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September 22nd, 2014

Some thoughts on listening to patients

A couple weeks ago, before we started the second leg of our book tour promoting More Than Two, I went to the dentist. I had a couple of old-style silver amalgam fillings that were disintegrating (who, I wonder, was the first person to say "Silver and mercury! I know, let's put that in people's mouths!"?), so I decided to pay someone to take a small high-speed drill and root around in my mouth for a while.

Now, whenever I go to a new dental practitioner for the first time, there's a little speech I have to give. It's my mother's fault, really. She has some kind of genetic quirk, you see, that makes her for all intents and purposes immune to common local anesthetics in the Novocain/procaine/Lidocaine family. I appear to have inherited a genetic allele from her that gives me a high degree of resistance to these anesthetics, which is, as you might imagine, more than a little inconvenient when facing a trip to the dentist.

Anyway, the little speech. It hasn't varied much over the past few decades, and it goes something like this:

Before we get started, you should know that I am highly resistant to local anesthetics like Lidocaine. It's really, really hard to get me numb. It is probably going to take you a lot of work and multiple tries before I'm numb, and it wears off very quickly.

Now, every time I give this little speech--every single time, with only one exception ever (when I went to an oral surgeon to have an impacted wisdom tooth chiseled out with a backhoe, farm equipment and oil-drilling machinery), the result is always the same: "Oh, pish-posh. I won't have any trouble at all!"

And then the misery starts.

This last go-round, it took my dentist no fewer than six rounds of injections before I was finally ready to have the old filling carved out. Three rounds in, she jabs me with the needle and I'm all like "Ow!" and she's all like "you can still feel that?" and I'm all like "remember how I said I am resistant to local anesthetics?" and she was all like "wow, you weren't kidding!" and I was all like "I've had this conversation so. Many. Times. Before.", though that last part was in my head and not out loud, and...

Yeah.

So anyway, about that. It is perhaps not surprising that some folks might greet claims of being resistant to anesthetics with skepticism--genetic resistance is documented, but uncommon1 (thanks, Mom!)--but to just dismiss them outright, and especially for everyone in the profession to dismiss them outright, seems to me to speak to a systemic problem. And that systemic problem is, we train doctors to be good at all the parts of treating patients except listening to patients, which might be argued to be rather an important bit.

Pseudoscience, quackery ("this random thing cures cancer! Big Pharma doesn't want you to know, which is why you're finding out about it in a Facebook group!"), and snake oil "medicine" are huge, and deadly, industries. According to an NIH document reported on NBC, alternative "medicines" (which might reasonably be described as anything that hasn't been shown to work, since the name for things that have been shown to work is just "medicine"), is a $34 billion a year industry. That's a lot of herbs, acupuncture, and magic water full of mystical energy vibrations but nothing else.

There are lots of reasons why. Anti-intellectualism is a big one, and the fact that anti-intellectualism tends to be joined at the hip to conspiracy nuttery doesn't help. Rejection of science, distrust of "big corporations" (except the big corporations marketing herbal supplements, naturally), superstition, wishful thinking...all those things play a part.

But some of the problem is, I think, self-inflicted. Too many medical practitioners are at best dismissive of, and at worst hostile to, their patients' own self-reported information. There are probably a bunch of reasons for that, from fear of drug-seeking behaviors (and the spectacular fuckedupedness of a medical establishment that doesn't take pain management seriously is worthy of a blog post of its own!) to simple arrogance.

The new flavor of trendy pseudoscientific bullshit is the claim that cavities can be "cured" by minerals and "oil detoxification," and unsurprisingly, this new brand of bullshit smells pretty much the same as all the old brands.

But dammit, I wish my dentist would listen when I say local anesthetics don't work very well on me, instead of having to find out through painful (to me, that is, not to her) experience.

1 According to Wikipedia, the genetic allele associated with lidocaine resistance is linked to ADHD as well. Go figure.