Doctor No

October 24, 2013 7:48 PM

What doctors would not do
posted by paleyellowwithorange (51 comments total)

plenty of good advice.. some eye-rolly bits too.
posted by edgeways at 7:55 PM on October 24, 2013

"I would not "turkey baste" a friend's semen to get pregnant before talking to a doctor and a lawyer first!"

Whoa! I was not expecting that one. All the others seemed pretty sane (the no tattoos one seems a bit silly).
posted by mathowie at 7:56 PM on October 24, 2013 [2 favorites]

Hey there obgyn guy, care to rationalize your professional opinion instead of making stupid puns? Christ, what an asshole.
posted by Pazzovizza at 7:56 PM on October 24, 2013 [16 favorites]

They don't mention it, but I suspect they wouldn't move to a country without unversal health coverage, for one thing.
posted by Horace Rumpole at 7:57 PM on October 24, 2013 [9 favorites]

I suspect they wouldn't move to a country without unversal health coverage,

I wouldn't take that as a given... I know a Doctor/Nurse US couple who are moderately liberal who hate the idea of a Canadian style medical system.
posted by edgeways at 8:01 PM on October 24, 2013

Oh my god, these are mostly super annoying. Many are not that rational, ie: tattoos are super safe at this point and you'd be hard pressed to find someone who had any negative health effects from a professional quality tattoo.

The turkey baster one is straight up offensive. Dear entire human race: did you consult a doctor and lawyer before you reproduced?

But I liked the first one: that's the only one that actually encourages any kind of critical thinking or involving the patient in their own care, in fact, she's encouraging you to go against medical advice if it makes no sense to your experience.
posted by latkes at 8:02 PM on October 24, 2013 [5 favorites]

I wouldn't take that as a given... I know a Doctor/Nurse US couple who are moderately liberal who hate the idea of a Canadian style medical system.

This appears to be an Australian web site.
posted by XMLicious at 8:05 PM on October 24, 2013

If I were a pregnant woman, I would never self-medicate without medical or obstetric advice
And I would never plan to have a home delivery – unless it was pizza.
-Professor Alastair MacLennan, professor of obstetrics and gynaecology

Well ok then!
posted by spikeleemajortomdickandharryconnickjrmints at 8:06 PM on October 24, 2013 [1 favorite]

the no tattoos one seems a bit silly

Ah, my fellow Oregonian, you have been coddled by our sensibly regulated tattoo industry. Trust me, a basic Google search on "tattoo+hepatitis" turns up all kinds of interesting stuff from seemingly civilized places (like Maryland) that have either no regulation, or toothless regulation, to ensure consistent sterility.

Good taste, as ever, is still unregulated.
posted by ivan ivanych samovar at 8:10 PM on October 24, 2013 [2 favorites]

Well ok then!

And just below that is a female doctor saying "Yeah, and if I were a man I wouldn't piss all over the goddamn toilet seat."
posted by George_Spiggott at 8:27 PM on October 24, 2013 [7 favorites]

And I would never plan to have a home delivery – unless it was pizza.

This also points to how much of medical advice is not evidence based. Obstetricians have an enormous bias against homebirth because they have a tradition of thinking it's dangerous. But the available research does not support this position: Citation 1, 2, 3.
posted by latkes at 8:40 PM on October 24, 2013 [13 favorites]

I would not trust a nurse with no eyes and a shiny, rigid head of hair. Probably an auton.
posted by dumbland at 8:41 PM on October 24, 2013 [12 favorites]

I do happen to know of a man, (an old friend's father) who at the age of 79 decided to climb up a ladder and then fell off it and died as a result. Knowing him for years as we did, we were sad but not really surprised. I have a feeling he'd have been okay with that for an exit. (He was a lovable old rascal and had been so all his life. ) Telling Jack to stay off that ladder would probably have gotten you a one finger salute.
posted by St. Alia of the Bunnies at 8:50 PM on October 24, 2013 [2 favorites]

latkes: The turkey baster one is straight up offensive. Dear entire human race: did you consult a doctor and lawyer before you reproduced?

Well, I suspect this article was penned for an Australian audience, and the legal situation for Australian "informal" donor conception could be a bit more complicated than that of the general conception of the "entire human race". We had a very difficult case here in Australia in 2002, Re Patrick (you can read about it here), that makes me think it would be at least prudent to discuss rights and responsibilities with a lawyer.

Of course, many people who conceive children otherwise than by informal donation also end up in bad family law situations, but it would surely seem best to avoid them where possible, or at least to be forewarned of what might happen.
posted by curious.jp at 8:57 PM on October 24, 2013 [10 favorites]

The thing of it is, if you think the advice is poor, that's fine, provided you have facts to support your position. Consider the source and their bias, against your own source and bias. Think. It's the thoughtless blunders we're seeking to avoid. Also, consider most people are probably not as bright as you are, and need this sort of advice.
posted by Goofyy at 9:22 PM on October 24, 2013 [1 favorite]

Professor Alastair MacLennan, professor of obstetrics and gynaecology, I like the way you think.

(Err by which I mean getting some pizza delivered. I have no opinion on where you have your babies.)
posted by turbid dahlia at 9:41 PM on October 24, 2013

Dead Doctors Don't Lie
posted by mrgrimm at 10:11 PM on October 24, 2013 [1 favorite]

I wouldn't take someone's advice based on the fact they once acquired an academic qualification without first corroborating it with my own research.
posted by walrus at 10:36 PM on October 24, 2013 [5 favorites]

The turkey baster one is straight up offensive. Dear entire human race: did you consult a doctor and lawyer before you reproduced?

I also read this in a slightly more charitable light. America has also had at least one legal kerfuffle involving an informal sperm donation agreement, and, honestly, it also makes good sense to inquire whether a donor has any heritable genetic conditions, especially if it isn't someone you know. I was only offended when she started to wag her finger at single mothers.
posted by pullayup at 10:38 PM on October 24, 2013

I thought some of this was interesting, but I did think there was a frustrating myopia from a lot of medical professionals as to the things that drive people towards investigating treatments outside the mainstream - it's not just stupidity, ignorance, fear, etc but often frustration at lack of progress; feelings of being ignored or patronised; lack of communication from medical professionals in appropriate language, in appropriate ways; distrust of a profession that often refuses to acknowledge its own flaws; reasserting a sense of control and activeness in the face of one's illness, etc etc etc.

I mean, I am as medical establishment as it gets - I love the medical establishment, but let's not pretend that only stupid people look outside it for stupid reasons.*

I would love to have seen a doctor say "I wouldn't accept any form of bribery from a pharmaceutics company - including free samples - as research demonstrates how much it can affect my prescription and treatment regimes."
posted by smoke at 10:44 PM on October 24, 2013 [12 favorites]

* This all being said, my mother was a medical receptionist, and I spent many an afternoon hanging out in the surgery, and it's undeniable that a lot of people do, also, pursue alternative treatmens based on fear and ignorance, or I don't even know, like what they had for lunch some days, it seemed.
posted by smoke at 10:51 PM on October 24, 2013

And I would never plan to have a home delivery – unless it was pizza.

"...despite the fact that most humans were born this way since, oh, the dawn of time and I'm refusing to quote sources to back up my opinion." Gee thanks. That's real helpful in making an informed decision, doc.

I would not ignore suicidal feelings in myself or someone else...There is good evidence to suggest that this makes all the difference. Suicidal thoughts are usually like waves on a beach: they come and go. Surviving a wave of suicidal thinking with the help of another caring person makes the next wave much easier to bear.

Now this, complete with helpline numbers, is actually useful.
posted by billiebee at 3:47 AM on October 25, 2013 [1 favorite]

I did not know "Dutch courage" was a term for having a drink to decrease social anxiety.
posted by Renoroc at 4:32 AM on October 25, 2013

I'm a bit startled by the doctor who wouldn't drink to relax socially. I mean I can sort of parse what she's saying, which is that relying on alcohol as a crutch to deal with severe social anxiety could lead to alchoholism, but it sort of comes across as saying that having a drink or two in a social situation to allow oneself to mingle more freely will inevitably lead to addiction.
posted by Cannon Fodder at 5:13 AM on October 25, 2013 [1 favorite]

toothless regulation

When talking about tattoo parlors, that could have multiple valid meanings.
posted by gimonca at 5:22 AM on October 25, 2013

There are tons of things that are safe most of the time that doctors will nonetheless advise against. Chances are, in the rare instance that things go wrong, the unlucky individual will indeed seek medical help to fix the problem. Doctors have a biased view because they see a disproportionate number of "cleanup" cases compared to the average outcome, so take the advice for what it's worth and make your own choices accordingly. Of course this assumes most people will be thoughtful about their choices and weigh the risks and benefits, which involves intact frontal lobe function, which is not always a safe assumption either. However even in that case most doctors will do the best they can to clean up the mess.
posted by fraxil at 5:33 AM on October 25, 2013 [1 favorite]

I would not use a bathroom without wet wipes

Many people use really crappy toilet paper, and it scratches their buttholes. I've lost count of all the pains and sufferings I've seen in people's buttholes emerged from war-torn 0.5-ply warzones, all just to save a few bucks. My advice is this: if you're at someone's house and they only have steel wool on the roll, take a quick shower instead.
The transplant list isn't getting any shorter.

Gladsby Bartholoulew, Adjunct Butthole Consultant and Clinical Fartknocker
posted by oceanjesse at 5:50 AM on October 25, 2013 [4 favorites]

This also points to how much of medical advice is not evidence based. Obstetricians have an enormous bias against homebirth because they have a tradition of thinking it's dangerous.

The danger isn't with the homebirth itself, it's more to do with being in a medical facility if something goes wrong.

If we had tried homebirth, my son might not be alive. After 3 hours of hard labor, he just wouldn't fit through the birth canal. His heart rate dropped, and they got him out by caesarean within 20 minutes. Being in a hospital saved his life.

No one anticipated my wife's pelvis being just slightly an odd enough shape that his head wouldn't fit through. Everything appeared perfectly normal in advance.

The statistics may say that homebirth is safe most of the time, but I'm glad I didn't gamble my son's life on that.
posted by Fleebnork at 5:57 AM on October 25, 2013 [7 favorites]

I'm glad your wife and son are doing well. Not to turn this into a derail about home birthing, but personally my gripe is not with his opinion (with which I disagree, each to their own etc), but that he didn't back up his opinion with any facts, statistics or reasons (such as you have mentioned), contenting himself instead with being a smartarse on the interwebs.
posted by billiebee at 6:07 AM on October 25, 2013 [1 favorite]

I don't think the intent of this webpage is to back things up with statistics. Some people are more interested ultimately in what a doctor would choose for themselves and their family, and hearing it in a clear and concise manner is what they are after. YMMV.
posted by fraxil at 6:26 AM on October 25, 2013 [3 favorites]

This was interesting and I could see a whole series of these being enlightening. I have a feeling nurses would have a list of more practical "never do this" responses. In my field of IT I could see an interesting range of answers. I would also like to see this question posed to attorneys.
posted by dgran at 6:39 AM on October 25, 2013 [3 favorites]

The transplant list isn't getting any shorter.

Trans...plant? Is this...serious?
posted by Steely-eyed Missile Man at 6:54 AM on October 25, 2013

Generally low-risk patients are the ones that have home-births, which may prejudice the statistics. In addition, (as stated earlier), it's not the birth that you need the hospital for, it's the complications.
posted by blue_beetle at 7:09 AM on October 25, 2013

I had any interest in homebirth scared right out of me by a visiting lecturer in grad school. He was an artist and his 21 year-old daughter had lived her entire life in, essentially, a coma. He and his partner provided for her needs around the clock. His artwork reflected this reality in his life.
After the series wrapped up he became very still and serious. He explained that he and his wife had chosen home birth for all the right reasons. Nevertheless, a complication during birth meant that his daughter need oxygen, and quickly, and the doula was unable to meet that need. By the time medics arrived his daughter's brain was too oxygen-starved to make any difference.
Had she been born at a birthing center or hospital it would have been a trivial matter.

Many of my friends have had incredible, successful homebirths but this one story scared me off of it.
posted by Baby_Balrog at 7:56 AM on October 25, 2013 [4 favorites]

I don't know how the Australian system works in comparison, but here, obstetricians mostly see only the high-risk or more complicated patients - straightforward pregnancies and births are dealt with by midwives. So while I'm all in favour of homebirth, I don't have a problem with an obstetrician who's spent his career largely seeing the cases where something went dangerously wrong thinking in terms of worst-case scenarios and saying 'if it was me, I would never give birth at home, whatever the safety stats'. Still, maybe mention that, rather than making a flip comment about pizza?

(I might have a home birth for subsequent pregnancies. I would definitely have one if you could order in babies like pizza. No nine months of pregnancy suckage, and extra jalapeños!)
posted by Catseye at 8:02 AM on October 25, 2013

Yeah, the turkey-baster bit was pretty yucky. The problems stated are:
1) Possibility of STI's, which are easy to check for before the, ah, procedure.

2) Possibility of genetic disorders, which has absolutely nothing to do with surrogacy. In fact, baster fertilization allows more screening based on genetics than people typically feel comfortable with when choosing a romantic partner. "Let's go get our genomes sequenced!" isn't typically a sexy second date, and at some point one tends to be a bit too locked in for the genetics to make or break the relationship. Indeed, if a romantic partner happens to have a REALLY BAD genetic condition (active or latent), it's a good argument for going the surrogate route.

3) The 'ethical minefield' is for the people involved to sort through. And their ability to decide should be respected.

4) Which just leaves the legal questions, which should absolutely be dealt with through a lawyer. It would be great to see some good law on the books positively addressing sperm surrogacy, but in the mean time it's a lawyer's game....
posted by kaibutsu at 8:56 AM on October 25, 2013

I would not use alcohol to reduce social anxiety

I would never fall prey to the kind of unnuanced thinking that led me to believe every single person is just one drink away from becoming an alcoholic.
posted by Squeak Attack at 9:56 AM on October 25, 2013 [3 favorites]

Story of my life:

a disastrous combination of declining reflexes, poor balance, odd jobs and power tools.

--Dr Sue Ieraci, emergency medicine specialist
posted by ohshenandoah at 10:38 AM on October 25, 2013

I'm reminded of when that ICP song "Miracles" came out, and people here and elsewhere were quick to mock the bit about magnets, and the follow up line where he says "Don't tell me to talk to a scientist / always lyin' and making me pissed", because that kind of quasi-religious 'faith-based' thinking is anti-intellectual and dangerous, and such ignorance leads to things like anti-vaccination and creationism.

And yet, now I'm reading a thread where people are arguing about medicine. With doctors.
posted by Uther Bentrazor at 10:39 AM on October 25, 2013

I was kind of hoping to see "I would not do plastic surgery to to look like the twin of Justin Bieber or Barbie".
posted by sammyo at 10:42 AM on October 25, 2013 [2 favorites]

And yet, now I'm reading a thread where people are arguing about medicine. With doctors.

Some of us have good friends who became doctors. We know how fucking stupid they are. (Actually, many of them are delusional narcissists. I grew up with rich kids--I know a LOT of doctors. ;)

I would not use alcohol to reduce social anxiety

Seriously. If I didn't use alcohol to reduce social anxiety, I'd probably be dead by now. (No offense.)
posted by mrgrimm at 10:52 AM on October 25, 2013

"Most physicians already have in mind two or three possible diagnoses within minutes of meeting a patient."

How Doctors Think
posted by mrgrimm at 10:55 AM on October 25, 2013 [4 favorites]

"What happens is a disastrous combination of declining reflexes, poor balance, odd jobs and power tools." I can predict with 99% certainty that this will end up engraved on my husband's tombstone.
posted by helpthebear at 11:10 AM on October 25, 2013 [2 favorites]

The differential diagnosis actually works pretty damn well for most cases. How Physicians, Engineers, and Scientists Approach Problems Differently
posted by klarck at 1:05 PM on October 25, 2013

I don't understand the joke upthread about wiping your ass with steel wool but I can only assume it was made by someone who isn't familiar with or even aware of peri-anal disease. Because I wouldn't wish that on my worst enemy.
posted by telegraph at 1:45 PM on October 25, 2013

Reminds me of the radiolab segment on what doctors would want in terms of terminal care. (tldr: nothing except pain relief.)
posted by gaspode at 1:53 PM on October 25, 2013

And yet, now I'm reading a thread where people are arguing about medicine. With doctors.

Doctors aren't immortal, and are subject to exactly the same cognitive biases that the rest of us fall prey to - but can often ignore this very important fact due to a cultural construct that they are somehow demi-gods.

As I say, I'm extremely pro-doctor, and pro-conventional medicine, but there is still room for improvement, and acting like a doctor's word is law is silly when so many of them disagree with each other.
posted by smoke at 2:55 PM on October 25, 2013 [3 favorites]

smoke: "due to a cultural construct that they are somehow demi-gods"

Not unlike drinking at work, I believe that this cultural construct is pretty well-eroded. Even as far back as the 1980s, you had surveys like this one, finding that some 70% of folks believed doctors were paid too much. I round with some attending physicians who entered practice in the '60s, and they will talk of a time when their field was more prestigious and they were afforded a higher place in society, but my experience of docs under 40 (and especially those who entered practice after the IOM published To Err is Human) is that they don't feel particularly revered or worshiped.

Rather, I'd say that the confidence/egoism/narcissism/hubris of the docs I've trained under stems from the very real fact that they are some of the most highly-trained members of society. Med school is about 9,000 hours or instruction and study, give or take. Add that to a three year residency (about the shortest you can get away with) and you've got 20,000 hours (nearly double for some surgical specialties) over seven years (averaging about 60h/wk) spent learning how to take care of patients. Judges take about 13,000 hours; computer science experts about 15,000. It takes a long time and a lot of effort for relatively little reward, but damned if by the end of our training we are not whip-smart when it comes to medicine, and I've seen more than a few try to suppress their utter indignation when some parent comes in waving blog printouts about mercury in their vaccines.

Of course, as has recently been pointed out in another thread, the water can be deep without the river being particularly wide. To drag Socrates into the blue yet again,

At last I went to the artisans. I was conscious that I knew nothing at all, as I may say, and I was sure that they knew many fine things; and here I was not mistaken, for they did know many things of which I was ignorant, and in this they certainly were wiser than I was. But I observed that even the good artisans fell into the same error as the poets; -- because they were good workmen they thought that they also knew all sorts o high matters, and this defect in them overshadowed their wisdom; and therefore I asked myself on behalf of the oracle, whether I would like to be as I was , neither having their knowledge nor their ignorance, or like them in both; and I made answer to myself and to the oracle that I was better off as I was.

I've witnessed attending physicians work themselves up over Obama's birth certificate. I've heard abysmal financial advice dolled out by surgeons who should know better. Every doc has an opinion about the ACA but not many of them really understand the policy behind it. All of us have witnessed the particular but reproducible idiocy that occurs when physicians go to Washington.

So yeah, I still don't understand why people listen when doctors talk outside their expertise. But then I also don't fully understand why people refuse to listen when doctors talk inside of it.
posted by The White Hat at 5:14 PM on October 25, 2013 [4 favorites]

I’ve lost count of how many times I’ve seen elderly men fall from places where they should never have been – ladders, trees, even roofs.

This is giving me flashbacks to my favorite elderly church member, Henry, helping out with Christmas decorating. They take the biggest rickety wooden ladder we've got, put it on the pews, and reach up to put garlands on the hanging lantern lights in the sanctuary. I begged them to stop doing that but I have no idea if they listened. Henry does what Henry wants!
posted by ThePinkSuperhero at 8:02 AM on October 26, 2013

I’ve lost count of how many times I’ve seen elderly men fall from places where they should never have been – ladders, trees, even roofs.

I've spent a lot of time in assisted-living and nursing homes the past few years and it has done a lot to reenforce my feeling that the proper approach to life is that your willingness to do increasingly risky but fun activities should increase with age. If I reach my 80s, I'll be the guy base jumping in a wing-suit when I'm not cave diving or motorcycle racing.
posted by LastOfHisKind at 9:56 AM on October 26, 2013

I work in the finance industry and, anecdotally, MDs seem to get scammed by investments at a lot higher rate than the "regular" person, because they are so sure they're smarter than the average bear, and they mistake their very intense trade schooling for a broad understanding of the world. It's very easy to play on that if you're a scam artist.

tl;dr: MDs fall for some dumb shit, financially.
posted by small_ruminant at 2:07 PM on November 1, 2013