Reply to an e-mail concerning the medical profession

This is a reply to part of an e-mail which I have received. I am unable to provide direct replies to emails without a consultancy fee, as specified elsewhere on this website, but I am providing a public reply to part of this one.

The person who sent this email objects to the fact that I find the medical profession, as it operates at present, immoral and oppressive. In her view, 'If your car breaks down, you take it to the mechanic. If you get sick, you see the doctor to help diagnose the problem and fix it.'

In fact, interacting with a motor mechanic is a very different matter from interacting with a doctor (or docturd, as I prefer to call them). In dealing with a mechanic you are not expected to abandon your critical faculty, and you are free to consider whether he is dishonest, incompetent, or exorbitantly expensive. You are free to consider that he may completely misunderstand what is wrong with your car, and that in any case the process of getting your car repaired might be less arduous if you did the work yourself, whether or not that would involve you in researching certain aspects of car maintenance. The information is not made difficult to access, nor are the spare parts, tools, and other materials only available to qualified motor mechanics or on prescription from one of them.

If you are fed up with a given mechanic, it is not difficult to take your problem to someone else whether qualified or unqualified, without obtaining permission from the first mechanic to do so. Also, of course, you are stuck with your physical body in a way that you are not stuck with a car. If the problem of finding a mechanic to deal with a specific problem appears insuperable, you can sell your car and get a new one.

I note also that this correspondent makes an assertion about the motivation of the medical profession. 'The medical profession is here to serve us, not enslave us. …. They are not out to degrade or enslave you in any way. It's just a job…' The acceptability of the medical profession, as it operates at present, depends on entertaining certain beliefs about the psychology of those who pass the necessary examinations to become qualified sadists (docturds). This is no more justifiable than expecting people to believe in the virgin birth: in fact it is worse because people are supposed to expose themselves to certain risks on the strength of it. So it is something comparable to expecting them to entertain a belief in the prophylactic powers of shirts made from the feathers of certain birds, as did the red Indian tribe which was massacred by lead bullets.

In a free market transaction, one does not have to abandon one's right to evaluate the motives and intelligence of the person who is selling you something as best one can. In fact, the old-fashioned dictum was, 'Caveat emptor', or, 'the buyer had better look out for himself'.

An article in the Investors Chronicle of 7th February 2003 (page 52) has this to say about the comparison between a wealth manager and a car mechanic. The ideas expressed apply just as well to a comparison between a doctor and car mechanic.

'We have to assume that the so-called 'experts' are motivated to deploy their knowledge for our benefit. That idealised notion is not one you'd believe when taking your car to the mechanic, and it's no more likely when you hand over savings to a wealth manager.
If advice you've paid for needs careful interpretation, imagine the caution needed with free financial advice.'

The writer goes in to recommend a suspicious attitude towards recommendations from corporate business advisors, which may be assumed to 'capture insider insights', but in fact express pontifical conclusions with no indications of the underlying reasoning or motivation that went into arriving at them.

'Instead of giving us reasons to expect retailers to fall even more than they have already, we are treated to familiar notions that consumer confidence might fall if house prices drop and there's a prolonged conflict in the Gulf.
This is not to damn all surveys. They're useful when they tell us things we didn't already know - or couldn't have deduced from other sources. But what Grant Thornton hasn't done is explain why its panel of bankers and lawyers should have a better angle on the future path of market returns than the rest of us.'

Such considerations apply at least as much to doctors as to financial advisors, but in the case of the former it is taken for granted that they will make their judgements, and make or refuse prescriptions, with no reasoned explanation of the factors that have gone into their doing so. Not that it would make the situation acceptable if they did, because the right to argue is of little value when you are arguing with someone who has the right to make the decision about he likes to regard as being in your interests, whereas you have no right whatever to do so yourself.

One might also apply this line of thought to other 'experts' who pontificate about what is good for other people. For example, educational experts, who have a very clear ideological axe to grind, and would not have been appointed to their socially prestigious positions if they did not.

Celia Green
February 2003

Medicine\medical email reply for website jan 2003