In “Decoding the God Complex” MoDo says Dr. Jerome Groopman may look like God, as Stephen Colbert noted, but he and his wife, Dr. Pamela Hartzband, avoid the God complex. The Moustache of Wisdom, in “2 for 2, or 2 for 1?”, says the breakdown in the Middle East peace process really does have us back at Square 1. Here’s MoDo:
Medical schools are starting to train doctors to be less intimidating to patients. And patients are starting to train themselves to be less intimidated by doctors.
We haven’t completely gotten away from the syndrome so perfectly described by Alec Baldwin’s arrogant surgeon in the movie “Malice”: “When someone goes into that chapel and they fall on their knees and they pray to God that their wife doesn’t miscarry or that their daughter doesn’t bleed to death or that their mother doesn’t suffer acute neural trauma from postoperative shock, who do you think they’re praying to? … You ask me if I have a God complex. Let me tell you something: I am God.”
But there have been baby steps away from the Omniscient Doctor. The federal Agency for Healthcare Research and Quality has begun a new campaign to encourage patients to ask more pertinent questions and to prod doctors to elicit more relevant answers.
“I used to think, ‘He’s a doctor. Who am I to ask a question?’ ” Bill Lee, a Baltimore man who has suffered 10 heart attacks, says in a video on the agency’s Web site urging people to speak up.
Patients have more options, a flood of Internet information and a bombardment of drug ads listing side effects — and that can be terrifying. It adds to the general anxiety level that health insurance costs are rising sharply and that President Obama’s health care law seems headed toward the Supreme Court.
The “experts” are always issuing guidelines, which are soon contradicted by another set of “experts.” It happened with the recommended age for regular mammograms, and it’s happening with guidelines on hormone replacement for postmenopausal women.
First, estrogen was going to be the fountain of youth. Then hormone replacement therapy was going to spell doom, causing heart disease, stroke and breast cancer. And now, as The Wall Street Journal reported on Tuesday, “some experts are reaching a more nuanced view of the risks and benefits and concluding that hormone therapy may still be a good option for healthy women in their 50s, depending on their symptoms, family history and worst fears.”
Each patient, a Michigan gynecologist told The Journal, is like a Rubik’s Cube, and must get an individual solution.
That is also the message of a new book, “Your Medical Mind: How to Decide What Is Right for You,” by Jerome Groopman, an oncologist, and his wife, Pamela Hartzband, an endocrinologist, both members of the Harvard faculty and staff physicians at Beth Israel Deaconess Medical Center in Boston.
Few people have done as much to demystify medicine as Dr. Groopman, who has written four other books and lots of New Yorker essays aiming to help doctors understand that patients are often neglected allies with good intuition, and to help patients get confidence and control by understanding how doctors think.
Like a Middle East peace broker, he aims to lower the stress level and bring together two sides who perpetually misunderstand each other.
With his white beard, 6-foot-5 stature and friendly manner, the Queens native certainly looks trustworthy. Stephen Colbert once accused Groopman of “trying to look like God.”
And I can say from personal experience — since I’ve known him, he’s provided guidance that helped save the lives of three members of my family — that he is a fierce, sensitive and generous patient advocate. (And an aficionado of Irish literature.)
Dr. Hartzband and Dr. Groopman warn against excessive reliance on overreaching so-called experts and nebulous metrics and statistics.
“The answer often lies not with the experts but within you,” they write, adding that the Albert Einstein line is apt: “Not everything that can be counted counts, and not everything that counts can be counted.”
The authors stress that “the best” and “informed” can be subjective terms, and that your prognosis can often look very different if you “flip the frame” of reference.
They try to decode the Orwellian language that prevents physicians and patients from cooperating, and show how doctors can project their own preferences on patients.
They interview patients who are Doubters and Minimalists, who may agree with Voltaire’s view that “the art of medicine consists in amusing the patient while nature cures the disease.” And they interview Believers and Maximalists, who go for radical treatments too quickly. They confess that they have a mixed marriage: Dr. Hartzband tends to be a Doubter (her mom’s mantra was “Doctors don’t know everything”) while Dr. Groopman tends to be a Believer (a status that got shaken when he jumped into a spinal fusion operation that had “disastrous consequences.”)
“The unsettling reality,” they write, “is that much of medicine still exists in a gray zone, where there is no black or white answer about when to treat or how to treat.”
But they are both optimists who warn against the “focusing illusion” — focusing on what will be lost after a colostomy, mastectomy, prostate surgery or other major procedures.
“The focusing illusion,” they write, “neglects our extraordinary capacity to adapt, to enjoy life with less than ‘perfect’ health.”
Having worked for doctors for 35 years the one thing I’ve learned is you’ve got to make it clear to them that you understand that “M.D.” does NOT stand for Magnificent Divinity. Here’s The Moustache of Wisdom:
Prime Minister Bibi Netanyahu of Israel, the Palestinian president, Mahmoud Abbas, and President Obama all spoke at the U.N. last week and, honestly, it is hard to decide whose speech was worse. Netanyahu’s read like a pep rally to the Likud Central Committee. Abbas’s read like an address to an Arab League meeting. Obama’s read like an appeal to Jewish voters in Florida. The president meant well, but domestic politics required that he whisper where he once spoke bold truths to both sides.
The whole soap opera was just another reminder of how broken the peacemaking effort is today and how much both sides still suspect the other of really wanting two states for one people rather than two states for two people.
I’ll explain that in a moment, but, first, let me note that the Israeli newspaper Haaretz summed up the Netanyahu and Abbas performances perfectly, saying: “From these two narratives of demand and complaint, it appeared as if the Israeli-Palestinian conflict traveled in a time machine back to the end of the last century, and decades of dialogue were wiped out — to the great joy of the extremists on both sides. Not peace, but rather the very fact of direct contact between the parties is once more perceived as a goal, and even that is increasingly fading into the distance.”
That is, indeed, where we are — questioning whether the two sides will even talk to each other anymore, let alone negotiate an implementable deal. Yet both sides act as if time is on their side. I beg to differ.
This is a “New Middle East” — but not in the way that we had hoped. When you leave the field empty of diplomacy now, with so many unstable characters roaming around — like extremist Israeli settlers given to occasionally daubing “Muhammad is a Pig” on Muslim buildings in the West Bank and extremist Palestinians from groups like Islamic Jihad given to shooting Israeli civilians or lobbing mortars from Gaza onto Israeli towns — you are really asking for trouble because many of the old firewalls are gone.
If clashes erupt between Israelis and Palestinians today, there is no President Hosni Mubarak of Egypt to absorb the flames. Now there is a Turkish prime minister, Recep Tayyip Erdogan, ready to fan them — toward Israel. It is not an exaggeration to say that if serious clashes erupted between Israelis and Palestinians, both the peace treaties between Egypt and Israel and Egypt and Jordan could be undermined. And if Palestinian violence spreads in the West Bank, Abbas may just tell the Israelis that he is shutting down the Palestinian Authority and will no longer serve as Israel’s policeman on the West Bank. That would be the last nail in the coffin of the Oslo accords. So all three pillars of peace — imperfect as they may have been, but so vital to Israel’s security since the 1970s — are in danger.
Given these stakes, here is what a farsighted Israeli government would say to itself: “We have so much more to lose than the Palestinians if all this collapses. So let’s go the extra mile. Abbas says he will not come to peace talks without a freeze on settlement-building. We think that is bogus. We gave him a 10-month partial freeze and he did nothing with it. But you know what? There is so much at stake here, let’s test him again. Let’s offer him a six-month total freeze on settlement-building. What is six months in the history of 5,000-year-old people? We already have 300,000 settlers in place. It is a win-win strategy that in no way imperils our security. If the Palestinians still balk, they will be the ones isolated, not us. And, if they come, who knows? Maybe we cut a deal.”
That is what a wise Israeli leader would do now. And when this Israeli government won’t do that, it fans the Palestinian fears that Israel really wants two states — both for itself. That is pre-1967 Israel and post-1967 Israel, i.e., Israel, the West Bank and East Jerusalem.
The Palestinian leadership, though, could do much more to encourage such an overture because the only thing that can force Netanyahu to move is the Israeli center. It has done so before. Why not now? Because when the Israeli silent majority sees its army unilaterally withdraw from Gaza and uproot settlements there and get rockets in return, and when they see previous, dovish, Israeli prime ministers make far-reaching withdrawal proposals and get nothing back, and when they hear that Palestinians insist on the “right of return” for some of their people — not only to the West Bank, but to Israel proper — it raises Israeli fears that the Palestinians still dream of having two states, both for themselves: the West Bank and pre-1967 Israel. If Abbas spoke more directly to those fears, Netanyahu would be under much more domestic pressure to move.
We really are back at the beginning of this conflict. Until each side reassures the other that both of them really do want two states for two people — not just for one — nothing good is going to happen out there, but something really bad might.
