Dr. Feelgood?

The most recent episode of another pop pseudo-psychologist making headlines has got me perturbed. Dr. Drew Pinsky was babbling about how Tom Cruise is mentally ill, due to his involvement in the cult of Scientology. To quote Drew: “To me, that’s a function of a very deep emptiness and suggests serious neglect in childhood — maybe some abuse, but mostly neglect.”

Of course, he then has to retract and apologize. He is the host of Celebrity Rehab on VH1 after all. (Ironic, here, that Cruise, et al, called the Jewish Dr. Pinsky, a “Nazi,” in their rebuttal.)

And then, having learned his lesson real good, Drew comes out with this brilliant piece of work:

“I'm concerned with what's really going on with Angelina Jolie. I've never seen someone remit heroin completely. You're either still on heroin, Oxycontin, or something else. Unless you're dead. Is she still using something? Is she in recovery? If she's in recovery, I don't see any evidence of it, because people in recovery invest themselves in simple, selfless acts of service, not global self-serving acts."

I am irritated for multiple reasons. For starters, this causes me to side with (at some level) Tom Cruise and the scientologists, with whom I personally (not professionally) have a few beefs…..another time on that. The last thing this group needs is to win PR points because some wannabe shrink has to publicly apologize to them. And regarding Ms. Jolie, well…I just think Angelina Jolie is hot. Um…and of course there’s the obvious trashing of medical and professional ethics.

Paging Dr. Drew! Dude, where in your Hippocratic Oath did it state that you should make public diagnoses on people who are not your patients, do not want to be your patients, and are not soliciting your advice? Pinsky is a board certified internist and addiction specialist- which means he went to medical school, specialized in internal medicine and passed a board exam. He is not a therapist, either psychiatrist or psychologist. This is critical, because the untrained pseudo-therapists seem to have difficulty with certain concepts, like confidentiality (Hello Dr. Phil, RE: Brittany Spears), neutrality (Dr. Laura, preaching personal dogma like “don’t marry someone from a different religion.”), doctor-patient relationships, and other medical ethics. Dr. Phil has a PhD in Psychology, but was sanctioned by the Texas Board of Examiners and is not licensed to practice psychology anywhere. He appears to be more concerned with skirt-chasing or dollar-chasing than in actual practical therapy. Dr. Laura Schlessinger has a PhD in Physiology, not in any therapy modality, and uses her title to wax rhapsodically about the “biological error” of homosexuality, rather than focusing on an individual’s emotional need, thus ruining any sense of neutrality in the therapeutic relationship.

Perhaps I’m off the mark, but using a title like “Doctor” denotes some professional expertise; and professional service if you are going to a “Doctor” for advice, treatment, etc. There appears to be no such professional service being transacted here, and the use of “Dr.” is nothing more than false advertising. So, Laura, Phil, Drew and others, if you’re just giving your opinion, drop the whole “Doctor” schtick. And Drew and Phil, stick to the scripts handed to you on TV, and otherwise shut up.

Medical Truths #2

The most important sentence a doctor can speak is "I don't know."

Our medical schools are chock full of high performers (gunners, in parlance), being taught that the right answer is imperative. Differential diagnoses are screened a-la-House, M.D. and the message is to always be right, and always have an answer. I remember students being berated for "guessing with your mouth open," a favorite phrase, of one particular attending. That mindset is reinforced all through training. Primary care doctors are told to be gatekeepers, and that they should have the ability to treat everything. Certain insurance structures (such as capitation) financially punish those doctors who refer out to specialists or order to many tests. And doctors are given a heavy responsibility (patients' health), for which they do not want to be wrong, and thus be a failure.

It's good to know stuff. We want our students and residents to learn by experience and going to find information that will help in the diagnosis. Certainly we all want to have confidence in our physicians. And there are many benefits in gatekeeper medicine. (Having one doctor keeping track of all of a patient's treatments is one.) Illness, though is not so black and white. However, there is very little positive reinforcement for the student or resident when presented with these grey areas, and even less for those in practice.

Patients respect an "I don't know," even though it may be frustrating to hear it. Most do not expect doctors to be superhuman. I recently had a friend of mine (another physician) be told that he had stage 4 cancer by a national expert, only to find that his nodules in his lungs began to shrink with antibiotics were given by another doctor who said "I don't know." He's glad that the doctor didn't.