Is it true that M.D.'s are taught in medical school that the majority of their patients will have nothing physically wrong with them, but instead are either deluded, insane, or are hypochondriacs?
Thanks.
Oh, that kind of nuts.
Not all their patients; just you.
They’re taught that every illness has a cause. When they can’t figure out what’s wrong with you then the diagnosis must be that you are deluded, insane or a hypochondriac.
I tend to think that it’s a combination of two things;
1> Their schooling does not include the art of LISTENING. I’ve been screaming mad at doctors who refuse to hear what I’m telling them. Told the Neurologist that most of my pain was in the upper back/shoulders. Did the moron ever look at that area? Nope. Kept concentrating on the herniated disk in my lower back.
2> Arrogance. Most doctors think they know everything and you don’t, which heavily reinforces #1 above. Seems to me that they need a class in Humility 101.
Maybe if they’re an Ear, Nose and Scroat specialist.
I cant’ wait to hear Qadgop’s reply to this one.
Scroat! He said scroat! Too funny!!!
“To develop listening and interviewing skills. . . .”
PSYCHOSOCIAL ASPECTS OF CARE. Offered to first year medical students. Beth Israel Deaconess Medical Center–HMS SM716.1
from Harvard Medical School, Division on Aging.
“In the first year, the students explore both the various aspects of the doctor-patient relationship and the relationship of medicine to some of the broader, social issues of our time. In the second year of ICM, communication skills are reinforced. . .”
from Boston University, School of Medicine
It’s at least a beginning.
Not for the meek:
Even this guy’s only approaching about 22% nuts
I’ll give you 10 to 1 he got that knot on his forehead from a headboard.
When I was a med stud, my school began emphasizing that we would not discover the physical pathology behind at least one-third of our patients complaints. They emphasized that the resulting functional symptoms were still very real symptoms, but that we would become frustrated in not finding the cause, and had to learn to not assume the patient is malingering, or faking it, or mentally ill. Because the vast majority of them are not any of those things.
Many docs still don’t cope well with this concept. At times I don’t either. But it’s true. At least one-third (1/2 to 2/3 is probably closer) of the complaints I see are functional in nature.
By functional, I mean that no disease state can be found, and the pain is probably from chronic nervous system changes. Better treatment for these types of complaints are being found.
And I agree with Chimera’s first point. Docs need to listen better. Up to a point. Generally when I ask “when did it begin hurting” and they reply “It was in 1983… or was it 1984? No, it had to be before 1984, because it was at Aunt Guggie’s and Uncle Buckle’s wedding (we called him Uncle Buckle because he was a real safety buffalo) that my sister came up to me, and… my sister had something like leukemia but that wasn’t it, and she went to a herbal therapist and got treated and got better, does that run in families, and what herbs should I be taking?” that I generally stop listening.
But I disagree with Chimera’s 2nd point. Bashing an entire group of people because of the actions of a few is never appropriate. Unless they’re lawyers 
QtM, MD
Don’t be so hard on yourself, Q. You’ll always be a med stud in my book. 
“Are Doctors Taught That Most Of Their Patients Are Nuts?”
No. They learn that when they start treating patients.
In “Lost Art Of Healing”, Dr. Bernard Lown essentially agrees with Chimera above, that med school doesn’t teach the skills needed to expertly perform/analyze “history taking” (i.e. listening to patients,) and so contemporary med students assume that listening isn’t very important. Lown builds a case for a direct connection between doctors’ recent deafness to patients, and the recent huge rise of malpractice suits (‘recent’ being the last few decades.)
His book is excellent, very much like Oliver Sacks’ books, full of interesting case histories and lots of brutal self-honesty.
PS, Lown is the one who developed the modern cardiac defibrillator and was a key player in stopping heart attacks from being an automatic death sentence like they were back in the 60s.
Lost art of healing
Thanks, Qadgop.
Medical training tends to focus on observable signs. This can lead to complaints about quantifiable problems being privileged over self-reports of symptoms that have no associated rash, lab test, or what have you. In the extreme, it leads to the “I don’t see anything, so there’s nothing wrong with you” response.
As a psychologist, I’m very aware of how luxurious my training was. Plenty of attention was devoted to active listening and building rapport with clients. One of the ways I support my M.D. friends and associates is to provide case consultation. Even being a deluded, insane, hypochondriac is not the same as having nothing wrong with you.
Jon Carroll of the San Francisco Chronicle wrote a great column this week on the subject of doctors’ listening abilities. Be sure to read all the way through – he starts by discussing a hoax and then gets into the fascinating results of a study about doctors and listening.
One of the reasons that my wife and I have been seeing the same doctor for so long is because he listens to her. There was a brief period we were not able to see him because he got fed up with the HMO’s “in-and-out, fifteen minutes-and-not-one-second-longer” attitude" and left the clinic to set up in private practice. The next year, after dealing with several doctors who dismissed her complaints (and seemed to have trouble telling her left half-foot from her whole right) I changed our health plan to Blue Cross so we could go back to him.
As far as my wife is concerned, if a voice from the sky identified itself as God Almighty and expressed an opinion on her health, she wouldn’t believe a word of it until she got confirmation from Dr. T. Her confidence in him is based in part on his listening ability, and that confidence contributes to his effectiveness as a doctor.
“In “Lost Art Of Healing”, Dr. Bernard Lown essentially agrees with Chimera above, that med school doesn’t teach the skills needed to expertly perform/analyze “history taking” (i.e. listening to patients,) and so contemporary med students assume that listening isn’t very important.”
It sounds like Dr. Lown didn’t get a very good medical education. Did he do some kind of study or did he just extrapolate his poor experience to all 100+ North American medical schools?
I have met physicians who were expert not only at listening to patients but at getting their patients to tell them what was troubling them. My favorite example is the case of a woman with some kind of vague gastrointestinal complaints (e.g., tummy pain, contipation, or something like that) who presented to an outpatient clinic at a teaching hospital. A medical student was assigned to taker her history and examine her and then discuss his diagnostic impressions and treatment plan with a senior physician. The medical student dutifully spent a half hour speaking with the patient and examining her, after which he reported that he hadn’t found anything wrong with the patient but wanted to order several sophisticated and expensvive diagnostic tests. Then the senior physician then went in the room and after less then five minutes had discovered that the patient’s real concern was that she had just discovered that her husband was having sex with her daughter.
Unfortunately, although some physicians do get excellent training in listening to their patients, many, in my experience, either never received the benefit of such training (such as Dr. Lown) or are too lazy to use it.
In addition, many physicians come from privileged, upper middle or upper class environments where they have no opportunity to learn to communicate with uneducated people except, perhaps, the housekeeper but she only speaks Spanish. People like that are handicapped in the clinic because, unless the clinic is on the upper East Side or in Beverly Hills, or some place like that, they have trouble understanding uneducated patients even if they do listen to them, and hearing them try to speak to such patients is enough to make you want to cry.
There are many patients who are pretty much nuts, but the dr. still has the responsibility to LISTEN and rule out physiological cause…I don’t think they are taught most patients are nuts, I think other factors detract from being able to listen (productivity concerns, an institutions political messes)…
And as an RN, I’ve come to realize that given the right circumstances we can all be nuts…And the healthcare setting is prime ground…