It’s a silencing and derailing tactic, an excuse to not deal with the argument itself and a way to dismiss the person making the argument as not worthy of being listened to. Personally, I think that doctors ought to doctor because that’s their job. I didn’t realize they only had to do their job if people were nice to them.

Dr. Rob wrote two follow-up posts, My Side: What It’s Like to Sit on My Side of the Exam Room and To Know and Be Known. “My Side” reads like a defense of Dr. Rob, and I think it is. He’s tired, he’s only human, he’s running a business and his “blog is a refuge and a tool.” Charitably, I think he’s upset because some of the reactions to his Letter were negative, and I understand that. Here’s the thing, though, when you talk the talk about relationships being mutual then you shift the blame onto only one party, well, you’re not walking the walk.

The apologies are going to be familiar to anyone who has ever been on the marginalized side of an argument like this, he’s sorry people were offended but if you only knew him you’d know just what he really meant. “To Know and Be Known” makes that perfectly clear: “The people who are regular readers of this blog, those who know how I think (and are not totally terrified) will read my words with a level of understanding that new readers can’t have. … So, to those who are new to this blog I say, read other stuff.  You will understand me much better if you don’t base your conclusions on a single post.”

So I’m seeing from all this that it’s my fault if I don’t agree with all of Dr. Rob’s points? If I only knew how he thought–and wasn’t “totally terrified”–then I’d get it. Here is where I point you toward the concept of victim blaming: “Victim blaming is holding the victims of a crime, an accident, or any type of abusive maltreatment to be entirely or partially responsible for the transgressions committed against them. It is also about holding individuals responsible for their own personal distress or difficulties instead attributing responsibility to the transgressors who caused it.” Victim blaming is an excuse to not take responsibility for your own actions and to somehow prove that the victim was responsible for what was done to them.

I don’t think Dr. Rob is a bad guy. I think he was trying but he couldn’t quite recognize his own privilege (as an abled person and as the person with the power in the doctor-patient relationship). I wish he’d spent his follow-up posts trying to do that instead of defending himself. But, at the end, his post Call off the Dogs says all I need to know about Dr. Rob, in his own words: “So why would two posts that are actually positive in nature elicit such a negative response? Why would people unleash the guard dogs on someone who comes as a friend? I can only guess, but I suspect that I somehow reduced their victim-ness by what I wrote. Some people seem to identify themselves by what bad life has dealt them, and any threat to that identity is met with hostility. I think that’s what I saw.” *sigh* It isn’t Dr. Rob’s fault you didn’t understand him, it’s your own. Yeah, call off the dogs (because that isn’t an insulting and offensive thing to say), because he just doesn’t care to listen.

ETA: Dr. Rob left me a comment today saying this among other things: The “call off the dogs” post was actually not written to deal with the comments on the letter. It was from the vitriol unleashed by a anti-vaccine website against a subsequent post I wrote about the joys of caring for kids with autism. This came fairly soon after the letter, so some of my emotions regarding the incredible response to the letter (again, mostly positive over the internet) had not cooled. Check out his full comment.


I know, I’m late to this. I was having a cancer-scare while all this was originally happening, I’m only now having a chance to read and think.

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Written by tldegray

August 21, 2010 at 6:49 pm

2 Responses

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  1. Very well-written. I agree that as I responded to some of the comments, I became more defensive. I do regret that.

    The “call off the dogs” post was actually not written to deal with the comments on the letter. It was from the vitriol unleashed by a anti-vaccine website against a subsequent post I wrote about the joys of caring for kids with autism. This came fairly soon after the letter, so some of my emotions regarding the incredible response to the letter (again, mostly positive over the internet) had not cooled.

    This is a nice and balanced post. Good advice to writers who unwittingly touch a third rail they were not aware existed. I knew what I wrote would cause a stir, but the response was tenfold of what I expected. If you write you need to bear the consequences of the words you choose, and if a substantial portion of your readers misunderstand you, you must always look again at how you wrote it.

    Rob

    August 22, 2010 at 9:03 am

    • Thanks for your reply. I’m going to edit the part of my post about your “call off the dogs” post right away so there’s no more confusion coming from these parts.

      I think it’s hard not to be defensive, especially in a public forum. Like you say, we write publicly and we bear the consequences. It’s so much less overwhelming one-on-one.

      As I said above, I really liked what you wrote in your post about doctors being human and scared and normal. I’m fortunate in having more than one doctor like that and I know how wonderful it is. I’m also fortunate that they realize I’m human and scared and normal, too.

      tldegray

      August 22, 2010 at 3:46 pm


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