Category Archives: medicine

Enver Hoxha, flamur i luftës për liri e socializëm

War flag for freedom and socialism

All kinds of considerations, Dalrymple says in a recent talk (from 4:38), make medicine

a happy hunting ground for the politically correct. Nowhere is this more so than in medical journals.

He has

no objection to the publication of any particular point of view — much to the contrary.

What he finds distressing in the medical journals is

the lack of any other point of view, as if the medical profession were the Albanian electorate in the good old days of Enver Hoxha.

The thrill of the illicit

screen-shot-2017-01-28-at-21-45-40That cannabinoids should, writes Dalrymple,

be treated as ordinary medications has always seemed to me reasonable. If they relieve unpleasant symptoms, it would be wrong to withhold them.

He notes that of course,

when given as medicine, the fun is rather taken out of them: there is no longer any thrill of the illicit.

You’re the doctor. Be a paternalist

Screen Shot 2016-04-29 at 08.52.09Dalrymple writes that when he has been in need of treatment,

I have wanted the doctor to decide what to do and do it, without any intellectual input from me (a doctor). The last thing I wanted was to hear a disquisition on the various possible courses of action the doctor could take, with all their possible disadvantages, and then to have to make up my mind.

But, he says,

this attitude is rather against the temper of the times: it smacks of a return to paternalism. What we want is information, more and more of it, to help us decide what is best for us.

The problem is that

there are many questions in medicine that are without a definitive answer. Is it worth running a small relative risk of a major side-effect to obtain relief from a non-life-threatening condition?

Perfectly sensible people

may give different answers to the same question, according to their own scale of values.

Unfortunately,

people don’t like living with uncertainty. For them, intellectual honesty has its limits as a virtue. They (or perhaps I should say we, because we are most of us the same in this respect) prefer living with a sense of certainty, at least about our illnesses, even if this certainty is not well-founded. We want the doctor to act as if he were certain, even if he is not certain. And this desire is not completely without rational justification, because faith in the doctor has a healing quality. It is hard to put one’s faith in a man who presents us with a series of insoluble dilemmas.

A patient comes to Dalrymple with somewhat raised blood pressure.

I conscientiously told him that there was a small statistical chance that treatment would do him a lot of good, but a large statistical chance that it would do him no good. Did he want treatment or not? He looked at me as if I were mad. He hadn’t come to the doctor for this, but to be told what to do. He had never thought of medical treatment as a game of roulette: treatment either worked in every case or it didn’t. ‘I don’t know,’ he said. ‘You’re the doctor. Do what you think is best.’ What he meant was, be a paternalist.

Colonic irrigation courtesy of the taxpayer

Screen Shot 2016-04-20 at 08.21.48The Department of Health’s tie-up with the Prince of Wales’s Foundation for Integrated Health is, writes Dalrymple,

an invincible alliance between bullying bureaucracy and social snobbery, between administrative cynicism and ignorant folly.

Screen Shot 2016-04-20 at 08.18.40Providing homœopathy on the NHS

is part of the persistent attempt by the government further to debase and demoralise the medical profession. The point is not to raise the status of alternative medicine, as Prince Charles has no doubt been gulled into believing, but to lower the status of orthodox medicine.

Screen Shot 2016-04-20 at 08.23.46This is because

doctors are trusted by the population, while politicians most certainly are not: therefore they, the doctors, represent a danger to the politicians. The people who will pay the price for the wicked folly of the Department of Health will be the British people, who will come to be treated by a professional body of uninterested timeservers while their rulers seek first-rate medical treatment elsewhere — that is to say abroad.

Screen Shot 2016-04-20 at 08.31.08Dalrymple has no objection to irrational whims involving

  • colonic irrigation
  • healing crystals
  • chakras in the earth
  • hopi candles

Screen Shot 2016-04-20 at 08.20.03But he sees no reason why he or any other taxpayer should fork out for them.

No doubt the Department of Health will present its position on alternative medicine

as being broad-minded and socially inclusive. There is another way of looking at it: the Department of Health is embezzling taxpayer’s funds for partially hidden, political purposes.

Charles II touches a patient for tuberculous swelling of the lymph glands

Charles II touches a patient for tuberculous swelling of the lymph glands

By all means

let the Prince of Wales spread propaganda for his brand of hocus-pocus. Let him touch people for the King’s Evil, if he and they so wish — the revival of the ceremony might add to the gaiety of the nation. But medicine is too serious a matter to be left to amateurs such as the Department of Health.

Screen Shot 2016-04-20 at 08.26.10Screen Shot 2016-04-20 at 08.24.31Screen Shot 2016-04-20 at 08.19.33

May my surgeon be human-hearted

Screen Shot 2016-04-04 at 08.49.19Dalrymple points out that the media’s attitude towards medicine

swings between lauding a miracle cure and excoriating the murderous incompetence of doctors, leading to a dialectic between unfounded hopes and hostile suspicion.

Yet very occasionally it perhaps ought to be acknowledged that medicine,

for all its deficiencies and the carping of its critics, is a noble enterprise.

Doctors must act

in the absence of definitive knowledge. Sometimes this leads to tragedy, sometimes to triumph.

Screen Shot 2016-04-04 at 08.20.47A paradox

Everyone who comes under the knife

wants his surgeon to be as highly trained and as experienced as possible: but how is the surgeon to come by that training and experience unless he practises on people while he is untrained and inexperienced? Someone has to be operated on by tyros, even if they are under the supervision of more experienced surgeons. In practice, for compelling practical reasons, that supervision may be light: senior surgeons cannot be everywhere at once. What is true of surgery is true of other specialities: decisions of vital importance to individuals are taken by people who are still learning.

In the old days,

Thomas Rowlandson, 1793

Thomas Rowlandson, 1793

perhaps explanations of treatment options were less elaborate or full than they are today, but they were still given and consent to such treatments was still sought.

Patient autonomy as the single most important guiding principle of medical ethics has drawbacks.

Patients who are very ill are often in great pain, or severely weakened. Their concentration is poor, they may be irritable or in a state of panic. This is not generally the best moment to ask them for a reasoned assessment between two or more alternatives, each with its own advantages, side-effects and chances of failure. The insistence that they do so is often a form of disguised cruelty.

Dalrymple says that when he has been seriously ill or injured,

I have wanted my doctors just to get on with it as best they could, without any interference from me. So far, at any rate, my confidence in them has not been misplaced; and the paradox in the doctrine of autonomy is that the person may — in fact, often does — wish to abrogate it.

Surgeons

need human as well as technical understanding, and kindness is at least as important as respect for patient autonomy.

Who on earth would want to be a doctor?

Screen Shot 2016-03-24 at 21.04.40Dalrymple points to the

steep decline in the attractiveness of medicine as a vocation, profession and career.

And no one

who ever experienced an ordinary Soviet hospital will be in any doubt as to what a decline in the prestige of the profession meant to patients.

It has long been the goal of the government, he points out,

to deprofessionalise medicine and to turn its practice into a mere job. An independent profession, with its high standards and old traditions, is dangerous to the government, especially when it is as respected as the medical profession, in a way in which a mere group of shift workers will never be. Shift work dehumanises patients and deprives the work of most of its satisfaction. It is also grossly inefficient.

The independence of doctors

has eroded almost completely, and you cannot expect highly educated people who have undergone a long and strenuous training to remain contented for very long with being harried and reprimanded by people who are of lower calibre than themselves.

A vivid exemplification of the New Hospital Order is the noticeboard in the corridor of the hospital in which Dalrymple works, which

informs the public of the senior staff of the hospital. The senior consultants, all men of considerable distinction, appear on the fifth and bottom row, under four rows of bureaucrats. The impression is given that they are of very minor significance.

The shortening of training,

both graduate and postgraduate, is another straw in the wind. New hospital consultants do not have the breadth of experience that old consultants had at their appointment, and this is because doctors are increasingly regarded as technicians and nothing more.

Darling, your meal replacement product is on the table

Screen Shot 2015-12-01 at 07.34.34In his Find Out What the Children are Doing and Tell Them to Stop It and Other Essays (2015), Dalrymple points out, among other things, that doctors don’t have all the answers. He says in the foreword:

I still have faith in the enterprise of medicine and when I have been seriously ill have had no cause to regret my faith. But progress is rather less straightforward than I had imagined before I started to write these pieces.

Screen Shot 2015-12-01 at 07.37.05Screen Shot 2015-12-01 at 07.37.17

Harmless futility of alternative medicine

Ayurvedic steam treatment for irritable bowel syndrome

Ayurvedic steam treatment for irritable bowel syndrome

The continued popularity of alternative medicine does not matter, writes Dalrymple. There may be cases

in which a belief in it prevents someone from seeking treatment for a serious but treatable disease, and thereby causes avoidable death. But most believers in alternative medicine also avail themselves of the orthodox variety.

Supposedly healing herbs and minerals

can be poisonous. I have seen people poisoned with lead and arsenic by Ayurvedic practitioners. But these cases are few and far between.

Screen Shot 2015-05-30 at 08.20.07

Consolation

The number of people saved by alternative medicine

approaches zero,

but

I have long since ceased to be irritated by the irrationality of others in this matter, for we are all of us irrational about something and all of us in need of consolation at some time or other in our lives.

Screen Shot 2015-05-30 at 08.24.53

Propriety in the evacuation of waste matter

 

 

Too old a doctor is past it…

…while too young a doctor is inexperienced, writes Dalrymple.