Monday, October 20, 2008

The Doctor Will Insult You Now

"I have a certain alacrity in sinking."

Falstaff


Medical horror stories aren't hard to come by, but sometimes the seemingly minor ones are both most telling and most poignant (the ones about surgeons cutting off the wrong body part are more titillating but, fortunately, more exceptional).

I saw a morbidly obese woman who told me that the medical doctor she had seen in a small town free clinic called her a "fat ass." She is a bit acerbic in her manner, and maybe something she said rubbed the doctor the wrong way, but needless to say this sort of thing does not endear one to the medical profession. I'm glad for her sake that is was a free clinic--one would hate to have to pay out of pocket for that kind of treatment (adding insult to injury you know).

But then again, maybe the doctor was resorting to a little-used therapeutic tool: insult therapy. Granted, obese patients will often have received myriad insults from family, "friends," and acquaintances over the years, but such lay insults are less effective than those delivered by someone in a white coat. This is both a low-tech and a time-effective treatment--without any instrumentation at all, a callous, moralistic, and demeaning tirade of considerable detail may be delivered in less than five minutes.

Insult therapy has been inadequately studied, not least because it is difficult to devise a control condition for blinded studies. In fact, few are aware that insult therapy has not in fact been demonstrated, in rigorous random and controlled fashion, not to be effective for any number of conditions which could have a behavioral component. It reminds me somewhat of ultra-brief, one-time "get a life" psychotherapy, which is similarly underresearched.

Not having been trained in this sort of treatment, and somewhat lacking in general aptitude, I could only shake my head in wonder as my patient described her doctor's approach.

(For any literalists still out there, this was irony).

2 comments:

Dr X said...

(For any literalists still out there, this was irony)

You haven't been blogging for long, but I see that you're thoroughly acquainted with the need to explain things that you shouldn't have to explain.

Punditarian said...

Another possibility is that what the patient told you she heard was not what the doctor said.

An old, wise teacher of mine counseled me never to believe what a patient tells you another doctor said or did.