There’s a difference between tact and respect. Tact is a negative virtue: it means not saying or doing anything to offend. Respect, on the other hand, is a positive virtue. If you respect someone, you trust their words and their judgement. You listen to what they have to say.
It’s a little odd that I’m affianced to a medical doctor (and that my life is now as a result completely full of doctors), even though I have always had strongly negative feelings towards doctors. Not as people, obviously, but in their professional role. I remember every year when I was growing up, the doctor would tell me to lose weight. And I understand why they did it, but it made me feel really bad and really terrible, like a failure. And the warnings would grow more grave and more dire each year. And there’d always be in them an implicit lack of respect both in the warning itself: “Oh, you must not know this is bad for you” and in the advice “exercise and eat right.”
Once a long time ago I wrote a blog post about how it wasn’t really my fault that I was fat when I was growing up, because I didn’t really prepare my own food. My dad took subtle exception to that: he thinks I’m blaming him because I’m fat. But that’s not what I was saying at all. That’s obviously not true. My brother is as thin as I was fat, and he grew up eating the same stuff. What I was saying is that losing weight is a very difficult thing. Adults fail in it all the time, and they have total control over their own diets. As a kid, I didn’t. I faced challenges much more difficult than an adult trying to do the same thing. But no one ever respected that.
I remember feeling so guilty and ashamed after one doctor’s visit that I swore I’d never go again. And once I went to college, I didn’t. Not for eight years. Part of that is that I took up smoking in that time, and I knew that would only result in even more shaming. Finally, after I got sober and quit smoking, I was feeling good about myself again, and I went back to the doctor.
And the first thing he told me? To lose weight. And that’s what doctors do. But again there is a lack of respect. I had done so much to improve my life, but he didn’t care. To doctors, it’s not about individual human beings or about the struggle to live in a body in the world. It’s about consulting a checklist of everything an ideal human being should do and be, and if you don’t fit that checklist, then you need to be brought into line.
Anyway, my cholesterol levels were high in that visit. I started losing weight, bringing them down to healthy levels within six months! But I never got a word of congratulations. It was always just a warning to “be careful.” And, two years later, when I went back to that same doctor as a 100 pound lighter, healthy weight individual, I still didn’t get a word of recognition. All he did was ask me how much I exercise and then warn me that I needed to exercise more.
I don’t know what it is that makes doctors so annoying. After all, I don’t see a doctor more than once or twice a year, and really I ought to be able to shrug off what they think. But I don’t think they realize the way they control our awareness of our own mortality. If a doctor looks at me and tells me that I’m doing something wrong, then I hear it as, “You’re going to die, and it will be your own fault.”
Doctors aren’t less terrified of death than ordinary people are. In fact I’ve found they’re even more terrified of it. And they view it in more starkly moralistic terms. I find that so many doctors seem to think if you eat just right and exercise just right and avoid all the environmental toxins, then nothing will ever go wrong with you. And whenever something goes wrong with a person, their first thought is, “Well what did they do to themselves?”
Doctors are like people who were abused as children and who now, as adults, fall into those abusive patterns with everybody around them. They have such a screwed up, moralistic value system, and instead of examining it, they attempt to transmit it to everyone they encounter.
And the result is that patient care suffers. People don’t like to go to the doctor. They don’t tell the truth to the doctor. They don’t comply with what the doctor tells them. They don’t trust doctors. They don’t believe that doctors are accurately diagnosing them. They don’t believe doctors are prescribing the proper courses of treatment. They believe that doctors are biased towards blaming the patient rather than, you know, actually treating what’s wrong with them.
Now what am I saying? Do I think people shouldn’t do stuff to get healthy?
Obviously they should. Some shit is bad for you, and it’s the job of doctors to say that (even if I think they’re wrong about many of their specific suggestions).
But I do think doctors shouldn’t operate from the standpoint that the person they’re talking to is a fucking idiot. People want to be healthy, and they do their best to be healthy. And if they’re not, then it’s because being healthy is difficult. Live for a month inside someone else’s head. Live with their means and their work schedule and their commitments and their cultural background, and then try to give them advice.
That’s probably too much to ask from doctors. After all, they only have fifteen minutes to talk to you. But how about at least a mental reframing? How about at least in your own head saying to yourself, “I don’t know everything there is to know about this person.” I think if doctors did that, they’d end up helping many more people.
And the thing is, I have experienced good medical care: I have an amazing dentist.
Five years ago I went to the dentist for the first time in eight years. And again it was lecture after lecture. I wanted to yell, “I know I need to take care of my teeth! That’s why I’m here!”
I dropped that dentist, at least, and found one who talks to me like I’m a human being. Until I found him, I don’t think I even knew what a good doctor might look like. But he’s so good! (Actually the dentist I had in the interim, in Maryland, was also very good, but he’s nowhere near as good as Dr. Easton, in Richmond).
First of all, he keeps things in perspective. Yeah, teeth are important. Good dental hygiene reduces heart attacks and all kinds of shit. But those are all a matter of percentages. You can have excellent teeth and still get cancer and die. As such, there’s no point in framing shit as, “You will die if you don’t do XXX,” because we know that’s not true. People do all kinds of unhealthy shit and live forever. And people who do healthy things can also die. It’s all about percentages.
I think doctors believe that if you make everything sound really grave and serious, they’ll increase compliance, but that’s not true. When a problem is too big, people hide from it. If you want someone to do something, make the problem sound manageable.
Secondly, focus on specific processes. When my dentist sees something going on with my teeth, he’s not like, “You should take better care of these!” Instead he’s like, “You’re missing this spot. Here it is. If you can focus while you brush and try to hit the spots along the gumline, that’s more important than getting the tops, really…”
Thirdly, he explains shit. “This is what this means, this is what that means, this is how this all works, this is how everything might turn out.” He frames it in terms of mechanics and biology. “Plaque when it hardens forms an environment for bacteria that tip the PH balance of your mouth, etc, etc.” You know he’s not just giving you a checklist or a rote answer. You know why he’s recommending this shit.
I’ve yet to find a primary care physician who can do these things. I don’t know, maybe that’s a Kaiser problem. I know Kaiser doctors are really overworked, and that they have to answer a zillion emails every day. But the Kaiser specialists I’ve gone to, my psychiatrist and an ear doctor I had to see, were both excellent in exactly this way. Maybe because I saw them for specific problems, so there was less ability to blame me and be condescending.
Finally, I just have a note on weight. This has to be the most difficult and serious topic that a primary care physician needs to bring up with their patients. I’ve heard so many doctors say they have all these patients with all these weight problems, and that patients almost never lose the weight they need to lose.
SHOULDN’T THAT BE SOME KIND OF CLUE?!?!?!?!?!?!?!?!
I mean I don’t know the answer to this question, but if every doctor is having this problem, and if nobody has solved it, then something has to change.