Wednesday, September 10, 2008

David Newman in Hippocrate's Shadow: Paranoia in Medicine

I always find it frustrating when I come across an article that seems to drive a wedge between doctors and patients. The relationship is under siege enough as it is. Why introduce more suspicion? Well, I suppose some people do it to make a buck, such as this book promo piece in the Sun-Times:
Your doctor keeps secrets from you -- and a new book reveals them.
Dr. David Newman, a New York City emergency physician, tells what doctors don't want you to know in his book, Hippocrates' Shadow: Secrets From the House of Medicine (Scribner, $26).
• Doctors don't know as much as you think they do. For example, they don't know what causes most back pain -- or what makes it better.
• Doctors do know that many tests, drugs and procedures they order and prescribe either don't work or haven't been proved. Case in point: They keep prescribing antibiotics for colds and bronchitis.
• Doctors like ordering tests better than they like listening to you.
"These doctors are not bad human beings,'' said Newman, who trains medical students and residents at Columbia University.
Time limits, lawsuit fears and the demands of insurers deserve some blame for the truth gap, but medical training and traditions play big roles, he said.
Take the antibiotic problem. Studies show that half of all patients who go to a doctor with a cold are prescribed an antibiotic. Colds are caused by viruses; antibiotics kill only bacteria. "Doctors think patients want a prescription," Newman says. They also know that patients feel better once they get that "magic pill," he said.
But doctors should know that patients are just as satisfied when physicians take a few minutes to explain why antibiotics won't help and suggest symptomatic relief -- relief that won't come, as some antibiotics do, with side effects such as diarrhea, yeast infections and allergic reactions.
Doctors also don't like to admit that many test results are not as black and white as they appear.
"It's not uncommon for the decisions we make to be entirely based on opinion," he said.
Letting patients in on these secrets allows them to make better, more healthful choices, he said.
Now, I am certainly all for patients being informed consumers. I think it makes the experience better for all parties involved, and in the long run, leads to better health outcomes. However, pieces like this only sow the seeds of doubt in the minds of patients. I hope the book takes a more balanced view, but it would indeed be sad if a physician was spreading this view about his colleagues to the general public. We need to have our patients' trust, not evoke their suspicions.


  1. I haven't read this book. Yet. But I will.
    I studied pre-med at Columbia and volunteered in the ED under Dr. David Newman. Dr. Newman is to this day one of the best physicians I've ever observed. His listening skills are impeccable, and I have every confidence that he wrote this book to benefit the patient population and not, as you suggest, simply to make a buck.
    I would argue that patients do need to be aware of some facets of the practice of medicine in order to be better patients and to ask more incisive questions. Let's not disparage those professionals in our field who hope to IMPROVE patient-physician communication with an attempt at transparency.

  2. Yea, I agree. As I said in the piece, I haven't read the book nor do I know Dr. Newman. However, I can imagine a casual reader browsing his newspaper and coming across this piece. The intent of the piece I quoted is to grab the reader's attention and hopefully have them buy the book. The spirit though, is one of confrontation and suspicion rather than enlightenment. It's just sad that books about medicine that most likely do intend to educate the public are marketed via fear tactics. I suppose my beef is more with the writer at the paper than Dr. Newman, but perhaps that wasn't clear enough in the original post. My bad.



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