Why do people think they know more than doctors?

[Dr. Death]

An acquaintance of my wife has a 4 month old baby. Doctors recommend babies are bottle or formula fed until they are one year old. She doesn't breastfeed and and won't give her baby formula because "it's just corn syrup" (obviously she's not the brightest bulb in the box)

This made me think of countless other times when people believe old wives tales, the internet, their friends or complete strangers over what a qualified physician says. Why? Is it a communication or trust issue? I just don't get it. How can I get my patients to follow my recommendations?

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[Meeehai]

I think in general patient education has/will always be very poor when it comes to healthcare. A lot of people don't understand the amount of schooling and experience a doctor has to go through (in any field, really). This is why everyone wants to be a doctor when they're in high school or entering college, then when the reality of the situation hits them they back out. Your job will be to give recommendations, not force your patients to do something.

 

[Mad Jack]

Because America is awash with anti-intellectualism and it is going to destroy us as a culture.

 

[wholeheartedly]

What was she feeding the kid?


I wonder sometimes if it's because the info/solutions the non-doctors, etc give tend to be more palatable or more quick fix than taking meds, making lifestyle changes, ditching bad habits. There's also seems to be strong dislike of things that aren't natural by some people, like somehow natural is always safer. Never mind that the botulinum toxin being natural...

 

[LivMoore]

An acquaintance of my wife has a 4 month old baby. Doctors recommend babies are bottle or formula fed until they are one year old. She doesn't breastfeed and and won't give her baby formula

Then what is she feeding the baby??

 

[Cotterpin]

I don't think it's because they don't appreciate the amount of training a doctor has. I think it has a lot more to do with the perception some people have that doctors are "the man" or whatever and that there's some layer of dishonesty where doctors are just mouthpieces for some big medicine industrial complex or something. Plus with the internet, people think they can figure it out all on their own now. Like they think they're clever for rejecting Western Medicine and going with the hippie nonsense they find on the internet. A little bit of knowledge can be a dangerous thing.

 

[LizzyM]

Perhaps because some physicians sold out to corporate interests and took money (funding for continuing ed, cheap swag, nice dinners, "consulting fees") from formula manufacturers. Some members of the public may think that docs recommend formula because they are in cahoots with big business. Furthermore, despite decades of effort, nutrition is not a major component of medical education in the US. Word of mouth, peer pressure, social media can all contribute to a false sense of knowing what is "best" although it runs counter to evidence.

Given your relationship with the woman in question, you may not know what has been discussed in the clinic... or even if she has told the truth to the doctor about what she's feeding the baby. The physician's advice may come down as an order with no rationale offered whereas an essay on the internet recommending against formula comes with statements that appear authoritative.

 

[Dr. Death]

What was she feeding the kid?


I wonder sometimes if it's because the info/solutions the non-doctors, etc give tend to be more palatable or more quick fix than taking meds, making lifestyle changes, ditching bad habits. There's also seems to be strong dislike of things that aren't natural by some people, like somehow natural is always safer. Never mind that the botulinum toxin being natural...

Then what is she feeding the baby??

Juice and baby food with some adult foot mixed in I think. He's a pretty skinny baby from the one time I've seen him. Thanks for the responses everyone.

 

[Revolution9]

I think the issue is that there is so much information easily accessible on the internet that people can usually put together a reasonable solution to most of their problems based on just what is found online. I know it helped me to fix my dishwasher, change a door nob, etc. But when people start extrapolating this into the complex world of healthcare, they retain the same confidence without the competence.

 

[getdown]

First, it's inherent in the American culture of individualism where kids are brought up with the "you're special" and "you're the best" attitude without being punished when they show ignorance. This feeling of false individual superiority is retained when they're adults and now we have this problem.

Second, there's more of a shift from paternalistic medicine to where patient and provider are collaborating together in decision making. However, the downside of this is we're now too far on the other side where medical decision making is completely left to the patient or family member, who often barely completed high school and have no understanding of medical science at all. They may hear or read a few things here or there and base their decision on that. So is it so shocking that letting poorly informed people make decisions about things they don't know result in overall poor choices and bad outcomes? Do you tell the mechanic how to fix your car when you have no idea about anything car related?

Three, there's a lot of misinformation out there by people trying to either promote themselves or promote a cause . Add to that mix my first and second points above and you have a reason why measles, mumps and other diseases that have almost been eradicated by vaccinations are now making a comeback, in affluent areas of the country nonetheless.

It's a very frustrating time to be a physician these days.

 

[DokterMom]

If someone in authority tells me what to do, I may or may not do it, depending on the circumstances and my inherent biases. You see, I don't really like being told what to do -- especially when I am treated like an inferior being and given no explanations.

But if I search for information and find a source that explains why a certain course of action is best, and those explanations make sense to me and fit into my prevailing thought patterns, I am much more likely to follow those recommendations.

I'm guessing the mother in this situation was flat-out told what to do by a physician with a paternalistic tone and worldview, and she didn't like being treated like an idiot and didn't like the advice she was given. Formula is expensive and unnatural and full of chemicals... So yeah, she looked on the internet and found a source that explained to her in terms she could understand something she wanted to hear. Since the internet source probably had no profit motive in recommending 'regular food', she gave that source extra credibility...

For a patient like that, a nurse practitioner and/or nutritionist with a 'natural is better' bent might be able to get through to her --

 

[Psai]

If someone in authority tells me what to do, I may or may not do it, depending on the circumstances and my inherent biases. You see, I don't really like being told what to do -- especially when I am treated like an inferior being and given no explanations.

But if I search for information and find a source that explains why a certain course of action is best, and those explanations make sense to me and fit into my prevailing thought patterns, I am much more likely to follow those recommendations.

I'm guessing the mother in this situation was flat-out told what to do by a physician with a paternalistic tone and worldview, and she didn't like being treated like an idiot and didn't like the advice she was given. Formula is expensive and unnatural and full of chemicals... So yeah, she looked on the internet and found a source that explained to her in terms she could understand something she wanted to hear. Since the internet source probably had no profit motive in recommending 'regular food', she gave that source extra credibility...

For a patient like that, a nurse practitioner and/or nutritionist with a 'natural is better' bent might be able to get through to her --

Oh god

 

[Cotterpin]

If someone in authority tells me what to do, I may or may not do it, depending on the circumstances and my inherent biases. You see, I don't really like being told what to do -- especially when I am treated like an inferior being and given no explanations.

But if I search for information and find a source that explains why a certain course of action is best, and those explanations make sense to me and fit into my prevailing thought patterns, I am much more likely to follow those recommendations.

I'm guessing the mother in this situation was flat-out told what to do by a physician with a paternalistic tone and worldview, and she didn't like being treated like an idiot and didn't like the advice she was given. Formula is expensive and unnatural and full of chemicals... So yeah, she looked on the internet and found a source that explained to her in terms she could understand something she wanted to hear. Since the internet source probably had no profit motive in recommending 'regular food', she gave that source extra credibility...

For a patient like that, a nurse practitioner and/or nutritionist with a 'natural is better' bent might be able to get through to her --

So this is why there's such an emphasis now on a physician's people skills, understanding of psychology and sociology, etc. If we're going to be able to help people like this, we need to communicate with them in ways that they're going to be comfortable with, no matter how much we might internally be rolling our eyes at the some of the stuff they believe.

 

[JohnConstantine511]

Reading the above posts, most of what I was about to say has already been said.

Pre-Internet Era--Your source of information largely came from the Physician.

Now--With the abundance of information readily available to the public, people are seeing radically different philosophies from many so called 'experts'. The abundance of pseudo-scientific information is astronomical. (That is not to say there is a lot quality information on the Internet. Which there is.) Misinformation combined with the lack of context, since many approach this with no scientific training beyond high school.

Combine this with the overall distrust for science. The average layperson willing to take the scientific opinion of a political talk show host over the general consensus of a community of science PhD. (e.g. evolution or global warming) People willing to believe obviously debunked hypothesis's (e.g. vaccinations cause Autism.) Some think they are cleaver for not going with mainstream science.

One obvious benefit of a Physician's rigorous scientific training followed by clinical training is discernment. To approach the abundance of information that has proliferated the average consumer and separate the 'wheat from the tares' proverbially. The passive consumer doesn't have that rigorous training to have such discernment.

It's funny, 100 years ago the Flexner Report came out calling for Physicians to undergo rigorous scientific training first before going into to the clinic. Now in lieu of so much progress it is very evident that it is still very much needed.

Now, I am NOT saying we should have a model where the Physician makes a decision with no patient input. However, the input should be guided input by the Physician and the patient should definitely get a second opinion. There are many 'clever' people who have done a lot of damage to themselves and their children because of bad information (e.g. not vaccinating)

 

[Lannister]

It kind of bothers me that so many intelligent, well-educated people are so judgemental of the vast majority of Americans who have less natural intelligence and perhaps did not have access to as good of an education as they did. This woman is doing what she thinks is best for her son, just like people who don't vaccinate their kids are doing what they think is best for their kids. They're just scared and misinformed, they're not purposely trying to harm anyone, so why are we so aggressive towards them? If we treat them like they're stupid and evil then we're probably just going to push them to keep mistrusting doctors. We'd have more success getting them to listen to their doctors if we are understanding and listen to their fears and don't judge them so harshly.

 

[Doudline]

Recently one of my relatives went to the doctor for a check-up during recovery from an illness. The doctor told this person, I'm paraphrasing, to eat a lot of "good things", like "white bread" and "fruit juice", to ensure maximal recovery.

Granted, the MD was in his early sixties, and probably hadn't opened a nutrition book since medical school. Nonetheless, physicians as a group do not have the first clue about nutrition. It's barely taught in many medical schools, and quickly forgotten. I'd trust my doctor without second-thought on most medical issues -what other option do I have?- but certainly not on nutrition.

 

[getdown]

If someone in authority tells me what to do, I may or may not do it, depending on the circumstances and my inherent biases. You see, I don't really like being told what to do -- especially when I am treated like an inferior being and given no explanations.

But if I search for information and find a source that explains why a certain course of action is best, and those explanations make sense to me and fit into my prevailing thought patterns, I am much more likely to follow those recommendations.

I'm guessing the mother in this situation was flat-out told what to do by a physician with a paternalistic tone and worldview, and she didn't like being treated like an idiot and didn't like the advice she was given. Formula is expensive and unnatural and full of chemicals... So yeah, she looked on the internet and found a source that explained to her in terms she could understand something she wanted to hear. Since the internet source probably had no profit motive in recommending 'regular food', she gave that source extra credibility...

For a patient like that, a nurse practitioner and/or nutritionist with a 'natural is better' bent might be able to get through to her --

This is where the problem lies. You're basically saying that if you go to a doctor and he doesn't tell you what you want to hear you'll look online for sources that confirm your preconceived notions and the follow that instead regardless of if there is any or abundance of proof on the contrary. Do you bother searching if whether what the doctor told you is correct? Did you even ask him to clarify his reasoning. Sometimes we don't have the time to sit down with every patient and spend 30 minutes telling them what and why are thought processes are. Mostly it just doesn't pop into our heads to do so but if you ask most will try to explain it to you. I'm not saying doctors are infallible and with all the recent news of doctors prescribing/performing unnecessary stuff to make money definitely makes us look bad but a majority of us aren't in it to harm or belittle our patients. We just have a million things going on in our heads at the same time.

 

[Lannister]

Recently one of my relatives went to the doctor for a check-up during recovery from an illness. The doctor told this person, I'm paraphrasing, to eat a lot of "good things", like "white bread" and "fruit juice", to ensure maximal recovery.

Granted, the MD was in his early sixties, and probably hadn't opened a nutrition book since medical school. Nonetheless, physicians as a group do not have the first clue about nutrition. It's barely taught in many medical schools, and quickly forgotten. I'd trust my doctor without second-thought on most medical issues -what other option do I have?- but certainly not on nutrition.

Totally agree, I'm normally very trusting of my doctors but I do not at all trust that they know what they're talking about when it comes to nutrition. It's frustrating that so many people still think that bread is not unhealthy and eggs are bad for you.

 

[deleted407021]

It kind of bothers me that so many intelligent, well-educated people are so judgemental of the vast majority of Americans who have less natural intelligence and perhaps did not have access to as good of an education as they did. This woman is doing what she thinks is best for her son, just like people who don't vaccinate their kids are doing what they think is best for their kids. They're just scared and misinformed, they're not purposely trying to harm anyone, so why are we so aggressive towards them? If we treat them like they're stupid and evil then we're probably just going to push them to keep mistrusting doctors. We'd have more success getting them to listen to their doctors if we are understanding and listen to their fears and don't judge them so harshly.

The problem is that, very often, such behavior is not born of sincere ignorance, but instead from a concerted effort to resist scientific understanding and "the establishment". It's the basis of anti-intellectualism/anti-science sentiment, and this is a very harmful trend, leading to everything from accelerated climate change to the re-establishment of measles in the pediatric population.

These are bad ideas, and I've found that tolerance of such concepts doesn't allow them to disappear naturally, as they should. Instead, they're allowed to fester and perpetuate, as people are often too anxious to offend to actively disassemble the bad ideas.

 

[Lannister]

The problem is that, very often, such behavior is not born of sincere ignorance, but instead from a concerted effort to resist scientific understanding and "the establishment". It's the basis of anti-intellectualism/anti-science sentiment, and this is a very harmful trend, leading to everything from accelerated climate change to the re-establishment of measles in the pediatric population.

These are bad ideas, and I've found that tolerance of such concepts doesn't allow them to disappear naturally, as they should. Instead, they're allowed to fester and perpetuate, as people are often too anxious to offend to actively disassemble the bad ideas.

I mean, I'm not saying we shouldn't "disassemble the bad ideas", just that there's a better way to go about it than saying "you're stupid, you don't know what you're doing, you're killing your child". Doing that just makes people defensive.

Edit: also, I think there are very few people who are truly anti-intellectual and anti-science. The problem is that some of these people are very influential, and the uneducated masses are disposed to believe them because they don't know any better.

 

[getdown]

It kind of bothers me that so many intelligent, well-educated people are so judgemental of the vast majority of Americans who have less natural intelligence and perhaps did not have access to as good of an education as they did. This woman is doing what she thinks is best for her son, just like people who don't vaccinate their kids are doing what they think is best for their kids. They're just scared and misinformed, they're not purposely trying to harm anyone, so why are we so aggressive towards them? If we treat them like they're stupid and evil then we're probably just going to push them to keep mistrusting doctors. We'd have more success getting them to listen to their doctors if we are understanding and listen to their fears and don't judge them so harshly.

Because a lot of people don't want to be wrong and refuse to listen to reason regardless of what you tell them. And the reason that we're so aggressive with the anti-vaccination club is because their decision actually effects others. Same reason why we're aggressively trying to stop misinformed people from joining ISIS... because their decision directly leads to the detriment of others. I don't care if you decide to stop eating meat or stop eating all together because of some nonsense you read online. The only person that suffers in that scenario is you. But you refuse to vaccinate your kid because of some garbage that has been disproved a million times over leading to the reappearance of diseases we've almost nearly been rid of? I'm sorry, that's on you and I have no problem forcing you to comply.

 

[Lannister]

Because a lot of people don't want to be wrong and refuse to listen to reason regardless of what you tell them. And the reason that we're so aggressive with the anti-vaccination club is because their decision actually effects others. Same reason why we're aggressively trying to stop misinformed people from joining ISIS... because their decision directly leads to the detriment of others. I don't care if you decide to stop eating meat or stop eating all together because of some nonsense you read online. The only person that suffers in that scenario is you. But you refuse to vaccinate your kid because of some garbage that has been disproved a million times over leading to the reappearance of diseases we've almost nearly been rid of? I'm sorry, that's on you and I have no problem forcing you to comply.

I wouldn't mind having a legal means to force people to vaccinate their kids either, but right now in the US, doctors have no legal basis to force people to vaccinate their kids, as far as I know. So for the time being, if we can't force people to do it, we have to somehow persuade them to do it. And I don't think treating them like they're stupid is going to have the best outcomes.

 

[mvenus929]

I have a story that might show things from the other side. One day in clinic, I saw a baby--4 months old, I think, and this was her first check since her newborn check. Mother had decided not to breastfeed, and dad was super suspicious of formula, so found a recipe online for goat's milk formula. Now, there are multiple things in the literature about feeding infants goat's milk, mostly surrounding the electrolyte content and lack of folate. But, the recipe this father was using seemed to address those concerns. I thought it was strange, but went and spoke with my attending, who freaked out as soon as 'goat's milk' was mentioned and demanded that we get electrolyte levels and CBC in the child, and recommend switching to regular formula, etc, etc.

Infant got her labs, and they were all normal. They never returned to our clinic.

Now, if I had been working with a different attending (who I actually showed the recipe to and has an interest in integrative medicine), the conversation likely would have been very different and much more reassuring, and we might've actually seen this child again. We would have been able to vaccinate her and make sure the choices her father was making weren't harming her, and instead she dropped out of the healthcare system (as far as I know, at least). How the information is presented to the parents is important in determining whether or not they will actually follow-through on our recommendations.

 

[username456789]

.

 

[getdown]

I wouldn't mind having a legal means to force people to vaccinate their kids either, but right now in the US, doctors have no legal basis to force people to vaccinate their kids, as far as I know. So for the time being, if we can't force people to do it, we have to somehow persuade them to do it. And I don't think treating them like they're stupid is going to have the best outcomes.

Well I know doctors can't force people do stuff. I'm just glad some state legislatures have finally grown a backbone and made it a law that if your kid is going to be in public schools they need to be vaccinated. Blows my mind how people are claiming a religious exemption to get out of vaccinations.

 

[Catman21]

Totally agree, I'm normally very trusting of my doctors but I do not at all trust that they know what they're talking about when it comes to nutrition. It's frustrating that so many people still think that bread is not unhealthy and eggs are bad for you.

This is exactly the problem, because bread ACTUALLY isnt unhealthy. Do you realize how many people in the world consume bread and live healthy lives? Yeah, you're diet should not consist primarily of bread, it should be balanced. But people like you spewing nonsense about bread being unhealthy is too much for me to really handle.

Edit: stop contributing to this wave of bull**** about bread products being cancerous and maybe start encouraging a balanced diet

 

[Lannister]

This is exactly the problem, because bread ACTUALLY isnt unhealthy. Do you realize how many people in the world consume bread and live healthy lives? Yeah, you're diet should not consist primarily of bread, it should be balanced. But people like you spewing nonsense about bread being unhealthy is too much for me to really handle.

Sorry, I should have said excessive amounts of bread (which is the level most Americans are consuming it) are unhealthy. Calm down. If you're going to get that upset at a simple statement, you're going to be a very angry physician.

Edit: just looked at your post history, and if your attitude in real life is as bad as your attitude on SDN, then I hope you never become a physician.

 

[jl lin]

Juice and baby food with some adult foot mixed in I think. He's a pretty skinny baby from the one time I've seen him. Thanks for the responses everyone.

Wow. So she thinks baby will get caloric needs as well as full complement of nutrients doing this at 4 mo.s? If she is anti-formula, why isn't she breastfeeding?

I had a mom that wanted to give her 6 mo. old MacDonald's fries and pulled apart pieces chicken nuggets. Baby was a cardiac baby too--already bone skinny w/ other problems--not to mention concerns re: aspiration. I do try to be understanding and respect cultural influences and such, but it still blows my mind. Wondering if some of that baby food is at least meat-based--or something w/ a decent amount of protein.

 

[Cotterpin]

Now, if I had been working with a different attending (who I actually showed the recipe to and has an interest in integrative medicine), the conversation likely would have been very different and much more reassuring, and we might've actually seen this child again. We would have been able to vaccinate her and make sure the choices her father was making weren't harming her, and instead she dropped out of the healthcare system (as far as I know, at least). How the information is presented to the parents is important in determining whether or not they will actually follow-through on our recommendations.

That's the key right there.

 

[jl lin]

I have a story that might show things from the other side. One day in clinic, I saw a baby--4 months old, I think, and this was her first check since her newborn check. Mother had decided not to breastfeed, and dad was super suspicious of formula, so found a recipe online for goat's milk formula. Now, there are multiple things in the literature about feeding infants goat's milk, mostly surrounding the electrolyte content and lack of folate. But, the recipe this father was using seemed to address those concerns. I thought it was strange, but went and spoke with my attending, who freaked out as soon as 'goat's milk' was mentioned and demanded that we get electrolyte levels and CBC in the child, and recommend switching to regular formula, etc, etc.

Infant got her labs, and they were all normal. They never returned to our clinic.

Now, if I had been working with a different attending (who I actually showed the recipe to and has an interest in integrative medicine), the conversation likely would have been very different and much more reassuring, and we might've actually seen this child again. We would have been able to vaccinate her and make sure the choices her father was making weren't harming her, and instead she dropped out of the healthcare system (as far as I know, at least). How the information is presented to the parents is important in determining whether or not they will actually follow-through on our recommendations.

Yes. I respect this. So long as they demonstrated an understanding of the needed nutritional components and such, and there were no other issues, and also they adhered to supplement where it was necessary. If they showed this, I would try to be supportive and gently guide them to a place of balance. I wouldn't want to alienate the family, b/c they you cannot keep an eye on the baby's progress and work with the family, which is pretty darn important.

But with the OP mom and baby, it is a safe bet that the child is not getting the full complement of nutrients and calories. Sigh.

 

[deleted407021]

I mean, I'm not saying we shouldn't "disassemble the bad ideas", just that there's a better way to go about it than saying "you're stupid, you don't know what you're doing, you're killing your child". Doing that just makes people defensive.

For sure, but I worry of moving too far in the other direction, where such ideas will be protected as valuable opinion, instead of dangerous nonsense.

 

[Lannister]

For sure, but I worry of moving too far in the other direction, where such ideas will be protected as valuable opinion, instead of dangerous nonsense.

Yeah I understand, but I think there can be a middle ground, like we can recognize that people think that way for valid reasons, while still maintaining that that thinking is dangerous, if that makes sense.

 

[jl lin]

That's the key right there.

ITA. Still, it's very difficult to work with some parents--recalcitrance, ignorance, and other social/psychological issues. It can get quite frustrating.

 

[Cotterpin]

ITA. Still, it's very difficult to work with some parents--recalcitrance, ignorance, and other social/psychological issues. It can get quite frustrating.

That's why doctors get paid the big bucks. Lol, but really, that's why we need to make sure we're training doctors to have excellent skills dealing for dealing with these patients.

 

[timetwister]

nevermind nutrition. This woman needs to give her milk to allow antibody transmission. My thought is the baby could become sick otherwise.

 

[Lannister]

nevermind nutrition. This woman needs to give her milk to allow antibody transmission. My thought is the baby could become sick otherwise.

OP didn't really clarify why she isn't breastfeeding, some mothers can't, for various reasons.

 

[jl lin]

That's why doctors get paid the big bucks. Lol, but really, that's why we need to make sure we're training doctors to have excellent skills dealing for dealing with these patients.

Having worked in pediatrics for a long time now, I would say that most of those with whom I have worked are fairly to pretty darn good with this. It's just that you will still have a certain percentage of people--people, honestly from cultures that make some medical care difficult, to people that live for their booze and drugs, and their kids pay the price, to many other sad scenarios, and you can't fix them all. You try. You try to be culturally competent and work with them. I have stories that are so alarming in this regard, but I can't share them here. Part of the frustration of working in pediatrics can be dealing w/ parents that are, shall we say, quite challenging for a variety of reasons. And I am all about the family, but it still can be enormously challenging--mind bogglingly frustrating.

 

[timetwister]

OP didn't really clarify why she isn't breastfeeding, some mothers can't, for various reasons.

I believe in olden days they tried to solve this by hiring a nanny/midwife that could. It's very upsetting to hear that OP mother isn't. I really hope this baby is alright.

 

[jl lin]

OP didn't really clarify why she isn't breastfeeding, some mothers can't, for various reasons.

Well, some can't, but they are very, very few in reality. It has become easier to bottle feed w/ formula--that's a separate issue here though. But especially if one is new to breastfeeding, one has to be very motivated in a number of cases to do it, and they often need support. This is why women that have had mothers that successfully breastfed have a better chance of succeeding with it.

 

[jl lin]

I believe in olden days they tried to solve this by hiring a nanny/midwife that could. It's very upsetting to hear that OP mother isn't. I really hope this baby is alright.

You mean a wet-nurse.

 

[timetwister]

You mean a wet-nurse.

yes my bad, I just remembered that they had someone to do feeding if not the mother. I can understand that some patients just physically can't and even though to the normal person they seem to have the ability to, you just don't know the physiology of every person and I don't want to shame the mother on this but I would on the fact that she isn't finding a proper substitute and I would blame the doctor for not taking the time to share the bad news if she decided to not go the traditional route.

 

[The Buff OP]

Because America is awash with anti-intellectualism and it is going to destroy us as a culture.

Hippie.

 

[Lawpy]

An acquaintance of my wife has a 4 month old baby. Doctors recommend babies are bottle or formula fed until they are one year old. She doesn't breastfeed and and won't give her baby formula because "it's just corn syrup" (obviously she's not the brightest bulb in the box)

This made me think of countless other times when people believe old wives tales, the internet, their friends or complete strangers over what a qualified physician says. Why? Is it a communication or trust issue? I just don't get it. How can I get my patients to follow my recommendations?

This is just a problem of communication. Since a physician has access to a lot more information than the patient, the objective is for the physician to relay the necessary information to the patient in the simplest, most effective way possible. It is assumed that the patient is open-minded and willing to accept treatments, but it's always good for the tone of the physician advice to be sincere, friendly and educational.

 

[Cotterpin]

nevermind nutrition. This woman needs to give her milk to allow antibody transmission. My thought is the baby could become sick otherwise.

My younger sister couldn't be breastfed because my mom was on chemo for breast cancer at the time. But my sister is fine. It's not like she has severe immune deficiencies because she was fed formula.

 

[RaspberrySlushy]

I used to live in a very New Age type place, and there was a huge community there that did seem very anti-science. Anything that came from scientists or doctors was almost always dismissed out of hand but if someone started telling everyone, as an example, that eating ground up grasshoppers would prevent cancer, everyone would be eating grasshoppers without even questioning it. Except, of course, the various people who were already deeply entrenched in their own special health diet they'd just started, or whatever. Of course there was still a culture of oneupsmanship and my fad diet is better than yours, but generally, new trends caught on quick.

It's hard for me to understand why groups of people would automatically dismiss science and medicine yet take on with full force some really ****ing crazy ideas without question. Some, probably a lot, were fairly well-educated. But if I started listing some of the whacko things (diet or otherwise) that were spread around as if facts, it would sound like a cross between a sci-fi novel and the trashiest tabloid in terms of plausibility. We are talking really cray cray stuff. A lot of times, I was looked down as being inferior, unenlightened, naive and ignorant for having a more science-based mindset. It could be condescending at times.

So I'm a little cynical. I still see a lot of this crap where I live now but usually not as extreme. I completely agree with the idea of trying to communicate clearly and in a way patients can understand, that matters a lot. And of course, working woth patients to find a palatable solution when possible (like the post about the goat milk formula that was augmented to account for missing nutrients) is a goal worth pursuing.

But I also feel that there are people who are under the spells of self-help or diet gurus (who are of course profiting) and very distrustful of science, evidence, doctors, etc. And they may go from one fad idea to the next. I'm not sure how to get through to people with those beliefs. Or to fully understand why people wouldn't want to rely on something evidence-based. I get not wanting to be told what to do, especially when it's about your own body, or your child, but how do we get past that emotional barrier? I have no idea.

 

[NotASerialKiller]

I think it's also a response to the expectations that people have when it comes to medicine. This comes from the prestige of the job along with TV shows like House with genius doctors solving every medical mystery, or the surgeons (aka super-doctors) on Grey's Anatomy.
Patients then think that if their problems aren't resolved or a doctor ever makes a mistake that they're all falling short even though doctors think they're soooo smart, which then leads to people to reject basic advice and go to a homeopath instead.

 

[Catman21]

Sorry, I should have said excessive amounts of bread (which is the level most Americans are consuming it) are unhealthy. Calm down. If you're going to get that upset at a simple statement, you're going to be a very angry physician.

Edit: just looked at your post history, and if your attitude in real life is as bad as your attitude on SDN, then I hope you never become a physician.

Yeah, you should have specified. Because as a future authority on health and healthcare, you should know that people might actually listen to what you say someday, and to casually drop a remark like "bread is unhealthy" wouldn't be bad or anything right? Lol, pls go through my search history more. Thats not pathetic. My attitude is fine on both, SDN just happens to be a collection of pretentiousness second to none. I'm not an angry person, but you are certainly entitled to your opinion.

Edit: I actually just went through my own post history, and I dont know where you get any sort of indication that my attitude on SDN is "bad." Pls avoid psychiatry.

 

[jl lin]

yes my bad, I just remembered that they had someone to do feeding if not the mother. I can understand that some patients just physically can't and even though to the normal person they seem to have the ability to, you just don't know the physiology of every person and I don't want to shame the mother on this but I would on the fact that she isn't finding a proper substitute and I would blame the doctor for not taking the time to share the bad news if she decided to not go the traditional route.

No, you can't shame people. That doesn't work. IMHO, unless it just comes to them very easily--and for a lot of women it does--or it isn't their first time at the rodeo so to speak, there is a learning and tolerance curve. I would easily say 99.99% of all women can breastfeed. It's just that there are those that are not motivated enough to work through the learning/tolerance curve--and they don't have to do so. Why? Pharma has provided them with a relatively easy out. Although once you get the swing of it, it's actually easier to nurse a baby than deal with warming formula and cleaning bottles and such. The difficult part is when you aren't w/ the baby. There is pumping, but it generally doesn't do the same thing as nursing; b/c there is nerve stimulation that the baby provides with sucking that tells the brain to send needed messages to make more milk. I mean it works to some degree with pumping, but it's not as good. And this is important early on when one has to get into the rhythm and swing of it with the baby. It's like baby and mom are a team and are somewhat dependent upon each other to make it optimally work. Also, you have nimrods telling people that nursing destroys your breasts. This is nonsense. What may change your breasts is pregnancy itself--and the weight can and such. I breastfeed all my children, the first one, not easily, and it did not change my breasts. But some women fear this, or believe it was the breastfeeding, when in reality, it was the pregnancy and the growing size of the breasts and some hormonal changes (darkening nipples for example) through the process. Depending upon weight and fluid gain and skin turgor and hormonal factors, you skin may tolerate 40 weeks of these things well or it will not.

At any rate, I respect BF as a choice by the mother. I would that more people and our culture would embrace BF as the optimal way to support an infant, and I fear that we are losing the ability to do what our bodies were naturally designed to do. I can't make them or shame them, but I must respect their choices. OTOH, it's imperative that a newborn and infant get the correct calories and nutritional components. When this is not happening, well yea. It becomes an issue of neglect, which is considered, at least in many states, a form of abuse. But it's better to try to work in a positive way with parents and families. I am a mandatory reporter of abuse, but I don't like to take that approach unless there is absolutely no other choice.

 

[jl lin]

This is just a problem of communication. Since a physician has access to a lot more information than the patient, the objective is for the physician to relay the necessary information to the patient in the simplest, most effective way possible. It is assumed that the patient is open-minded and willing to accept treatments, but it's always good for the tone of the physician advice to be sincere, friendly and educational.

Yes, but trust me. It is not "just," b/c it is definitely not always that simple.

 

[Lawpy]

Yes, but trust me. It is not "just," b/c it is definitely not always that simple.

Yeah I am really restricting myself here by assuming that patients are open-minded and receptive to treatments...