Nov 7, 2010

the wisdom of ERP

Can anyone explain to me why some physicians are belittling, condescending, and obnoxious towards certain groups of patients?

Today's lack of empathy in medicine comes from ERP, who has chosen to vent his hostility on what he calls "Nutty Patients". He rants about how much he hates to give them a "real" diagnosis (such as Lyme Disease, Lupus, Crohn's) because:

"These diagnoses are like crack to them. They LOVE it. They FINALLY can now say that have a real problem and go on to blame nearly every symptom they ever have on it!"

Of course, ERP makes a distinction about these diseases and the ones that he doesn't believe are "real" (such as Fibromyalgia, Chronic Fatigue Syndrome or IBS), because according to ERP, these are all "psychiatric disorders".

I'm sure in ERP's worldview, my critique of this repulsive post will be written off as "nutty", but I wish that ERP would take a few moments to work on some empathy skills.

ERP - do you know why patients "love" to have a "real" diagnosis?

Perhaps it is because physicians like you, people in positions of power, take pleasure in degrading the experiences of your patients when they cannot be easily verified with an 'objective medical test'.

Do you really think that patients enjoy feeling awful day to day, losing their jobs, dreams, relationships whilst being told that their problems are "all in their head?".

Perhaps if you were in this position, you would understand that being given a diagnosis means having some legitimacy. I have actually felt at times I would rather have a diagnosis of cancer than an unexplained illness, just so that I wouldn't have to deal with the shame of being labelled "nutty".

For the record, I have been evaluated by top mood disorder specialists (Psychiatrists) who agree that my symptoms are not psychiatric in nature.

Trust me, I would be happy with a mental health diagnosis if it came with an effective treatment. But ultimately what I would like is to be afforded some dignity by medical professionals.


  1. I don't even read ERP any more. It's one of those anonymous ER docs that give anon medblogs a bad name.

    If a doctor/nurse doesn't understand something, instead of figuring out what the problem is (or even an effective treatment without a specific disease name) then these guys blame the patient. In their eyes, the problem couldn't possibly be that the doc doesn't have enough experience to know what to look for, or didn't bother with a good enough history or exam to figure out what should have been an obvious diagnosis. Nope; it must be psychological.

    The lack of compassion displayed on anonERblogs is appalling. That's one reason I like so much to read the family practice blogs. Family physicians seem much more likely to respect patients. They see people long-term, and they develop rapport with their patients. They're nice people. ER docs thrive on NO-relationship, bounce from one case to the next, trauma instead of mundane. (Exceptions made for StorytellERdoc & EdwinLeap who are willing to sign their names and don't express the disdain found on most of the ER blogs. Although anon, Whitecoat seems pretty respectful, too.) The rest of the anon ERblogs I've seen are doing the medical profession a disservice by ranting in public, and driving a wedge between physicians and patients.

    Okay, now this is getting long enough that I could do a whole post/rant on the subject, so I'll stop.

    Hang in there. Some docs just couldn't be bothered to learn enough to help non-trauma patients.

  2. I've never read that blog before but his post was really asking for it.

    I agree that it is frustrating for doctor and patient alike to have to deal with somatic complaints for which there is no traditional diagnosis and for which there is often no treatment.

    I do beleive that functional somatic disorders are "real" and that the experience of pain, fatigue, etc. is real. People with functional somatic disorders can get traditional diagnoses too, but I do my best to help them differentiate what symptoms are likely coming from which thing.

    I have also seen malingerers and fakers; in a way it's good to see these people, because it is easy to fix: "I can find no cause for your symptoms given the clinical picture today." The fear is that one might dismiss something or miss something important, but the wonderful thing about Family Practice is that you can give strict instructions for return and arrange for follow-up regulary.

    I have learned lately that many functional somatic complaints are correlated with the modern age, and probably our lifestyles; recent studies show that cardio exercise and tai chi render significant improvement in fibromyalgia. I can see how recommending therapies such as these are not on the menu offered by ER physicians, but I agree they need to be respectful in all they do.

  3. What I didn't get from that post was all the congratulatory 'I love it when you stir the pot' comments. Really? No one caught that ERP communicated poorly and that was why people were upset.

    No, instead the perception was he just proved the point by drawing the 'crazies' out of the woodwork.

    The truth was that was a crappy post, his opinion was poorly conveyed, but somehow he was lauded for it and all the people he offended were laughed at.

    I was unimpressed.