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Mary Shomon

Time Magazine's Dr. Scott Haig Proves that Patients Need to Be Googlers!

By November 13, 2007

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It's been ten years since I wrote my essay on Petit Papier Patients. Petit Papier Patient is a derogatory way that doctors describe a patient who comes in with "little papers" -- "petit papier" in French -- for the doctor to read. I first heard this term from a doctor who referred to me this way. He said most doctors did not like "petit papier" patients, as we're too "high maintenance."

Here we are, ten years later, and it's same story, second verse. We have orthopedic surgeon and Time magazine writer Scott Haig, who has written an article, titled "When the Patient is a Googler," which you can read online at the Time magazine site.

Haig may use the term "Googler," and the hapless doctor I saw may say "petit papier" patient, but it's the same. They're just code words for an "empowered, well-informed patient." And even if the terms are different, one thing hasn't changed in ten years: Some doctors don't like us.

Another thing that hasn't changed in ten years: getting good health care still depends on your being a Googler or petit papier patient. Haig's article proves it!

In his essay, Haig makes an example of his patient Susan, who in his view is clearly an archetypal "Googler." Haig depicts Susan as rude, nosey, and overprepared for her appointment. She brings her uncontrollable, disruptive and destructive three-year old toddler -- the "little monster" according to Haig -- to the appointment. According to Haig, Susan launches into him "with a barrage of excruciatingly well-informed questions," and talks so much he can't even get in a word in edgewise. According to Haig, Googlers like Susan are "suspicious and distrustful, their pressured sentences burst with misused, mispronounced words and half-baked ideas." Haig declares that "her complete and utter selfishness was nearly a thing of beauty." Haig bemoans the fact that "Susan had neither the trust of a nurse nor the teachability of an engineer."

After reading Haig's essay, there's no doubt that Haig finds patients like Susan extremely difficult, so difficult, in fact, that he admits that he "punted," and referred her to another doctor, primarily, it seems, to get rid of her.

Now I don't know Dr. Haig. Maybe he's a great doctor, maybe he's not. Maybe he has a charming bedside manner when he's not aggravated by patients, or maybe he's an equal opportunity curmudgeon. But his essay is quite revealing. Because if Susan is a perfect example of the nightmare "Googler" patient, then Haig has depicted himself as the perfect example of the "Empowerment-Phobic" doctor. The arrogant, derisive, and dismissive tone of this entire essay -- and his choosing a patient like "Susan" to represent a "Googler" -- is, sadly, illustrative of the destructive way some doctors actually view their patients.

Susan would be annoying to most doctors, but Haig chose to highlight her for a reason. He wants to make a case that "Googlers" are irritating. Haig, like many doctors, is making it clear that he doesn't want Googlers -- and not just talkative ones with misbehaving toddlers. By condemning "Googlers," he made it clear that he's threatened by empowered, educated and assertive patients who do their own research. He can't handle a patient who talks and doesn't just listen. Good patients -- and toddlers -- are seen and not heard, right?

And this is why, in this essay, Haig actually makes the case even more for why we must do our own research -- why every patient needs to be a "Googler."

Why Should You Do Your Own Research?

1. Research is critical in order to find a doctor who is a good fit for you.

It's easy to find a list of doctors who belong to a professional organization, or who are lauded in your local magazine's "Best Doctors" issue. What's not easy is to find a doctor who not only has technical competence and credentials, but the communications and practice style that will best serve you. So ask -- ask other doctors, ask nurses, ask friends and family, ask online support groups and listservs -- and ask about the doctor's style, personality, and attitudes. Read articles the doctor may have written, check out media interviews the doctor has given. If the doctor has a web site, take a look at it. If the doctor is a professor, go look at his or her university web page. Ask other patients. Readers frequently write to me, shocked, after discovering the hard way that some of the most highly credentialed physicians and self-proclaimed experts from academia and medical societies actually have a dreadful bedside manner and deplorable people skills. Don't make the same mistake!

2. Doing your own research may be the only way you get answers.

Haig says: "Every doctor knows patients like this. They're called 'brainsuckers.' By the time they come in, they've visited many other docs already— somehow unable to stick with any of them. They have many complaints, which rarely translate to hard findings on any objective tests."

What Haig calls "brainsuckers," I call empowered, informed -- and often misdiagnosed -- patients. The reality is that many patients do have to visit more than one doctor. Why?

  • Because some doctors rush through appointments, and don't have enough time to do a proper examination and diagnosis
  • Because some doctors lack the skills, knowledge or patience to make a more complicated, subtle diagnosis
  • Because some doctors routinely misdiagnose women's symptoms like fatigue, depression and weight gain as mental health problems, rather than evaluating for other medical conditions
  • Because some doctors -- and especially as we see in the case of thyroid disease -- can't even agree on how to interpret the so-called "objective tests"

3. Doing your own research may be the only way to find out what your doctor isn't telling you.

Doctors can all-too-easily fall into a pattern of providing cookie-cutter diagnosis and treatment. This is very common in thyroid disease, for example, where many doctors follow a formula: "Diagnose using a TSH test, .5 to 5.0 is the normal reference range, give RAI for hyperthyroidism if TSH is below .5, give Synthroid for hypothyroidism if TSH is above 5.0." It doesn't exactly require much advanced education to follow that simplistic view of thyroid diagnosis and treatment, yet this is exactly what you'll get from many "experts." You'll never hear that there is disagreement among endocrinologists about the normal reference range for the TSH test, you'll never hear about the use of supplemental T3 drugs, you may never even know that there is more than one brand of thyroid medication! But if you've done your research, you'll know all this, and much more, and you'll be prepared to find the doctors who can work with you, and answer the questions that will help you achieve greater wellness.

Many doctors are also under the influence of pharmaceutical and medical manufacturers, and tacitly, or unknowingly, edit the information they give you, based on that influence. Only by doing your own research and homework can you find out what the drug companies -- and by association, some doctors -- may not want you to know.

Dr. Haig may not want Googlers for patients. But Haig and doctors like him need to realize that many patients feel equally strongly about not wanting an "Empowerment-Phobic" doctor. Patients are partners -- not subordinates -- in health care, and it's time for some doctors to get their heads out of the sand.

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Comments
November 13, 2007 at 2:34 pm
(1) Linda says:

I have recently been diagnosed with hypothyroidism. I get blood work done every three years for things like diabetes, thyroid, etc. just in case I need to start a battle for survival.

This last time I had the tests run, about three weeks ago, I got the wonderful news about the hypothyroidism! I have gained so much weight over the last couple of years and was so darn tired all the time, I just figured I was getting old and fat. Now I am old, fat and sick since they placed me on Synthroid!

I have done my homework (googler here) and wanted the doctor to consider placing me on the natural medication, Armour, because the side effects from the Synthroid are actually worse than the symptoms I was experiencing before diagnoses.

He has flat refused to even consider it! According to his nurse, he said I would have the same side effects no matter what thyroid med I was on. How narrow minded and ignorant he is!

I am now reading everything written on hypothyroidism and will decide if the medical community is going to be my route to success in beating this, or if my grandmother (Cherokee Indian lady) had the right idea on herbal medication rather than the medical community’s conventional path of ‘a pill a day for the rest of my life’. Now that does not appeal to me at all to be honest. :-)

November 13, 2007 at 8:30 pm
(2) Theresa says:

I read the “Time” article by Dr. Haig and was appalled. I was even more so after clicking on and reading the link under “related items” at the end of the article, called “The Best Patients”. He states that we patients benefit from a one-sided relationship with our doctors, constantly demanding, and taking up the doctors’ time with no regard to his or her feelings. All these doctors do is give, and the patients only take! They give up their youth, their time, and even spend their dream time considering us (selfish) patients. Give me a break! They are handsomely compensated for their time and concern. Even here in Canada, doctors earn a very good living (paid for by our government, no one waits til they are dying to seek care). The prospect of becoming comfortably well off is surely a motivating factor in the career choice of many, whether in medicine or other professions. The least that they can do is to treat their patients, often suffering and scared, with compassion and respect. Without patients, they would have no career at all.

November 13, 2007 at 9:05 pm
(3) leidah says:

I have the idea this doctor does google when he wants to buy his ferrari.
And we are blamed for reading, like in the old days, bookburning days.
But I am lucky, I have a doctor with selfconfidence who is not threatened by other people with some input.

November 16, 2007 at 12:18 pm
(4) Ed Arnold says:

Mary offers 4 reasons why we need to see more than one doctor. Here’s a 5th:

Some doctors are technically incompetent, and some doctors have personality disorders. Why should anyone continue to deal with them?

November 16, 2007 at 3:32 pm
(5) JUDY K. says:

Dr. Haig should find another career. I agree with the comments the people before me made. He is rude. As patients we have to educate ourselves. I live in a large city & I am very ill for the last several yrs. I kept getting mis-diagnosed to not diagnosed.

I have gone all over trying to get help. I started out being very polite & calm but as the yrs. went by, I became sick & tired of hearing, this is all in your mind, this is menopause, this is because you are getting older. Also this is all due to stress, panic attacks etc.

For the 1st few yrs. I heard this garbage. Recently I seen a new cardio Dr. at a well known teaching hospital. He told me that he was 99% sure that I did not have a heart problem. Then he examined me & heard something off with my heart which lead to more tests. Well, they found out something is wrong with a valve. I am waiting to get a 2nd opinion because the 1st cardio Dr. told me it is not a big deal. Keep in mind I can hardly breathe or function now.

My appointment is not till 11-27 & I’m on a waiting list. So, I can see why any patient would get fed up with doctors who don’t really care about their patients + the terrible medical care.

I also tried naturopath’s too & was ripped off buying their products which did no good for me. I am not knocking anyone who had help from that. I’m also not saying that all the doctors are bad. I finally found 2 good doctors in my area. My new family Dr. told me he knows that my symptoms are not in my mind.

Many doctors seem to go into it for the $. Maybe if they did not get paid when they can’t help a patient they would try harder. You would expect your $ back if you bought a computer phone or anything else that did not work for you.

Another thing that throws doctors off is if you look ok & healthy (even though you are not). I had doctors take 1 look at me & tell me there is nothing wrong with me because I don’t look sick. 1 dr. told me I will examine you but I won’t find anything wrong!

So, I still try to be polite but not when this junk is going on!I now get tough when I have to. I do think that if it is possible, to try to leave kids at home with a relative or babysitter. Unless the child is very well behaved. Dr. Haig had a point about Susan’s child acting up in the office. It is also good to have another person come with you for support.

I want to thank everyone for reading this. I appreciate all the comments & posts. It helps alot. But I had to get very aggressive with some doctors. I could tell with many of them they just did not want to be bothered with my complicated medical symptoms. Others ran all kinds of tests found things & tried to treat it. Then when I kept getting worse, told me there was nothing they could do. So, they did not try anymore & dropped me. Or referred me to a psych Dr. Even though I had symptoms they could see on tests & in person.

Dr. Haig uses the word “Bozo” which was a very popular clown in my Chicago area yrs. ago. He had his own show too. Well, Bozo has more compassion & class than Dr. Haig. Dr. Haig & others like him need to take classes in how to treat a patient well, no matter how they are. She was a bit rude but not that bad. I’m sure there are very good, caring doctors out there. But there are also too many un-caring Bozo’s around.

November 16, 2007 at 7:49 pm
(6) Myla Lee says:

I am sympathetic to both sides I guess. I am an attorney and a real estate broker, so I’ve worked in two heavily client intensive fields.

I think the concerns center on money primarily. Nobody enjoys the client who takes up 3 times more than what you allot to other clients. Here’s the problem — in the past smart and motivated clients did research and they were few and far between and their questions really didn’t take that long because they took the time to really understand what they were talking about. But, doctor’s have really been shielded from the semi-educated client — there were a lot of people in the past who just did exactly what their doctor said and that was it because people who didn’t go to medical school weren’t taught much about their bodies. I have an older aunt who will take ANY drug a doctor perscribes to her without question. Most people now go home and “google” that drug at the least.

So, nowadays even intellectually lazy people feel obliged to go to google and type in the word “thyroid” before going to an appointment. Most doctors schedule between 12-15 minutes with each patient in order to be profitable. You will NEVER get a 12-15 minute doctor to appreciate that he has to spend 35 minutes with you — you made him miss his lunch and he’s tired of missing his lunch. Plus, patients do half-hearted research and expect the doctor to fill in the blanks many times when the truth he is not an educator — he’s a 12-15 minute doctor. Do you remember the guy who half way does his homework and then wants you to walk him through the rest?

As a real estate broker, I don’t appreciate people walking into my office or calling me thinking they can buy a foreclosure for $500 because they read it on the internet or heard it from Carlton Sheets. I don’t have time to correct the entire internet and pay my bills every month.

Also, as an attorney you get tired of your clients calling you up with half baked ideas they got from watching “Law & Order,” or “The Firm”

So, part of this is just exposing what people don’t like about their jobs. Everyone in America is being breathed down on about “productivity” and we’re all concerned about paying our bills even if they are inflated.

On a side note, I personally found that when I stopped going to doctors that took insurance the whole situation changed. The doctor I see now loves to chat about what’s on google and the latest theory. I have to tell him I have to go home! He loves when I bring in articles and have new theories. I know everyone can’t pay out of pocket — but I have to give up a few things to go to doctors like him as well — I’m not rich. But it’s been worth it. ($185 for the 1st visit, $85 for follow ups). I changed over to a health care expense account plan to make it easier. It has worked out well, because ALL the doctors I go to that I really like and respect, don’t take insurance anymore. As a wise man once said, you can’t get a Cadillac at Chevy prices!

Doctors are not bad greedy people — they’re like everyone else — no business person likes the customer who pays the same as everyone else and expects more. And unfornately, we have decided that in our country health care will be run like a busines. Now I don’t think you’re wrong for wanting, expecting, and demanding more — but I also think that people should do their part too — make sure you really know what you’re talking about, read the entire article, look up the terms used in it, if necessary take a class and/or talk to some people who wouldn’t mind talking to you for free like in online communities.

Just some thoughts.

November 17, 2007 at 1:22 pm
(7) Denise R says:

I am a “brainsucker” according to this dr. I have been to many drs over the past almost 20 years, trying to get diagnosed with the hypothyroidism I know I have (& which has been confirmed over & over in my reading). I have been told many times that my symptoms don’t add up to anything–yet, God Bless you Mary–I have found them in your books & your newsletters. (This even came, by the way from an endo who prides herself on specializing in thyroid & not diabetes as apparently many do) The last dr. found me so threatening, he turned me over to the nutritionist in his office who told me I should become a vegan & eat as much soy as possible, tried to get me to say my symptoms were the result of a bad marriage (untrue) & said “you have too many problems (read “symptoms”) YOu can’t tell a dr. about all these because if you do, he will just pass you along.” That is when I left & gave up on looking for another dr. for a while. Can you imagine–he actually told me I was wrong to even talk about my symptoms!

November 17, 2007 at 1:47 pm
(8) luckitri says:

Ha Ha! Finally someone is addressing this issue. I have said for years that doctors have such a severe case of the us vs. them added to their arrogance that I am sure that any other individual demonstrating the collective behaviors common to most doctors – that individual would be diagnosed with a severe and disabling personality disorder.

Thank you for giving me the opportunity to say it.

Alot of staff working with doctors get a similar attitude problem and take liberties that are prosecutable however their advantage is that most of us are too sick to follow up on it.

November 19, 2007 at 12:09 pm
(9) mr Nybel says:

What a shame. What a knee-jerk shame on you Mary Shomon. If all our “educated, empowered, assertive” citizens get their diplomas at the University of Google in 3 hours and 45 minutes of intensive study we would be in a terrible mess.

If you would work with your readers, who apparently need and want your advice, you would strongly remind them that their physician probably DOES know more than they do in their field of study.

No, that does not mean the patient should knuckle under or become a sheep. It does mean that some respect and consideration is in order, After all, that’s what the patient wants from the doctor.

The complaint of so many of your readers seems to be that the MD acts like he has all the info – but then these same readers act like they are the ones who have the info and want to prescribe their own course of treatment.

If they want respect they should show respect. The golden rule still rules.

November 19, 2007 at 1:10 pm
(10) joe says:

Hi. Many of the comments Mary Shomon made might change if she consulted with some other physicians about this matter.

The general public doesn’t really know what it’s like to carry malpractice insurance, and the burden that comes from knowing making one little mistake can have profound consequences. For a good doctor, the worry whether s/he got the right answer is never ending. Only a handful of other professionals carry that degree of responsibility.

Today, the many patients enter a physician’s office with the same manner they might use at a McDonald drive through. Knowing how to communicate with a doctor isn’t hard; it’s like with any other highly trained professional: trust, respect, benefit of the doubt, politeness, until proven otherwise. There isn’t any indication that “Susan” displayed these behaviors. Google a doctor all you want, and understand that someone, someday may do the same to you.

November 19, 2007 at 1:23 pm
(11) Mary Shomon / Thyroid Guide says:

I definitely don’t agree with Mr. Nybel and Joe (#9 and #10). Nowhere am I suggesting that patients should take what they get in terms of research and attempt to be their own doctors. But being informed, and knowing what questions to ask, is critical when dealing with many doctors and HMOs these days. I have said clearly that Dr. Haig’s patient “Susan” is a terribly irritating person. Even without her Googling, most doctors would probably send her on her way. But Dr. Haig’s subtext, in choosing such an annoying person as his “Googler” is clear.

And respect works both ways. If doctors want patients’ respect, publishing articles in which they call them “brainsuckers” is probably not going to further the cause.

As for talking to other physicians, I have. And most are perfectly comfortable with patients who do their own research. Of course they don’t want neurotic nonstop talking “Susan” and her screaming toddler. But partnering with a courteous, informed patient — it’s not a threat, not a problem, unless you have something to hide.

November 19, 2007 at 1:27 pm
(12) DenD says:

Hooray for Joe. There is nothing wrong with being informed and having valid questions for the doctor. However, some patients take it way too far. The patient Susan sounds more arrogant than informed in my opinion.

If you think you know more than the doc, then why bother going for their opinion? Also, just because you read something on google does not make one informed, even if the article is valid it does not mean it will apply to your situation.

November 19, 2007 at 2:04 pm
(13) Nor says:

The problem is that Medical Science is not exact. You have to be your own advacate. I was having issues about a year ago. When I described my symptoms the Dr’s said that they didn’t reflect anything. I was getting chast pains in my upper back that started around my waist and moved up dead center. I was also getting back muscle aches and a knawing feeling and stomach tighening across my belly. I proposed that the Lipitor and maybe my gallbladder were causing my issues. They had ruled out my heart since I had had a couple of stents put in a few years back. Fianlly after suffering for six months I insisted that they do tests. Doctor’s follow the book and they were correct my pains did not fit the normal symptoms. Well my stomach turned out to be inflamed from possibly the Lipitor and Aspirin I was taking. The Lipitor was seemingly causing the muscle aches I was getting. Plus they also found gall stones. Once they took out my gall bladder and put me on different medications I slowly got better.

November 19, 2007 at 4:02 pm
(14) David says:

I have to second Mr Nybel’s comments. The doctor patient relationship is a two way street – that means each party respects and listens to the other.

It is true that a good doctor will hear out your concerns and work with you to tailor a treatment regimen best suited to your condition and illness. But even good doctors have limits that extreme patients can test.

I don’t think Dr. Haig was using hyperbole when he mentioned that Susan had three previous orthopedists, and it shouldn’t go un-noticed that Susan had, before even meeting with Dr. Haig, already scheduled an appointment with a 5th orthopedist. Without knowing a lot more about her medical condition and psychosocial environment, I won’t gander whether or not she is justified in her actions, but it does seem an unusual course to take.

In your (Ms. Shomon) defense, I don’t agree with Dr Haig’s method of “punting”, at least as he describes it. He should have been 100% honest with her. “Susan, with my previous patients who presented with your symptoms, this was the course of action that worked best overall. It was not an easy course, and not everyone benefited from it to the same degree. How do you feel about that?”

My guess is if Susan is the person Dr. Haig caricatured, she would move right on to the next appointment, and Dr. Haig would have done his job without “punting”.

It is important to remember that your doctor is your advocate for improved health. While they can’t possibly know your exact condition, they have seen many patients with similar conditions, and have trained for years to develop an understanding of the treatment options. Patients always bring something new to the table in terms of ideas, circumstances, or constraints, so you work to accommodate those. However, you don’t reinvent insulin each time a diabetic comes through the door. The practice and history of medicine has taught doctors one or two things about beneficial treatments – and patients need to consider that.

As Dr. Haig mentioned, “[a] major responsibility of an expert is to know what information to ignore”, and sometimes, the best information to ignore is that which was gathered from websites intended for generic consumer education and is only peripherally relevant to the “googler”.

And by the way – Unless invited, a patient has no business snooping around in their doctors’ private lives. Physicians only ask relevant questions of you. Respect them similarly. Their home/hobbies/religion/marital status/etc are not relevant to your quality of care, so when you are googling, stop at their professional career. If they’ve done something morally or legally questionable, the licensing board will let you know if they are fit to continue as a physician.

November 19, 2007 at 4:53 pm
(15) JUDY K. says:

I want to thank Mary for her very good comments. The respect factor goes both ways. Some doctors are not that good & some of them are greedy. I’m not saying that all patients are perfect either. but obviously there is a big problem with many doctor’s & bad medical care.

Not all of us can pay out of our pocket. Especially if a person is disabled, on a fixed income & not able to earn more $. I not in any way bragging or telling anyone that I am above them. But I did have medical classes & so did my adult daughter. So, many times we both know what we are talking about.

Real estate & health are 2 different things. Also as for patients paying the same & expecting more. When you have a illness instead of just going for the routine checkups there is a difference in what it cost the ins. & the patient.

There are always 2 sides of the story & the truth. I really disagree with the people who seem to side with Dr. Haig & others like him. I have a new family Dr. who takes alot of time with me & all of his patient’s. He is never in a big hurry. Yes, he does take ins. I just want to thank Mary S. again for not backing down on these issues. She really tells it like it is.

Even though I dont’ agree with some of the comments, I do appreciate all the different opinions about it. I hope that everyone has a nice Thanksgiving too! Best wishes to all. Judy K.

November 19, 2007 at 6:03 pm
(16) David says:

Just some comments on income and motivation for becoming a doctor. Money isn’t a motivation anymore.

In primary care, a return visit of 15 minutes is worth about $59 to the practice (per medicare rates for a 99213 code). The doctor has to spend a few minutes outside of the room documenting, reviewing, writing scripts, etc. Say the whole visit is 20 minutes. We’ll assume he or she never takes a bathroom break, answers a phone call, or calls for consults. in 52 weeks (no vacation) of 40 patient hours, that is $374,400.

Out of that the doctor pays for nursing/clerical/billing staff, malpractice insurance, facilities, and equipment. I’ll lump those together and fo a WAG of $175k (likely low). This leaves $200k pretax for the doctor. For those keeping track, that is $96/hour gross (52*40=2080 hours). If you go down to your local Ford dealership, you’ll see that is just a little more than you pay for your auto mechanic services ($85/hour).

Mind you, 40 hours a week of patients is not 40 hours a week of work. Figure more like 60 hours a week, bringing the hourly rate down to $64/hour (less than the average unionized autoworker makes in salary +benefits according to all the recent news). At $200k, the doc is definitely in the top federal tax bracket (39.6%), plus whatever local/state taxes, self employment tax, medicare, health insurance… Let’s call it 50% for for easy calculations. So the doctor takes home $100k for 3120 hours of work with no vacation or holidays. Now, the doc has to pay for a home, family, transportation, etc…

Everybody has those, so cry me a river, right? Except everybody doesn’t have student loans in the amount of $250k (tuition +living expenses for four years + accumulated interest while in residency). Government loans are between 6.8 and 8.5%, meaning for 20 year payback, you’re talking about an additional $2100/mo. And the doctor still hasn’t put anything away for retirement.

So, after all is said and done, the doctor is taking home $12 each time he or she spends 15 minutes with you.

Do you still think they are in it for the money?

November 19, 2007 at 7:29 pm
(17) Theresa says:

In response to David, here in Canada doctor’s book several patients at once and spend their time hopping from one room to another, barely stopping to greet the patient. The more claims that they can send through Medicare per hour, the more they make. Here, doctors get vacations, signing incentives, and drive very nice cars. Perhaps some of those poverty-stricken US doctors should move to Canada where, due to government funded health care, they are guaranteed to be paid for each appointment. The main point, which you missed, was that they chose this career, and should realize that, while some patients are difficult, even obnoxious, it is wrong to paint them all with the same brush. If a patient has tried a course of treatment without satisfactory results, and comes to him/her with information regarding an alternate treatment which may be beneficial, the doctor should at least look into it. If there is sound medical research contraindicating the treatment, it should be explained in a respectful manner, rather than in one which belittles the patient. Once in a while, the patient just may have a bit of information that the doctor did not learn in his/her medical training. No one doctor can keep up with every new development, and sometimes old-time remedies fall out of favour because something “new” and “more scientific” comes along (remember when mothers were told formula was better than breast milk for their infants? A whole generation of children grew up without the benefits of their mothers’ immunities and close mother-child bond.) Of course, so much of what our health care professionals learn is influenced by big money pharmaceutical companies (my daughter is a pharmacist, so I know this to be true) who use their clout to influence the course materials in our universities. And the influence of these companies on our doctors is an issue of growing public concern. So, I stand by my belief that doctors do not have the right to malign all patients who take the time to understand their health issues and try to enhance their quality and quantity of life. If medicine is such a tough job, they should go to community college and become mechanics, or plumbers. By the way, I have the greatest respect for those in the profession who take their awesome responsibility seriously (my husband suffered a life-threatening traumatic brain injury a few years ago, and the neurosurgeon who saved his life in several extremely diffucult operations was the most humble human being I have ever encountered; he refused to take credit for my husband’s amazing recovery, and treated my husband and our whole family with the utmost respect, care and compassion). I have never googled a doctor, only medical conditions and possible treatments. Respect is a two way street.

November 19, 2007 at 10:21 pm
(18) David says:

Theresa-

I hear you, and I understand your comments, and I fully agree. Each patient is a unique person, with unique expectations about their illness, treatment, and outcome. If a patient has unsatisfactory results, the problem isn’t solved, and doctor and patient work together to come up with a new solution.

See post #14, my comment, “Patients always bring something new to the table in terms of ideas, circumstances, or constraints, so you work to accommodate those”.

I could have made my sentiments clearer with the following modification, “…so you work together to accommodate those”.

I see the doctor patient relationship as a collaborative effort, and I think that view is being taught much more broadly now than ever before (at least in the US medical education system).

Even some old fuddy-duddy docs are learning. My grandmother was diagnosed with stage IV lung cancer. The doc wanted to do chemo immediately, but she wanted to try a homeopathic remedy. He researched the regimen, advised us of the potential risks and benefits associated with each therapy, and we decided on a one month course of alternative therapy. He asked that if there was no improvement at that the end of a month, we consider a more conventional therapy.

Unfortunately, there was no improvement during the month, and my grandma chose hospice over chemo, and died shortly thereafter.

Ultimately, I think we’re all circling the same point – mutual respect. What I see in the original article are elements of disrespect on the part of both participants – doctor and patient. When two people share responsibility for a situation, I don’t think it fair for one to shoulder the blame (even if he does come across as a jerk), and I wanted to share that opinion.

(incidentally, in the US if you double book and spend less than the 15 minutes with the patient yet still bill for it, it can be considered medicare fraud, which if convicted of, can result in a docs exclusion from all federally funded programs. There are similar billing codes for shorter visits with correspondingly lower reimbursements.)

November 20, 2007 at 9:50 am
(19) Kathleen says:

I’m not a doctor, I am an engineer and I couldn’t agree more heartily with the doctor’s essay. I’ve had more clients -so called “designers” and “inventors”- who couldn’t design a paper bag trying to tell me how to manufacture it. I usually dump them too. They end up with other service providers who live off them as a source of revenue -and mirth.

November 20, 2007 at 1:15 pm
(20) Erin says:

TIME magazine should promptly remove Dr. Haig from their staff.

November 20, 2007 at 8:27 pm
(21) David#2 says:

I should note that I’m a different David from the one that posted before post 21). I am currently a medical student. This is in regard to money. We are absolutely not in this for the money. You probably don’t believe me, but consider this:

1. We pay huge tuition, work all the time, don’t make enough during residency to even pay the interest on our loans, and then, at the age of 30-40, begin making money. For a student that goes into primary care and has $200,000 in debt at graduation, they will not break even until the age of 45! (on average). This is obviously different for more lucrative fields like surgery, or students that get family help paying tuition.

2. (more convincing argument) Any student who could make it into medical school, passed up much more lucrative options in order to become a doctor. Right now, about half of my friends are in medical school and the other half are making tons of money working at investment banks, hedge funds, or consulting firms. They don’t know what to do with all of their money (but do find clever ways to spend some of it). We med students passed up the road to huge monetary rewards and instead are buried in debt. Sometimes we complain about it, but in the end we all stay in school, go on to residencies, and become doctors because we want to help patients and can’t see ourselves doing anything else.

Now, there are always exceptions. And some people get disgruntled and lose that idealism and determination that drives us students. However, please stop saying that all or even most doctors are greedy and are in it for the money.

November 23, 2007 at 6:53 am
(22) nursepatient says:

Thank you SO much for this article. I am a nurse AND a patient so I’ve been on both sides of health care and have seen and experienced horrible treatment of patients. The worst experience I personally had was with an endocrinologist who is “renowned” in his field. After introducing himself the very first thing he said to me was an accusation that I didn’t want to follow my eye surgeon’s treatment. I don’t know where he got that info but it wasn’t true. If it were he should have used a different approach with respect and asked, not accused. He proceeded to ask me many questions and then interrupted my answers before I was done. One time he even answered for me and I had to correct him because he answered wrongly. One time I said, “Can I say something without you interrupting? I don’t mean to sound rude.” Then he listened for that moment while I spoke. I often felt demeaned by him and completely disrespected. And yes he knew I was a nurse. I’m glad I never had to see him again. If I had to remain in that office I would refuse to see him except for emergencies. Needless to say I was very angry and am going to write them a letter now that most of my anger is cooled off to a calm level. Part of my definition of health care is seeing each patient as a person that happens to have a disease seeking help and healing and sympathy. Health care is NOT a slave underneath a dictator. A relationship between a patient and any health care worker is a collaberation, not a mindless dictatorship. From a nursing perspective I know firsthand that doctors (and nurses) DO make mistakes. Asking respectful questions is normal and should be done for the benefit of the patient’s greatest health. It’s not meant to undermine or threaten the doctor (or nurse) but to have peace of mind and to be informed and take active part in the treatment being done to YOUR body. Thank you so much for understanding and agreeing. I sometimes even as a nurse feel alone as a patient seeing doctors. My current endocrinologist isn’t a believer in nutrition affecting the thyroid so I’m not sure what to do. It’s a pain to switch doctors so I think I’ll stay with him. It’s so hard to know what to do sometimes. As a nurse I welcome questions from patients because they have a right to know everything going on with their bodies (there are exceptions of course). Again I appreciate the encouragement of this article.

November 23, 2007 at 6:56 am
(23) nursepatient says:

FYI, I have Graves’ disease and severe exothalmos/thyroid eye disease. My thyroid levels are normal but the bulging keeps getting worse so the rude endo is wanting me to get a thyroidectomy. That is sounding like the only thing that will stop the bulging if the meds aren’t.

November 30, 2007 at 12:56 am
(24) Hitoshi says:

I am a thyroid specialist working in Japan and I could not help adding to this disscussion. Particularly for the benefit of nursepatient above.
To the best of my knowledge, there is no definate data suggesting that thyroidectomy will help your bulging eyes. Out of experience, I do feel that thyroidectomized patients tend to do better when given the same steroid treatment. But I believe that thyroidectomy alone is not a decisive factor per se. You may need eye surgery (popular with US doctors), steroid pulse therapy (not popular with US doctors), or external beam radiation (which most US doctors seem to deem as heresy) but thyroidectomy will only be a supportive therapy at best.

To David#1 and David#2, thanks for telling the truth. If it makes you feel any better, doctors here in Japan make a lot less in a country where most other things are more expensive. My cousin is a heart surgeon who performs over 200 heart surgeries a year and barely makes $100 thousand US before tax. Nice place to be a patient? I just finished seeing 30+ patients this morning in a span of 3 hours. That’s because a single patient will gross a lot less for the hospital than in the US. (About $2 for the interview. Total gross sale average of $50 including tests and medicines.) I try to be patient when a toddler starts tearing up the place.

Investment bankers in Tokyo make just as much as investment bankers in Wall Street. The result is that we are seeing an increasingly critical shortage of doctors in Japan, but the government, which runs the healthcare system, has no intension of alienating voters by raising the public insurance fee or the imbursements to the doctors. (The top bracket public health insurance fee in Japan is 600,000yen per year, roughly $5500US. It covers 70% of all healthcare costs. You pay the rest from your pocket or private health insurance.) Something to think about before you support the idea of universal healthcare.

As for Petit Papier Patients, I believe they are only a problem when they cling to the wrong information and insist that they’ve got it right. You should be a Googler. Get all the information you can and ask questions. But, by all means, keep an open mind. What you read on the internet may not be correct or apply to your specific condition. Do not ignore the doctor’s orders just because some published article told you to. It’s your health and the doctor is there to help you!

December 5, 2007 at 9:59 am
(25) L says:

Seems like there are a lot of INSECURE docs out there…grow up!
The question was asked why go to the doctor if you don’t want his advice? Because they are SUPPOSE to know more than the patient through their training and experience, because the insurance companies demand it in order to get prescriptions.
I, for one, had to bring the information to my doc on the best approach to switching from Levoxyl to Armour.
I have had THREE physicians want to switch me off the Armour to Synthroid or back to Levoxyl…ain’t gonna happen in my lifetime.
I have yet to meet a great, caring, kind, compassionate, want to get to the bottom of it physician and I too have repeated incorrect diagnosis’
Perhaps the physicians need to start using Google.
BTW, I am a nurse and frequently find the vast majority of docs want to prescribe another drug and shove you out the door.
Don’t believe me? Look at the sheer number of medications that any inpatient is taking…this should not be!

December 5, 2007 at 1:37 pm
(26) Jo says:

If it wasn’t for this site, I wouldn’t be on Armour, and I wouldn’t have had the knowledge to keep on until I found a doctor to treat me. My current doctor loves that I come in with information, like when I requested Lantus (insulin) to help control my diabetes. I had read their website and other users’ thoughts on it (diabtes.about.com) and came to the conclusion it would work for me. BUT – I asked him for it and told him why I felt that way after reading up on it. He agreed. He likes that I research and then “ask” him about what I’ve learned. If doctors cannot deal with the new way of patients helping themselves, maybe they need to be vets where their patients don’t talk back.

December 12, 2007 at 8:00 am
(27) stephanie King says:

How come the post I made recently was not posted?? Did anyone actually READ the article…it did NOT say don’t do homework. It said, a little knowledge does not an expert make…and patients need to understand that they do not always know everything. In addition, a thyroid issue/problem is VERY different to treat than most routine orthopaedic problems. Issues with the bones/joints are more visible and treatable than body issues that deal with how a patient ‘feels’. I too have been to uncaring docs, but in this case, the Dr is caring, he just wants patients to be working WITH, not against the doctor.

December 16, 2007 at 12:35 pm
(28) emd says:

Just remember that when a patient seeks consultation and treatment from a doctor, that is considered a contract.

Most doctors will entertain treatment options IF they are within the standard of care. In other words, if the treatment option is considered valid and effective by most doctors in the field.

If the treatment option proposed by the patient is outside the standard of care, and the doctor agrees to that treatment option, that doctor is breaking the contract. This is not only in the legal sense, but in the professional Hippocratic sense as well.

That is why as a patient you should be informed, but also be rest assured that your doctor is doing right by you. He or she is invested in you- personally, professionally, and (sad to say) legally.

February 5, 2008 at 1:42 pm
(29) Steve says:

I’d encourage those who have not read any other articles by Dr. Haig to read one entitled My Patients Are Not Customers. It might help you to understand where he’s coming from.

December 5, 2008 at 2:56 pm
(30) Tammy says:

Perfect! I have felt this for quite some time about this profession. I have had an excellent Dr. and many “not so cooperative” Drs. The cookie cutter syndrome is what I see the most of, when you question any they say than you become misinformed. The other challenge I find is that before you even talk to them they have a listed of blood tests to take, never get back to you with the results or won’t tell you the results without making another appointment even if everything is clear.

We need more Drs. who are open minded to what is going and not just stagnant in their approach or understanding of what’s new. Now they need to keep ahead of their patients who have a personal interest in keeping ahead of the game about their illness.

January 2, 2009 at 4:31 pm
(31) Rhonda Lea Kirk Fries says:

Unfortunately, some patients had difficulty distinguishing good science from anecdotal evidence. For example, a thyroid website is now telling us that if Armour Thyroid is taken sublingually, iron may be taken without any delay. (I have looked without any success for evidence that Armour can be absorbed sublingually.) Misinformation is dangerous, and while Google can be very helpful, it has no way to distinguish between good information and bad.

April 8, 2009 at 12:18 pm
(32) Bill says:

Countries in Europe has been using EMR for over a decade. It is completely past due in the USA. Time Magazine unfortunately published this one persons point of view which is obviously in the small minority. Too bad the American people keep watching “American Idol” (also taken from Europe, proving how far behind American’s are) than paying attention to needed concerns with healthcare. EMR is needed now!

October 24, 2009 at 10:35 pm
(33) wright says:

Dr. Haig is a cry baby. He has no respect for physician assistants or patients. But hey, look who he writes for: Time Magazine!

September 13, 2010 at 11:05 am
(34) Sue Z says:

Thank you for for sharing this. I am a “Googler” and I am proud! Just this morning I was telling someone at my doctors
office how I was not happy with the last two orthopedic doctors I went to in reference to a shoulder issue I am having.

The Dr. she told me about that her husband loved was Dr. Haig. Perhaps even if he is a talented surgeon he has revealed himself as a very inpatient intolerant, arrogant doctor who does not like to be questioned.

At this time I am NOT looking to have surgery anyway. I am also not looking to have cortisone shots . Both doctors I have been to keep pushing the injections and I have learned that in most cases my condition can and will get better with physical therapy.

When I asked one of the doctors why he ruled something out and how he knew for sure its not that..he said “because i just know”.

Thanks again for pointing out how necessary it is for patients
to NOT let there doctors bully them into feeling like they do not have choices. I am noticing more and more impatience
coming from doctors when I question them. I understand that not all information we find of the web is correct and can be interpreted, however there are plenty of reliable sources
out there, a good Doctor should be confident in themselves and not feel threatened by patients who like to learn about there own body and what might be going on.

December 14, 2010 at 9:14 pm
(35) angry emma says:

Wow. I, too, am a “googler.” At least it helps to know that I’m not alone.

And I also know this: if i weren’t a “googler,” I’d probably be dead within the next few years of a perfectly treatable heart condition.

After several atypical sudden-onset “seizures,” I consulted a host of “experts,” many of whom were all-to-happy to pigeonhole me into their relevant specialty and send me home with heavy medications. The neurologist said I had epilepsy. The cardiologist said I had neurally mediated syncope (and, I might add, that I “spent too much time on the internet.”) But after hours of tireless research (of legitimate medical publications, especially academic articles on PubMed), I was pretty sure I had a deadly heart condition called LQTS. And I had relevant, cogent, and rational reasons for believing so, though none of the arrogant “specialists” were the least bit interested in taking the time to find out what those were. They were instead inclined to form opinions of me based on my tendency to do my own research and on my lack of a medical degree.

As an informed, confident, intelligent woman who has an IQ in the triple digits and is perfectly capable of understanding how the body works in relation to my own symptoms, I continued to push for a proper diagnosis. And refused to be pigeonholed by the numerous “educated” specialists who only wanted to dismiss my experiences and send me home…

And guess what? Last month I had a sudden cardiac arrest and was able to document my near-death experience. And now I have a lovely Implantable Cardioverter Defibrillator to keep my heart in check, and a diagnosis my doctors have been dismissing for years: LQTS.

But if I hadn’t pushed? If I had just rolled over and let these “specialists” browbeat me into silent submission? I’d probably be one of those people who dropped dead without recourse or help.

So, hey, arrogant doctors, I can feel your pain in putting up with misinformed, annoying, or aggressive patients. Yeah, it sucks. But take a few deep breaths and jump out of your paternalism for a moment to talk to the patient and ask them WHY they have the beliefs that they do. And take the TIME to explain your own reasoning. And drop your ARROGANCE long enough to consider that your medical degree does not make you omniscient any more than a LACK of a medical degree makes me stupid.

Sometimes being right is no consolation. But you better believe that I called all of my dismissive doctors and played the “I told you so” game. They are lucky that’s ALL I did.

If you can’t handle informed patients, then perhaps you should get out of healthcare. Don’t you dare take your frustrations out on me and my body. Too many of your peers have shown me time and again that doctors are not infallible. And I almost died as a result of DOCTORS’ negligence.

December 14, 2010 at 10:13 pm
(36) angry emma says:

PS

I now have several very lovely doctors whom I trust wholeheartedly.

January 7, 2011 at 2:16 pm
(37) Mary says:

You may have watched Dr Oz when the woman was on whose mother had several heart attacks that were misdiagnosed. As I recall, she was either told she had stomach or mental problems.

The symptoms of heart attack in women can be very different than for men. Information given thanks to physicians on Google!!!

Autopsy was what it took to find out she had several heart attacks that were never correctly diagnosed and may very well be why she is now dead.

So in spite of your education and training, doctor, you don’t have ALL the answers, whether a person is a googler or not.

Many physicians know little or nothing about which supplements can help various symptoms.

And I also think they put down patients complaints of drug reactions when those same reactions are clearly listed by the drug manufacturer.

Why? Maybe the physician does not want to find out that what was ordered is harming rather than helping.

We do need to be knowledgeable healthcare participants today since so many of the drugs being approved have MAJOR side effects, including increased heart disease that may not show up for a few months or even years.

March 3, 2012 at 2:59 pm
(38) Sean says:

emd (28) brings up and important point which few Googlers comphrehend and that is the legal implications as to the Standard of Care (SoC). Most information obtained from Google is just that, information. It is not necessarily knowledge.

Doctors are required to make medical decisions on the best knowledge available (generally through scientific journals) not because they aren’t willing to listen to new ideas, but because if they did and something goes wrong, any lawyer would have a free-lunch in a case based on decision making based on ideas obtained from Googling. It would be a break in the Standard of Care, one of the most basic theories to initiate a lawsuit (and win).

A Doctor stating: “my patient brought me in this article from Google, so we tried this treatment or that treatment” is not going to be defense in the courtroom, and he or she will certainly be laughed out of court.

yes, we all need to be informed, but Google is not a reliable source of knowledge. At a minimum, all Googlers out there should be highly familar with using and understanding Google Scholar as a more reliable source to get to knowledge.

October 14, 2012 at 2:12 am
(39) luckitri says:

Statistics tell us that the percentage of US population becoming “mentally ill” is growing at fantastic pace. The truth of the matter is that scientific inquiring minds no longer function in the medical profession and there is no mandate insisting that all possible physical problems be ruled out before appending the “mental ill” status to a patient. Even when all possible physical causes are ruled out the patient could still be suffering something as yet unknown – NOT mental illness. But the bean counters need a proper name and if the patient is too ill to work and the doctors have no Dx, then mentally ill it is if the patient wishes to keep any form of financial sustenance. Then of course once the “mental ill” nomenclature is attached to the patient’s file even easily measured physical phenomenon become “mental” vs real physical and go untreated. Many people take good money along this path – resulting in extreme disser

November 11, 2012 at 11:15 am
(40) Lil says:

Oh gosh! You can’t use google for your information and expect your doctor to be happy about it!!! How would you feel if your doctor studied their medical degree using google and then used that info to diagnose and treat you? That would be irresponsible and as a medical student I can assure that they don’t do that!

By all means be informed, subscribe to medical journals and read peer reviewed literature, read textbooks recommended by your doctors. Take a class in biostatistics that teaches you how to read medical meta analysis. Pay the $450 subscription fee to up-to-date like your doctor does, they have amazing articles at basic levels and replicate ones that repeat the same info in more depth. Read the same info your Doc does and then discuss it with them, I honestly think they would appreciate that!

I don’t think the problem so much is with patients seeking info and being informed more with what methods they are using to find this info. If you were truly concerned with your healthcare and wanted more info you would surely use the legit sources!

I absolutely advocate being an informed, information seeking patient but spending a few hours googling on the next is nothing close to being informed!

March 30, 2013 at 8:07 am
(41) kitty says:

My educational and work background that has included empirical research and publishing in peer reviewed journal is dismissed by doctors. Accessing PubMed via Google is denigrated to ‘don’t believe everything you read on the internet.’ How about some of you doctors start accessing PubMed via Google so you can keep up to date on what standards of care could be considered ‘current.’ Ignorance is not a defense when it comes to medical negligence/malpractice.

November 9, 2013 at 8:11 am
(42) marya says:

I work with medical journals and clinical trials in my profession, and I’ve done it for 30 years. Doctors still patronize me. They seem to actually “run scared” over patients having information that might, just might, prove they don’t know as much as they want us to think they do. And here’s the thing. Long before a given condition or causal relationship was the subject of some study or trial, and tested, retested and (a)greed upon by people with advanced degrees and funding/sponsorship, it still existed.Sure, if there’s no backup in the literature, it seems like a crap shoot whether your hunch is correct or not, but finding doctors who will actually work with you and walk through the diagnosis tree decision-making procedure to explore options WITH the understanding that you are already prepared for this…why does this have to be so difficult? Doctors who will also admit that a given fact “may be true and worth exploring if you’re desperate to get an answer within your means even though it has not been “proven” or allowed by 75% of peer reviews” are rare. Note too that with the crazy costs and red tape associated with going to the doctor (and in socialist medicine countries, the need to persuade the doctor that you are worth spending public money on because your condition is more serious than he thinks and you are still contributing to society, after all, not ready to fade out) people often actually avoid doctors because they don’t think they can afford it or can’t deal with the hassle of trying to get simple good medical care, and try to cut to the chase by saying “Doc I am sure it is not X or Y, could we just check out Z please?”. Moreover, having done medical transcription as well, and having worked on medical claims and lawsuits – guess what, doctors are fallible. They make mistakes in diagnosing and they make mistakes in recordkeeping. They make mistakes ALL. THE. TIME. This arrogance is entirely misplaced.

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