They Don’t Need To Understand — They Are Peasants!


Beneath the University hospital that was associated with the medical school I attended in Amiens, France there was a seemingly infinite maze of interlocking concrete passages that connected all of the different “pavilions” (“units”) of the hospitals. I remember how my feet echoed as I walked along those corridors.

They had been constructed during World War II, to bring the hospital safely underground in case of German Bombing.

One day I was walking in step with all the other surgeons, echoing together, with a regular beat.

A patient’s family came at us from another direction. They thought it was fortuitous that they were approaching the chief. He was a generally inaccessible human, tall with a blond pompadour.

They had him “nailed.”

They asked how their relative was doing and what he was going to be like after the intra-extracranial anastomosis of his arteries.

They were humble and respectful.

He excused himself as the whole department was hurrying.

He explained the complex procedure as quickly as a human could and excused himself to keep walking. The folks were open mouthed but bowed their heads slightly in respect.

He told them to call the office, and he would talk more when he could.

I knew that would be even quicker and faster.

I was even more naive and idealistic then. I commented to the chief of Neurosurgery that I did not think the (obviously peasant) family that had accosted us in the concrete passage understood very much of what he had said. He did not even turn his face toward me as he answered my comment.

“They don’t need to understand. We will perform the operation perfectly. They are peasants. All you have to do is baffle peasants enough that you sound educated. They will then trust you.”

He picked up the pace of the group as we hurried to our destination.

I tried to rationalize it then. After all, this happened in Europe. My medical colleagues were all “upper class” in a country that was still very sensitive to class distinctions.  I believed, then, that such remarks, such attitudes, were impossible in America.

Every day I meet both patients and friends who have been treated in exactly the same way by their doctors.

They have been baffled by the results of tests, which they have been told are abnormal, but the significance of which has never been explained to them.

They have signed “informed consents” with no description of alternative procedures available.

Is this because the doctor is afraid of losing a patient if they prefer some other kind of treatment?

Patients are never informed about natural or alternative treatments or natural or alternative research data. Or ongoing research regarding their diagnosis.

Mind you, I am working in the region of greater Los Angeles, where there are many University Research Centers, and that research treatments are free of charge.

To get the best treatment possible, a patient must become an intelligent consumer of healthcare services.

With many of patients, certainly all of them that have underlying medical illness, this could actually be the most important skill I can teach my patients.  If you just can’t get enough of my stories, you should follow me on Facebook.

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