Sunday, November 1, 2009

Stupid People

An acquaintance of mine recently started work at the phone advice centre for our health authority. This service allows patients to call 24 hours a day and speak to a nurse who will triage according to protocols and give advice. This hopefully avoids some ER visits while getting some people who need to get into the ER right away into the ER right away.

She has been quite frustrated with just how stupid people appear. She feels that by tolerating their stupidity she is "enabling" them.

This of course reminds me of when I first started out doing locums as a family doctor. I was on call for a large clinic. They had a lobster party that night and even though I was on call for the group, they suggested I come out after the evening clinic as on call meant for the most part answering phone calls. At some point in the evening I had to call a patient who had called the answering service. I had already spoken to her earlier that day. One of the doctors overheard my end of the conversation and remarked when I hung up, "They don't teach you how to talk to stupid people in medical school do they?"

How true.

Both my parents were professionals and highly intelligent. I grew up in a middle class/upper middle class neighbourhood and went to a really good school. From junior high on academic and non academic students were segregated into different classes. I hung out mostly with the academic kids. I then went to university and on to medical school. Now some of the people I knew in University and Medical School weren't the sharpest knives in the drawer but we didn't have to deal with them except maybe to laugh at the stupid questions they asked during lectures.

Maybe I am a little dense but it wasn't until my internship that I noticed that there was this large underclass of people who didn't grow up with well educated parents, go to nice schools let alone university. These people showed up with complex problems that required some work on their part and some insight into their condition. And back then and now I still have a hard time putting a complex problem into simple words that can be understood.

Before the advent of pre-assessment clinics and screening, we saw most patients the night before their surgery and a few days pre-op in a pre-assessment clinic. When I worked at the CofE, just about every patient presenting for inpatient surgery was about to have some type of terrible horrendoplasty. I would sit there, try to make sense of their usual complicated medical history, and then try to explain the anesthetic aspect of their care including the epidurals, art lines, central lines and the possible ICU stay they were about to experience. I tried to go slowly. After all this, I would ask if they had any questions. Inevitably they asked one or more of the following three questions:
1. What time is my surgery?
2. How long will my surgery last?
3. Am I going to see my surgeon today? (I started replying, " I don't know, I'm not his secretary" until a patient complained about this.)

As a resident, when we did elective C-sections we actually used to give patients the choice between regional and general (as opposed to now where the OB tells them they are having a spinal). I actually overheard a person say, "Well if he doesn't know what is best, how am I supposed to decide". So much for informed consent.

Stupidity should not be confused with the absence of education nor does education guarantee the absence of stupidity. Stupidity is not just endemic in patients, it has infiltrated the system. Much of the administrative policy over the last 20 years has either been malicious or stupid. I think stupid. I used to think most internists and pediatricians were intelligent people who just lacked common sense. I know just think most of them are just plain stupid. I have already on this blog said what I think about surgeons. And yes, we have stupid anaesthesiologists too!


toast said...

As the great philosopher Jimmy Buffet says "There's no dumbass vaccine." Stupidity contributes to bad health in so many ways, yet it is a diagnosis we are not allowed to make. I guess because treatment is limited. In extreme cases, stupidity is a fatal condition. Come to think of it, death may be the only resolution of stupidity.

Bleeding Heart said...

It would be great if stupid people died younger; as far I can see they only seem to make the rest of us die earliers