> And to disregard their previous experience with high-functioning alcoholics who deny everything when they mess up. I’d bet there’s a lot more hidden day-drinkers out there than patients like this.

I'd rather them disregard their bias than disregard their patients. If someone insists they don't drink when challenged with the BAC data (especially with corroboration like in this case), do a test to determine if they're lying or not. Don't just assume they're lying.

But doctors often are arrogant and unwilling to admit error, even to other doctors. The best you can sometimes do in those situations is to get bossy and try to take control of the situation (e.g. I know you're assuming I'm a lying alcoholic, but I don't drink, so explain to me how I could be intoxicated without drinking...), but not everyone has the confidence to do that.

When I was extremely sick, I was super frustrated with the 15 Minute Appointment. It was more infuriating than the things that inspired me to bitterly joke "They majored in medicine and minored in hubris and contempt."

Some of my big breakthroughs came in ER visits where they are a little more focused on problem solving and less on getting you out the door in time to keep to schedule. It doesn't live up to the fiction of House but sometimes if I had good rapport with an ER doctor, they took a few minutes to think about how best to keep me out of their ER in the future.

This sometimes got me what a relative called "real drugs instead of tea and sympathy."

We have a broken system. I don't know how to fix it but some of the criticisms of specific people in the broken system implicitly assume "These people are the problem!" And that doesn't really fit my firsthand experience.

> little more focused on problem solving

I actually had a great ER experience along these lines. I felt bad being there after it became clear that I was going to be fine while there was a lady wailing in pain about 10 feet away, but at least I left with a lot of things to discuss with my regular doctor and I at least knew when I should/shouldn't worry in future situations.

In my second paragraph I pointed out that this probably isn’t bias, this is Occam’s Razor. If the razor cuts against you, it’s your problem as a patient to fight back.

Is that fair? No. Does a medical professional have an obligation to take a patient seriously? Yes. But I bet busy physicians have an hard time avoiding being biased by direct experience with unreliable patients: drug seekers, people with mental health issues, people who want the drug they saw on Fox News ads, etc.

Yes. High functioning alcoholics are not checking themselves into the emergency room 9 times over a year.

Should doctors never trust their patients?

What's the threshold for where doctors should begin to believe their patients' claims, as opposed to simply assuming they're merely some drug addict seeking another hit or someone lazy seeking time off work?

I'm someone who's specifically had GI doctors ignore what I say so intensely as for this conversation to have seriously taken place:

Me: "The [medication] might have worked, I feel slightly better, but it was way too strong. I had nearly all the major side effects that the instructions said to contact you if I get them. Is there any smaller dose, or could I try out something else?"

GI Specialist: "Ok, so would you like me to increase the dose? I can prescribe [double]."

Edit: meant to conclude that I think it's not just excessive distrust, and that it'd be absurd and cruel to just always distrust patients completely -- that doctors definitely seem to ignore patients heavily, especially if they're in any way abnormal.

Doctors are human. how did the rest of conversation go? did you explain that they misunderstood what you said?

Also, Did you consider just taking half the dose?

They can't be human too and make oopsie whoopsies with no repercussions while demanding unlimited deference from society.

What is this "unlimited deference" you speak of?

I dont think doctors should be elevated to some super-human status. They are human. Many of them do a tricky and socially useful job, but there is nothing magic about it or them.

The rest of the conversation was mostly uneventful, I did explain it but got told that it was the smallest dosage available. As for the doctor personally he mostly just acted like it was a misunderstanding and not actively not paying attention to what I was clearly saying, but I'd have to say that's a pretty incredible lack of listening/language comprehension for a native english speaker with a college degree. I sure didn't trust that doctor ever again to be paying attention or properly respond to my symptoms if he could hear the exact opposite of what I said.

And as for dose, it was a medication measured in micrograms -- I'd have to be able to carefully measure microgram amounts and put them back into new capsules, it wasn't very realistic. I wound up finding alternatives on my own.

As an aside, I actually have FAR worse stories of GI doctors being incompetent and careless, that one just seemed the most relevant to the topic there.

One other funny one seriously went like:

GI Specialist Dr., "No, you can't really be feeling pain there, the intestines don't have any nerves"

Me, "So why did you say I needed to be sedated for my colonoscopy because it would be too painful otherwise?"

Dr, [angry response about if I want to just argue or let him do his job]

If you can't tell, I soon switched doctors after. But overall that sort of encounter, or things like even violating their own medical association's recommendations such as with prescribing PPIs and Antibiotics simultaneously to a patient already at higher risk of c. Difficile or more than one doctor not being aware of which painkillers are NSAIDs (Yes, really! One GI and one Urologist) has really reduced my trust in specialists, at least in Texas. They so, so, so often seem to just ignore or disbelieve patients.

I think people have pretty unrealistic of expectations for doctors, and am really curious where it comes from. They are all humans with variability, and some aren't even particularly smart or even good.

I get being frustrated to work with a bad doctor, but the outrage seems deeper, like people are frustrated that they even exist.

I would imagine the expectation comes from them being very well compensated, and supposedly very well educated and trained experts that people entrust their current and future wellbeing to, and who try very hard (often successfully) to minimize their own accountability.

One would expect a nurse to know less about which medication is likely to produce the best outcome in a given patient than a doctor, but the opposite is often the case due to some mix of the average doctor’s ego, and their investment and presence around patients over prolonged periods.

Many doctors appear frustrated that patients exist, they’d rather just look at a list of symptoms and write a prescription without acknowledging the individual.

>I would imagine the expectation comes from them being very well compensated, and supposedly very well educated and trained experts that people entrust their current and future wellbeing to, and who try very hard (often successfully) to minimize their own accountability.

I just think this is delusional. Pay, and education, and accountability do very little to make them superhuman. similarly, just because people dont have good alternatives to doctors, doesnt make doctors good at their job or their expectations rational. That is wish casting, and not how the world works.

I think it is more realistic to think of them like a mechanic who you are asking for advice. They might shrug or give their best guess, but they aren't promising anything. At the end of the day, it is your car and your problem, not their problem. They might try to help, but they dont owe you anything.

I guess I dont think patients are entitled to results or anything else from doctors, besides trying not to leave them worse off and maybe a mild positive intent.

I replied to your other post in this chain, but felt like adding:

Does a bad mechanic leave you in physical pain and have the potential to leave you suffering worse than before you arrived?

Can you avoid the problem of a bad doctor by just getting a new body?

Remember that the origin of this discussion is in many doctors not believing a woman despite reasonable evidence to the contrary.

Nobody would be outraged if they still were broadly and even justifiably wary but put in ANY effort at all to attempt to at least humor the possibility she wasn't an alcoholic, especially after passing psych screening tests, however primitive.

And sure, she could have gone to doctors other than ER doctors, but that is why I mentioned my own experiences that it isn't very different with (at least some) specialists.

Going a bit back to the mechanic analogy, it's hard for people who are busy and suffering to make extremely well thought out and slow decisions in that state, especially if there's sometimes enough improvement they can seemingly be recovered.

I think the thing that gets me about this example is everyone comes into it with perfect hindsight, and then projects their own biases about lack of effort and care. If it was so obvious, then the woman should have been able to diagnose herself, or any of her family and acquaintances. It's not that clinicians didn't try to help, as some people claim. They gave her CT scans and psychiatric assessments try to figure it out, some of which she refused. It is easy to say that the doctor simply should have trusted her statements, and use them as a basis for further research, which may have identified the cause more quickly. However, people don't have an answer for how this would play out the other 999 times out of 1000 when the patient is lying or in psychiatric crisis. Armchair doctors say it would have been obvious if they trusted her and kept her overnight for observation. This ignores the fact that this is not what emergency departments are typically set up to do, if they did, they may have seen her blood alcohol decrease, consistent with her lying. For all we know, she left the emergency room each time with the recommendation to seek help from a specialist, but people fill in whatever narrative they want.

Regarding your questions, I do think both doctors and mechanics have a responsibility to try not to make things worse than if they had done nothing at all. I don't think the doctor is here made her condition worse.

If I have a broken car, it's my responsibility to fix or replace it, not the mechanics. If I don't like the service a mechanic offers, my choices are find a new one, do it myself, or go without.

I think people would be better served if they thought about doctors in the same manner.

Yes, people are frustrated at highly paid and educated specialists being paid large amounts of money by them while in severe pain, and sometimes not getting help.

Just like they're frustrated if they don't listen at a grade school comprehension level, which absolutely is not superhuman.

Are you autistic by any chance? If so, I recommend trying to think in terms of the suffering people experience specifically because of the circumstances and because of a common social treatment of distrust and inattention.

E.g. I'll be far more bothered by someone who pretends to listen then ignored me, or who actively accuses me of not feeling pain, than someone who merely does a bad job -- i didn't, for instance, complain about my first GI specialist who merely did a bad job but always paid attention and tried to work slightly more than a chatbot in terms of effort put.

And effort too there is relevant, especially someone in a context of great luxury and not insignificant "authority" (i lack a better term rn) afforded by their position.

Accurate grade school comprehension 100% of the time IS superhuman. However, I agree that some people probably half ass it and do worse than their best. I think it is fine to be frustrated when someone does a shitty job for you.

I think the interesting point for me is the "authority", or social part of it. This seems to be a projection from the patient, and then they get upset that doctors dont reciprocate.

This is what strikes me as screaming at the clouds. Respect, authority, and trust are in the eye of the beholder. To the degree that there is a mismatch between expectations and reality, the error is on patient for projecting a false reality. Then they are angry when reality doesn't match of with their imaginations.

I also think it is weird to place such broad expectations on doctors as a class of people, as if they are all the same. Some are great and some are shit. Most are somewhere in-between.

If the anger is that doctors are paid more, that doesnt make sense to me either, because it is just supply and demand, not some moral social quality of doctors that make them better humans, and therefore deserving of more luxury or financial success. It seems a weird special expectation that people have constructed for doctors. In contrast, Nobody has an elevated moral expectation of bankers just because they make more money.

I just think that people would be happier, and perhaps get better care if they based their expectations in reality.

You shouldnt view health as a responsibility you can outsource to a doctor. No doctor will care about your life more than you do. Doctors come in all levels of competency, and it is your job as owner of your body to shop around. Some people desperately want blind trust and freedom from responsibility, but if they go down that path, they are embracing a fantasy,