Monday, October 25, 2010

One afternoon at the conference (#15)

Recently, I was at a large medical conference. After my talk, I thought I would sit in on an open discussion of a case being presented by a well known doctor. When I arrived there were about 40 other physicians/practitioners as well as the mother of the child, whose history was laid out in front of us. She sat calm and poised on the platform next to the doctor.

The mother and doctor went back and forth filling in the details of her son’s history. The blood and other medical test results were flashed on to a large screen and the presentation was going as these things generally do.

Somebody asked a question which I did not hear. The mother responded that the most important factor in a successful patient-doctor relationship was utter and complete confidence in the doctor, which she had. Many of the attendees nodded their heads in solemn agreement but this type of comment to me, usually means bad things are a comin’.

I am all for complete confidence in the medical professional one works with but draw the line at utter. In any relationship, there has to be one finger of yourself left to raise questions and consider other possibilities in case the practitioner is human and prone to mistakes or has a few gigantic blind spots, like everyone in the world. “Don’t give all your power away,” I wanted to shout. “Retain your right to question authority.” Alas, it was too late. Not only had she given all of her power away, most of the practitioners in the room seemed only too happy to take it.

Yet, she seemed peaceful and satisfied with her care and she had a right to her own views so I got off my little mental soapbox and decided to get what information I could from the session. With all of these highly educated people in the room, there should be some good clinical pearls, I reasoned optimistically.

The doctor finished showing the blood tests and explained what he had done in response and a lively back and forth with the audience ensued. Most of comments were started with, “I spent 20 years as head researcher on this topic….” or “I used to be clinical director of….” These were followed by an observation or advice wrapped in a question. “In the hundreds of similar cases I have seen,” went one, “I found such and such worked best. Why didn’t you use that?”

The presenter took these Monday morning quarterbacking comments equitably, explaining his thinking about this or throwing questions back to the audience when an unfamiliar concept was broached. The audience jumped on these like bears at a salmon convention. And they were so smart. Obscure and fascinating research was quoted. The usual wind up for these tidbits was,” You are no doubt familiar with Dopplehoffer’s seminal work on blah, blah, blah.” I wasn’t! I furiously took notes.

As the presentation went along, I waited to hear what the doctor did to figure out what type of infection this child had. There was a significant infection marker in the blood work that he had skipped but surely would come up in his treatment protocol. It did not. I tentatively raised my hand and asked. He looked at me blankly. “Nothing,” he said and moved on to the next comment.

I eyed the audience suspiciously and stopped writing. This could not be good. Why aren’t these doctors concerned about a possible infection? Instead, he highlighted a low iron level which he explained needed to be corrected. Many heads nodded in agreement once again and there was a brisk discussion about how everyone is afraid of iron but how important it is. One former clinical director claimed he even prescribed iron injections. The consensus was, iron: excellent choice.

MayDay! MayDay! Iron goes low when there is an infection. The body has a protein called lactoferrin that eats it up so the bacteria don’t get it because bacteria need iron to thrive. The case went straight downhill from there. A secondary gastrointestinal infection was uncovered which was treated with antibiotics. Iron stops antibiotics from working so I was not surprised to hear that the child had the same recurring GI infection. The doctor treated the problem with antibiotics but sighed with frustration when reporting it just was not going away.

Here I thought I was in an educational seminar but I had forgotten about how myopic the culture of medicine can be. Everyone was more interested in quoting medical literature and looking brilliant than considering new perspectives or asking real questions. I tried to raise a few delicate points without being insulting but nobody was listening.

Afterwards, I realized my failure was in being polite and not coldly explaining the forgotten basic principles of infections and iron. I was not speaking their language. The most important criteria for being heard is thrusting forth with unassailable confidence. “To anyone familiar, as I am sure you all are, with the studies by Smurf that found that iron deactivates antibiotics,” is what I should have said. I have done this many times one on one with other medical professionals to help clients. The trouble is that Smurf did not do those studies and I would have to look up who did in order to posture effectively. And though I can be an intellectual bully when arguing for proper patient care, it always leaves a bad taste in my mouth.

When I left, I was downtrodden. Intellectual arrogance and jockeying is usually bad for patient care. That poor kid. He has some kind of primary infection nobody is looking for, he is being treated for a secondary infection with antibiotics which might even accidentally help the primary infection but are being deactivated by supplemental iron and everybody just thinks this is an unusually tough case.

I took a breath. There are many ways to do things and mine may not be the only or dare I say, the best. I should take my own advice to question my own thinking. Iron is an important nutrient so perhaps I am not using it effectively and often enough. Perhaps this child will get better because of other unknown factors. Maybe the mother’s unquestioning faith in her doctor will overcome the biochemical factors. Question everything, I told myself. Try not to be attached to what you think you know.

The truth is the price for good health care is eternal vigilance. Ask more questions if the advice you are getting does not feel right. Get a second or third opinion. Like your doctor or nutritionist but do not adore them unconditionally because they are human and therefore, will screw up sometimes.

But don’t take my word for it.

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