Wednesday, August 29, 2007

What are you, an idiot?

I need help.

I'm failing miserably.

I just can't figure out what to say, or how to say it. When presented with woo.

I learned about woo from white coat underground. Of course, I knew about woo, I just didn't know it was called woo. Woo is all that crazy alternative medicine quackery.

I'm not even talking about soft woo. I'll walk with you for a little way, on chiropractry, acupuncture, St. John's Wort. If you ask me point blank I'll tell you what I think (completely bogus), but if it's within reasonable context I leave it alone.

I'm talking about hard woo. Hair analysis, magnet therapy, chelation.

What would I say, if a friend or family member asked me about the above?

What are you, an idiot?

But somehow, that doesn't seem appropriate to say to patients.

I've been waiting for my script to develop, and it's going miserably. I end up mumbling and going on about misrepresentation and lack of controlled trials. I end up sounding like the idiot.

I need help. The Woo is coming out of the Woo-dwork.

I had a patient this week ask me what she should do about the high heavy metal levels that she has in her tissues that don't show up in her blood stream, that cause her fatigue, back pain, sinus pressure, etc. She got tested for it by being hooked up to some electrode type system 6 years ago. And heavy metals can cause blockage of the coronary arteries, didn't I know?

It did not go well.

What am I, an idiot?


Rob said...

I usually get a smile and say: "Do you want to know what I really think? I think that type of therapy can result in significant weight loss...from your wallet." I explain that there are a lot of people out there making unfounded claims and getting people to spend a lot of money off of people who are needy.

If someone asks me what I think, that is what I say. If someone asks me a question like the "heavy metal" question, I tell people I am really skeptical about that kind of thing (we hear that kind of thing a lot with "systemic yeast infections"). I say that it is outside of the area of standard medicine, which means that the scientific evidence is not good.

I make no bones about it, but don't tell them they are idiots. It is simply implicit.

Anonymous said...

I tell patients that the science is suspect but I guess the practioners therof have little woos to raise and educate. And Porsche payments to make. What I really want to say is "Horse&*^%!

The Country Doctor said...

At least they are telling you that they are interested in some type of alternative therapy. Studies clearly show that there is a much higher percentage of patients using some type of alternative treatment than physicians realize.

I'll never forget a patient I took care of in residency that had digitalis toxicity from an herbal medicine. It was this natural arthritis medcation with glucosamine and about 20 other random herbs that interacted with the digoxin.

My favorite line is to remind patients that hemlock and arsenic are natural (as is digitalis for that matter), but certainly not safe.

Femail doc said...

I respond to such comments by simply saying that I am unfamiliar with the benefits of that therapy, and therefore unable to give them an opinion on it. Then I share what I would recommend from my evidence and experience based medical viewpoint. That way I hear them out, I don't put them down, and I get my proposal on the table.

Where my approach fails is when they continue to spout their alternative wacko stuff, and I then picture myself pinned on my stool by their verbiage (like a giant moth pinned to a display board), eagerly awaiting their next inhalation to try to move the conversation forard.

rlbates said...

I get this from a sister-in-law who thinks all things herbal are "naturally" better than anything medicine (implied doctors) could possibly offer. I try hard to avoid the subject to keep family peace.

Dr. Smak said...

Thanks to all for your suggestions. I think I'm hoping for a great one-size-fits-all line to use, which likely doesn't exist.

I've essentially used bit of all of these conversations in the past - I guess I just need to work on my execution.

Ha - woo execution. I made a pun.

Dean Moyer said...

Hi Dr. Smak,

I just found your blog for the first time today via White Coat Underground and his post about this post.

I think there is a good short response you can give your patients when they bring up the subject of woo. Simply point them to resources such as Quackwatch and other anti-quackery sites where they can find good evidence-based information for themselves.

That way you don't have to be a walking encyclopedia on the subject and they will be impressed with your knowledge of alternative medicine. ;-)

Just a thought,

mchebert said...

I think what I would say is, "I don't agree with that. If you want that kind of treatment you will have to find someone else, but I am happy to treat your problems the way I was trained to treat them."

That's a little blunt, but at least the patient knows where you are coming from, and might come back if the alternative route doesn't serve.

I also had a cardiologist teacher who had a great line. He would pat the patient on the shoulder and say, "Leave the driving to us." I don't use that line much because it sounds patronizing, but in the right situation it is an assertive way to make the point that a doctor has methods the patient knows not of.