Dr. Leap: I’m the doctor, that’s why!

I’m the doctor, that’s why! (This months EMN column) at edwinleap.com
This is the age of intellectual democracy. In a frightening departure from millennia of human tradition, everyone is now an expert in everything. Turn on the television or surf Internet news services. We somehow believe that polls of individuals are useful for guiding policy, in everything from international politics to morals and religion. Legislators and marketing experts trust this information, as if masses of humans had extensive experience in diplomacy and warfare, in economics and federal tax structures, rather than what so many do have expertise in; video games and the accumulated out-takes from American Idol.

It’s especially odious in the world of medicine. How many times do we argue with patients that they don’t need an antibiotic or x-ray, admission or laboratory test? A family once skeptically asked me to show them the x-ray I had taken of their child, who swallowed a coin. Once they saw it, they were satisfied that I hadn’t missed anything. They weren’t radiologists, but they were experts. Because any idiot can be a physician, right?

Sing it, brother!


  1. It is with great frustration that I read your comments on Dr. Leap’s article in Emergency Medicine News. As a parent, of a six year old boy who was diagnosed with high risk stage IV neuroblastoma just prior to celebrating his second birthday and then progressing over upfront and secondary treatment modalities. Followed promptly by numerous pediatric oncologists across this great country of ours advise us to take him home and allow him to die with dignity.

    My boy is now six years old and off all anti-cancer treatments for over two years and free from the burden of neuroblastoma growing in his little body. Aside from hearing aides and a torso that looks similar to worn out cutting board, one would never know of his journey. Our son has had life joy and happiness precisely because we REFUSED to buy into the “Doctor knows best” mindset.

    We, as parents, learned everything possible about our son’s cancer, devised a conventional treatment regimine and then found doctors who would adminster the anti-cancer agents we wanted adminstered. We bravely plunged into uncharted territory with the FDA, NCI and pharma successfully, without one day of med school or practice.

    Fortunately one doesn’t need med school, fellowships and fancy addedums to their names to fight for the life of their child. Fortunately we live in a country where the freedom to choose compassion reigns for some.

    MD does not mean Medical Diety.

  2. Let’s see, this long monograph was brought on by ‘great frustration with your comments’, which were, in toto:

    “Sing it brother”.

    Yes, I can see why that would cause a 5 paragraph denuncination of doctors (an interesting tale without a shred of evidence), which, even if true, isn’t the way to bet.

    Frankly, seems you just want to be outraged about doctors in general, and are looking for an outlet.

    This isn’t it.

  3. Oooh, my fave is when a patient leans over, looks at his ECG and tells me it looks just the same as always.

  4. Had to respond b/c I really dig Dr Leap’s editorials. Personally, I think he is totally underrated. Don’t get me wrong, I respect and encourage patients to take an active role in their treatment. Still, I feel at times that no matter how thoroughly you explain why their condition does not merit an x-ray, patients will not be satisfied without one. Thus was conceived the miraculous diagnostic AND therapeutic radiograph.

  5. Capt Kirk says:

    The only times I’ve really gotten into trouble have been the times I’ve told patients/moms/family that they “didn’t need that X-ray/test”. I remember telling a mom that her teen daughter had a small cut to her head from the car accident, and that X-rays were not indicated. She insisted, and I did the skull films, to find a depressed skull fracture. Did a CT, found brain injury in frontal lobe area, with no neuro findings. Sutured the wound and found the fracture – but what if I hadn’t found the fracture on exploration? Dang.

    Saw a 16 yo male with left thigh pain for 3 months after playing soccer. Seen at an urgent care when this first manifested, told he had a strain, and sent home. It kept hurting and now was swelling. Simple X-ray showed a huge bone tumor – the soccer story was a red herring. Would I have X-rayed this “injury” initially? Probably not, but I think about it every time I don’t listen to what the patient wants and expects.

    My uncle had a cough and saw his primary doc who told him not to worry about it. It continued for a month, then 2, and finally he saw someone who did an X-ray and found lung cancer – too late to treat. Uncle wanted a chest X-ray, but doc talked him out of it.

    Now, most of the time, I don’t X-ray ribs for rib fractures or CT brains for bumps, but I also tell the patient that they are the “client” and that we can discuss what options are available. And when I find myself getting condescending, I think about the misses that maybe could have been foreseen.

    Wow – I just read what I wrote. Boy, do I sound condescending. Shit. Nevermind.

  6. As a doc I always tell the patients what I think is going on, and why I think certain tests would be of low or no yield. I try to give them as many stats as i can or as much as they want to know. But I recognize that patients LIKE TESTS. Before I do a test I always tell the patient about the cost of said test and potential side effects (CT scans emit a great deal of radiation, so head CT’s on 4 year old kids are a bad thing if they are unnecessary). And while i used to pride myself in being a minimalist, i now recognize that 1) it’s the patient’s body, not mine, and 2) a negative test that alleviates fear in a patient still has value.

    I’ve seen brain bleeds in 23 year old migraneurs with ‘typical symptoms’ and active heart attacks in folks that presented with head lacerations or tounge pain. I realize my field is a little different, but patients come see me because they are concerned about their health (in general). I owe it to them to share that concern.