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Medical Windmills

Medical Windmills

I have practiced medicine for over thirty years. And during my career, I have had probably close to twenty thousand patient care encounters of one kind or another. Helping the infirm in my office is enjoyable and never boring. I never know who will come through my doors with a desire to heal from a mystery disease of some sort.

After reviewing hundreds of medical histories, examinations and notes from my contemporary medical care providers (whether physicians or physician extenders), I believe there is an unusual insanity that has infected our healthcare system. Insanity? What insanity? It is my recurrent observation that when apparently healthy people show up to a physician's office with a list of debilitating symptoms and few clinical signs of active disease, the practitioners routinely dismiss the patient's complaints. Ultimately offering the majority of them mood altering medicines as treatment for non-emotional or psychological problems. Sometimes they make a referral to a mental health professional as well as a list of other medical specialists. There seems to be this inverse relationship between appropriate or attractive visual appearance and number of symptoms: the better someone looks and the more they complain of being ill, the more likely it is for their healthcare provider to label them hysterical or depressed.

Some of my patients have been passed around to at least five specialists as if they were participating in a game of pitch the hot potato. It seems as if the last specialist becomes their last possible hope of getting a diagnosis, and maybe a treatment plan. But too often, all of their physicians are stymied. The patient then embarks on a rather complicated and disjointed journey through the world of alternative medicine. Many times they experience the same kind of attention in the complimentary medical world. What is it about looking normal or well and being sick? There seems to be a contagious thinking disturbance amongst those who practice medicine. I call it Don Quixote Syndrome.

Perhaps you recall reading the novel El Ingenioso Hidalgo Don Quijote de la Mancha by Miguel Cervantes in a high school or college literature course. I have this imprinted image of Don Quixote in my mind: an old skeleton of a man, on an old bony horse, with a lance in his hand, wearing an old dirty, set of worn out armor and a helmet made out of a brass shaving washbowl. He is extremely romantic and idealistic to the point of absurdity. He becomes a knight-errant, desiring to bring justice to an unjust world. He finds a lady to love and recruits a squire named Sancho Panza.

Don Quixote is profoundly delusional. And all of the people he encounters plays along with his delusions. He charges at windmills believing they are dangerous giants. When he actually hits one during his attack, he is knocked off his horse by the powerful motion of the windmill's sail. At the point of impact, he realizes that he stormed a windmill, not a giant and lost the battle. He rationalizes his bizarre behavior by adopting the idea that an enchanter changed the giants into windmills to deprive him of his glory of victory. Regardless of his encounters, he reworks almost every conflict he has with reality into the symbols of his own fantasies.

So what would the Don Quixote Syndrome be in reference to healthcare providers? The absurd delusion that those patients who look well but are profoundly ill and seek medical care for their malady are actually overcome by an enchanter's spell of depression and/or hypochondria. I see these healthcare professionals as wannabes. They have the proper credentials to diagnose and treat disease, but lack the insight to dissect and indentify a medical disturbance that does not fit their medical worldview, especially if the illness arises in a patient who looks absolutely anatomically normal or even attractive. In the hour of uncertainty, it becomes convenient to label a complex infirmity as an emotional or social ailment brought on by some remote troublesome event. When I was in medical school in the 1970's, it was common for physicians to use the phrase, "It's a virus causing your problem" as a way of saying, "I don't have the faintest idea about what is causing your symptoms." The old phrase, "It's a viral illness" has been transformed to, "Here's some ProzacĀ®."

Recently a patient traveled north to an out-of-state tertiary care facility seeking advice about her husband's cancer. While speaking to his oncologist about her husband's prognosis, his cancer specialist asked her about her health. He thought she looked bad. She had lost weight on the Paleo diet. She told him about her diagnosis and showed him her medications. He immediately had her seen by their in-house specialists. It's no surprise that her new expert physician took her off all of her medication, pronouncing that she did not have any active or live disease. Within three weeks, her symptoms all reappeared. She returned to my office asking to get back on her medications. And she did. Prior to being on the medications a year ago, the patient looked good but felt really bad and no one could tell her what was wrong. They just told the pentagenerian she was aging, depressed and overworked.

It is not uncommon for paramedical support staff to play along with the physicians delusions about a patient's illness. It is common for nurses and medical assistant to absorb and reflect their physician's diagnosis even when they feel the patient is sicker than the physician realizes. When patients ultimately finds a doctor to listen to them and he/she creates a successful therapeutic adventure, their original practitioner deals with the reality conflict by recognizing that an enchanter changed the nature of the illness to deprive them of the glory of making the correct diagnosis and prescribing the appropriate treatment.

Be mindful of the delusions your healthcare provider lives by. If their explanation of your chronic active physically debilitating illness is a result depression because your scans and tests were normal, walk out of their office. There are hundreds of Don Qxiote MD's out there who are attacking all sorts of medical windmills. At the very least, make sure that you're not on the back of their bony horse when they charge. It could be dangerous.


Posted by Amanda Sanders at 8:54 AM
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