The name Charlie Teo first crossed my consciousness this year, when I met one of his patients during my rural GP week. She'd had a tumour on her spinal cord and was handballed between various surgeons who told her it was impossible to remove. None of them mentioned Teo, the surgeon who was willing to operate on the inoperable. They were finally referred to him when the tumour was far advanced. They got to him just in time to save her life, but she was already a quadriplegic at that point. This lady and her husband were fair dinkum Aussie Battlers, and I say that without irony. Her husband had his own health problems - chronic severe back pain, multiple injuries from past car accidents, and was visiting the GP with pneumonia, requiring hospitalisation - but still managed to care for her full time. Despite their ordeals, they were philosophical, not at all self-pitying, and deeply committed to each other in an unsentimental, no-nonsense way.
To me, the Outcast Teo vs Medical Fraternity fracas highlights the contradictions in our noble profession. Questioning the validity of Teo's techniques is justifiable, but the visceral hatred he seems to evoke from the establishment goes far beyond the scientific. It comes from something baser, something like insecurity and jealousy and resentment.
See, on one hand there are the bright lights - doctors who inspire with their integrity, passion, intellectual precision, curiosity, compassion, humility, dedication and conscientiousness. I've seen these qualities in doctors at all levels, from humble residents, to GPs, to consultants (ie. Gods). I see the potential in many of my fellow students. The docs I had in Armidale were awesome. Being a small hospital, the structure was really flat - consultants actually deigned to talk to us lowly students and treated us as really really really junior colleagues. And they could teach, hallelujah!
On the other hand, I'm always wondering what patients would think if they really knew what doctors are like backstage. They are given so much trust, and abuse of that trust is so commonplace. Not so much the Dr Evil "mutilating genitals during surgery for kicks" kind of thing, but insidious, small betrayals. Using big words to take advantage of patients' ignorance. Never, ever saying "I don't know". Making referrals to specialists who've been nice to you, or not making referrals to specialists who've slighted you once. Putting on a façade of professional reassurance, only to talk crap about them behind their back. Using bias-based, not evidence-based medicine. Blaming patients for depression or addiction. Being careless with infection control. Doing tests or procedures that aren't strictly necessary to cover your own ass or make a bigger buck. Never admitting mistakes. Writing off some patients as basket cases, too hard, or not worth the bother. Aiming for "good enough not to be sued" rather than best care. I could go on and on. And the personalities, god, the personalities. Impenetrable vanity, arrogance, selfishness, apathy, laziness, bullying. I mean, I'm sure these things occur in all professions - petty rivalries and so forth. But people's LIVES aren't at stake in other professions, people's lives don't depend on whether Dr X's pride has been wounded or not.
I'm on Flynnie placement yet again, and in moments of particularly brain-numbing boredom I fantasise about the scathing portrait of my boss' foibles I'm going to write. A by-product of observing him for most of my waking hours. Let me try to capture some of his flavour. Our protagonist is a late-40's American ex-surgeon, a footballer who injured himself out of a career in college, dressed in all-American blue jeans and polo shirts. Adopts a folksy straight-shooting manner but bullshits his way around questions he can't answer ("What's idioventricular mean? It's something that's not working like it's supposed to. Like idiopathic, idiosyncrasy, one of those old Greek word things"). FoxNews devotee, son of a blue-collar worker, now multi-millionaire, casually racist ("Med school was so hard back in the day that two guys from my class killed themselves. Just couldn't hack the pace. They were both Arabs from Pakistan or something. Good thing too. Those people are all terrorists in the making"). He's threatened by and contemptuous of anyone who dares question his authority by showing any knowledge about their condition or using alternative therapies . Starts lots of sentences with "In medicine...", eg. "In medicine, this is called a puritic [sic] rash". Writes referral letters with really bad spelling and grammar. Asks "guess what I'm thinking!" kinds of questions to show off his knowledge or exert his power rather than actually discussing or teaching. Is impervious to student's eyes glazing over during his lengthy Pearls O' Homegrown Wisdom About Medicine - which he repeats. A lot.
A recent consultation went like this. A gentle, child-of-hippies type of woman comes in with diarrhoea and constipation.
Her: I had a look on the internet...and I know I shouldn't try to self-diagnose, but I was wondering if it could possibly be IBS?Doc instantly bristles, patronises her ("Cactus extract? What kind of cactus? There are many many kinds of cactus"), contradicts everything she says, and boots her out. After she leaves, he launches into lecture mode.
Doc: Impossible. Can't believe anything on the internet. Inflammatory Bowel Disease is a very serious condition and it is very unlikely you have it...(etc etc etc etc)
Me: Um. Didn't she mean Irritable Bowel Syndrome?
Her: Yes, that's it. So I tried some natural medicines they recommended at the shop over there...
That there was a good lesson for you. What they don't teach you nowadays in medical school, which they did back in the days when I was training, is that you should never, ever let the patient take control. You'll see. When you've had 30 years of experience like me, you find out all patients want to use and abuse you. They'll come in with some scrap they've found off the Google and try to sell you some bullshit. Like that girl just then, she just flung piles and piles of bullshit all over the room. I picked it up right away, as soon as she came in - I've got my observations honed to perfection, it'll take you 30 years to get that kind of skill. Cactus extract! You saw how she tried to get her agenda on, but no way, I don't stand for that shit. You gotta learn that you're the doctor and you're the boss. She's a massage therapist - probably flunked out of high school - and she wants to tell YOU what to do! (etc etc etc etc)Somewhere, an artsy-fartsy tie-died hippy-dippy anatomy-sucks ethics-roolz Newie lecturer is weeping. To be fair, I don't want to completely vilify him. He's got his charm and is great with babies. He works up his patients really thoroughly and goes the extra mile for them...at least the ones he likes. I can tolerate him...and occasionally learn a thing or two, though I now take whatever he says with a fistful of salt - he's quite capable of making up facts.
Praps I have this impossible ideal of Perfect Doctor - one that others, and no doubt I myself, will constantly fall short of. But the standard's got to be at least: "how would I like to be treated? what if it was my grandma?".
1 comment:
He sounds a charming chap.
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