"Patients who disagree with their doctor can be 'fired' or flagged with scarlet letters in the corners of their electronic medical charts."

"'Exaggerating.' 'Resistant.' 'Noncompliant.' 'Hysterical.' To be sure, there are problematic patients, even dangerous ones. But for the rest of us, the imbalance between our defenselessness and the doctor’s discretion can create an unhelpful dynamic, one that pushes us to stop advocating and start accommodating. The result is waiting rooms full of people pleasers and providers who never get the full picture. The pressure to be pleasant and pliant is especially strong for women. Just as 'bossy' women often don’t get promotions and 'uppity' women are more likely to be sexually harassed, women who are branded as difficult patients are at risk of not being taken seriously or losing access to care. This is one of the reasons women overapologize, even for their own pain. A simple disclaimer — 'I don’t mean to be difficult, but …' — can backfire as well...."

Writes Allison Sweet Grant, author of "Lump: A Memoir in Ineloquent Reflections," "This Is Why Women Are Scared to Tell Their Doctors the Truth" (NYT gift link).

A mere 30 years ago, this was a highlighted modern problem on "Seinfeld" (Season 8, Episode 5, "The Package"):

 

(Yes, I know this is my second "Seinfeld" post this morning. It was in looking for this Elaine-at-the-doctor material that I stumbled into the unfilmed episode stuff I blogged an hour ago, here.)

"The process of note-writing helps me formulate my medical decision-making and then check whether it really holds up...."

"When that cognitive labor is offloaded to a machine, I’ve come to see, my job shifts. Even when I try to speak my reasoning aloud for the A.I. scribe, I am still doing something different from writing the note myself. I am no longer using the note, sentence by sentence, to think through the case in my own words, to decide what to emphasize, what to soften — or, as I’m writing, to identify when my reasoning strains. And unlike when I dictate a note, I can’t watch my own phrasing appear on the screen in real time. With the A.I.-generated note, I am instead auditing afterward. I am playing a version of 'Where’s Waldo?' — What’s missing? Has this note gone astray, and if so, where? — and it’s a search made all the more difficult because the A.I.’s draft arrives fluent, confident. It sounds so right."

Writes Helen Ouyang, in "How A.I. Might Change the Way Doctors Think/For generations, writing up a summary of a patient exam was a vital step for physicians trying to make an accurate diagnosis. What happens when A.I. does it for them?" (NYT).

"That cognitive shift does not happen the moment the A.I. scribe delivers a note. It begins in the exam room. Because I know A.I. is recording, I stop listening in the same way. Before A.I. scribes arrived, I would outline a story in my head as a patient talked, fitting the pieces together so I would know what to ask next. In the scribe’s presence, that work is deferred. Let the machine do it! The mind drifts."

"I realized what was winning me over about ChatGPT wasn’t its ability to sift through the latest studies, or diagnose my ailments; but..."

"... its unwavering messages of empathy and encouragement, and its endless willingness to listen and its patience. It’s not human, but it can model some traits we value most in human interaction. I followed ChatGPT’s advice, and when my blood work improved, ChatGPT affirmed my progress and urged me to keep going. I doubt I would have made those changes — much less stuck with them — without that sustained back-and-forth. I certainly hadn’t before. It’s a grim fact of American medicine today that doctors can’t come close to a chatbot’s availability.... A.I. may not replace doctors, but it will change what patients expect from us. Doctors need to adapt...."

Writes Helen Ouyang, in "As a Doctor, I Can Understand the Allure of ChatGPT" (NYT).

Why do people read this illustration to represent Trump depicted as Jesus rather than Trump with the miraculous power of the laying on of hands?

 

Trump shared this image, then took it down when he was attacked. The image was said to represent him as Jesus. He denied that he had seen it that way. He said the image showed him as "a doctor making people better and I do make people a lot better." Many observers hooted "Doctor!" What kind of doctor wears a robe and applies small orbs of light to the patient's forehead!?

But what is Jesus-y about handheld balls of light? What is Jesus-y about an American flag, the Statue of Liberty, the Lincoln Memorial, a bald eagle, fighter jets, soldiers ascending upward, and a medical worker with a stethoscope?

You can see what you want here, and maybe if you're genuinely concerned about blasphemy you'll want to err on the side of not jumbling up worldly images with things that might be sacred. But is there any serious Christian iconography there? I see nothing other than the white tunic and red mantle. What about the healing itself? But healing with the laying on of hands is not something limited to Jesus. Whether it is effective or not, it has been a widespread practice through human history, and it is a way to express the idea of profound healing.

There is healing through the laying on of hands in the Old Testament and, in the New Testament, it is not limited to Jesus. And in Western history, there was also the "royal touch" — "a form of laying on of hands, whereby French and English monarchs touched their subjects... with the intent to cure them of various diseases and conditions."

American Presidents are frequently portrayed as healers — spiritual healers — and the use of exalted imagery is common, not some freakish new thing special to Trump. It might be a bad idea — because it's trashy art, because politics and religion should be kept strictly separated, or because propaganda is deceptive and distracting — whatever. That image may be bullshit, but the outrage over it is also bullshit. When I think of all the times Barack Obama was portrayed as a Christ figure! Ridiculous. Grow up. 

And here are The Thompson Twins:

Oh, lay your hands on me/(Lay your hands) woo-hoo/(Ooh, lay your hands) oh, lay your hands on me/(Lay your hands) oh, oh-oh-oh....

"Everyone seemed to agree that the patients were self-aware — that they could feel, that they had a grounding sense of being a someone who feels."

"But nobody knew exactly how much they retained of themselves: whether they knew themselves as a particular someone, or the someone they once were. It was impossible to know. In the view of these researchers, covertly conscious patients occupied a phenomenological gray space that was inaccessible to scientific probing and even to the human imagination. But some researchers believed that at least some of the patients were largely intellectually intact.... Tabitha learned that once a patient was diagnosed as 'vegetative' and then admitted into a nursing home, it was almost impossible for family members to get a second opinion and a new diagnosis and then, maybe, though only maybe, a new insurance-company authorization and entry into a rehabilitation program. Instead, when a family member, sitting at the bedside, reported the early flickerings of consciousness in a loved one, she was usually dismissed as seeing what she wished to see...."

From "Vegetative Patients May Be More Aware Than We Knew/New research is upending what we thought about the consciousness of patients, leaving families with agonizing choices" (NYT)(gift link, because there's a lot more material at the link, very well presented, including much about the Terri Schiavo case, the recent research about covertly conscious patients, and the vigilance of one wife at her husband's bedside). 

"These videos are an unintended result of a law passed by Congress in 2016, mandating that providers give patients full access to the entirety of their medical records..."

"... as quickly as possible. The law went into effect in 2021, and ever since, 'raw' test results have arrived on our screens the instant they’re processed at the lab. This may be a victory for patients’ rights. But it also has the potential to be extremely unsettling. Information that was once delivered via live conversation with a human being, one trained in medical interpretation, is now frequently encountered first as decontextualized data on the screen. This unmediated medical data is now arriving at random moments in our lives. It can come any time of day, when you’re surrounded by people or all alone. Suddenly, you’re faced with a private decision — open? ignore? wait? It is out of the strangeness of this moment that the genre of medical results videos was born. People don’t know what to do with the experience of getting their data, and so they turn their cameras on...."

From "Why Am I Watching People Get Their Medical Results? What was once discussed with a doctor is now frequently encountered first as decontextualized data on a screen" (NYT)(gift link, with links to examples of these videos).

"Among my friends, getting private healthcare insurance through your company is seen as the best work perk there is. I have paid £70 for a private appointment...."

"Even for the friends who don’t get private healthcare for free through work, paying close to £100 for a private GP appointment is seen as worth it, a small price to pay for peace of mind about health.... As one [friend] says: 'The anxiety of waiting so long to get something fixed just isn’t worth it.... With the NHS, I feel like you have to start with a doctor who is tired, stressed and doesn’t have much time for you.' Another friend tells me she has noticed that private doctors are more likely to prescribe antibiotics than NHS ones. So when she thinks she has tonsillitis, she goes private to make sure she gets the medicine. Yet another goes private when she has 'big scares,' she says. 'Because of the NHS wait times, if I have something that I’m really worried about and that is affecting my mental health, that’s when I go private.'..."

From "I’m 30 and I avoid the NHS if I can. Here’s why/The latest survey shows that most people my age feel the same, says Georgina Roberts" (London Times).

"Working with the fantastic Governor of Louisiana, Jeff Landry, we are going to send a great hospital boat to Greenland to take care of the many people who are sick, and not being taken care of there."

"It’s on the way!!!"

Wrote Trump, quoted in "Greenland does not need US hospital boat to be sent by Trump, says Denmark/Prime minister and defence minister rebuff US president’s claim that Arctic islanders are 'not being taken care of'" (The Guardian).

"Look, we’ve been trying to apply A.I. and machine learning techniques to biology for a long time."

"Typically they’ve been for analyzing data. But as A.I. gets really powerful, I think we should actually think about it differently. We should think of A.I. as doing the job of the biologist, doing the whole thing from end to end. And part of that involves proposing experiments, coming up with new techniques.... [A] lot of the progress in biology has been driven by this relatively small number of insights that lets us measure or get at or intervene in the stuff that’s really small. If you look at a lot of these techniques, they’re invented very much as a matter of serendipity. Crispr, which is one of these gene-editing technologies, was invented because someone went to a meeting on the bacterial immune system and connected that to the work they were doing on gene therapy. And that connection could have been made 30 years ago. And so the thought is: Could A.I. accelerate all of this? And could we really cure cancer? Could we really cure Alzheimer’s disease? Could we really cure heart disease?"

Says Dario Amodei, in "Is Claude Coding Us Into Irrelevance? Dario Amodei shares his utopian — and dystopian — predictions for the near-term future of artificial intelligence" (NYT).

"More than 80 percent of nurses experience workplace violence each year.... Almost all of these assaults are perpetrated by patients..."

"... though patients’ family members can also threaten our safety. People don’t realize that hospitals are increasingly dangerous places to work in. Because nurses spend more time than anyone else with patients, we often get the brunt of their anger with the health care industry, lack of adequate services and long wait times. Throughout my career, I have sustained many injuries and threats. In a recent eight-month period, I was scratched in the face (which left a scar that I cover with makeup daily), kicked in the chest so hard it left bruises, bitten multiple times and spat on. I’ve been pushed, sexually assaulted and punched. I’ve been thrown across the ambulance bay. I’ve had to hide marks of violence from my four young children so they don’t worry about me...."

Writes Sheryl Ostroff, in "Nurses Get Bitten, Spat on, Thrown. That’s Why We’re on Strike" (NYT).

"Everyone will have access to medical care that is better than what the President receives right now."

Elon Musk wants you to know what it will be like 5 years from now.

Elon Musk's jaw-dropping prediction (Jan 2026):

“Don’t go into medical school.”
Elon Musk: “Yes. Pointless.”

In 3 years (2029), Optimus robots will be better surgeons than any human on Earth — at scale.
By 4–5 years? Not even close. The best medicine in the world will be free… pic.twitter.com/q7KTMpICk8

— Camus (@newstart_2024) January 10, 2026

And don't bother with higher education... except for "social reasons."

"The medical profession of the twentieth century was a hegemon; today, it is a regional power. When a hegemon loses status..."

"... it can take a few paths. It can aim for restoration—bringing back the empire—which in this case would probably focus on gatekeeping. It can retreat, which might mean abdicating medicine’s broad public role, perhaps in favor of a narrow focus on earnings and technical skills. The last—and, in my view, the best—path is reinvention. Doctors can remake their profession by embracing the multi-polar medical landscape they now inhabit, and by acting as a kind of system stabilizer: working with other powers to help shape rules, norms, and relationships. A superpower may act as though it can stand alone, but middle powers know the value of diplomacy and coalition-building. Reinventing the medical profession will require greater engagement with the world outside of hospitals and clinics. Many physicians are taking to social media.... A growing number of doctors seem interested in leading health-care companies themselves or in running for office.... Diplomacy also requires a willingness to stand in opposition to others.... A few weeks ago, a dozen former F.D.A. officials, all of them physicians, wrote that they were 'deeply concerned' about 'the latest in a series of troubling changes'...."

Writes Dhruv Khullar, in "The Role of Doctors Is Changing Forever/Some patients don’t trust us. Others say they don’t need us. It’s time for us to think of ourselves not as the high priests of health care but as what we have always been: healers" (The New Yorker).

"I had spent 12 hours with this man. What could I have done differently? What words could I have used?"

"My patient’s opinions were mystifying, as if the product of an unsound mind. Should we have disregarded them and performed a procedure against his wishes?... My patient had been clear. He was consistent. He had the right to make his own decisions. What I considered to be an unfounded and ultimately disastrous objection to a pacemaker was not, in and of itself, proof of incapacity.... I did not know what it was like to live with his autoimmune disease.... Because I was unwilling to accept my patient’s desires at the end of his life, his final 12 hours on this earth were fraught and contentious. I could not have changed his mind, but perhaps I could have changed that."

Writes Daniela J. Lamas, in "My Patient Was Making a Fatal Decision. What Could I Do?" (NYT).

"Ruth told me that a couple of decades ago her daughter was prescribed Zoloft, an S.S.R.I., at 11 by a psychiatrist..."

"... after a humiliating incident at school 'left her feeling out of sorts and anxious.'... Her daughter wound up staying on the drug for a decade, until 2011. Only over the past few years has Ruth learned, from her daughter, about the sexual side effects she still lives with and about her grief. 'Her erogenous zones don’t work,' Ruth said. 'It makes me deeply sad, because our sexuality, the pleasure we get from our bodies and our intimacy with another person, it’s such a beautiful experience; it helps us to feel not alone.' Thinking back, Ruth said, 'I have huge, terrible regret' about allowing her child to be medicated. 'I can’t believe I so easily said yes.'"

From "More Teens Are Taking Antidepressants. It Could Disrupt Their Sex Lives for Years. Research on adults who take S.S.R.I.s shows they tamp down sexual desire. Why aren’t we studying what that could mean for adolescents who take them?" (NYT).

In the comments over there, from someone who says he's a doctor: "Overmedicalizing normal variations in children will bite us in the behind."

WaPo shines a light on the ghost pipe... which looks familiar.

Screen shot:

Here's the link to my post from last year, and here's the WaPo article. Excerpt:

“Ghost pipe is the bee’s knees for anxiety, panic attacks, insomnia, migraines, muscle spasms and just all the things,” says a popular forager on [TikTok]. “It makes you feel very Zen and grounded.”

“Basically, it will solve all your problems,” a user whose account is dedicated to holistic healing says in a video that has been watched more than 17 million times....

Ghost pipe became widely popular in the mid-19th century, thanks to a group of physicians known as the Eclectics, who rejected the punishing medical practices of their day — such as bloodletting and mercury-induced purging — in favor of botanical remedies. Eclectic doctors administered ghost pipe as a tonic, sedative and antispasmodic. The odd flower also blossomed in the popular imagination. In 1890, the cover of Emily Dickinson’s debut book of poetry featured a painting of the plant; the poet called ghost pipe “the preferred flower of life.”...

"If they ever invent a pill where they could say, 'OK, your social skills will be normal, but your ability to concentrate would also be normal,' I wouldn’t take the pill."

"Maybe I am forgetting how painful it was, but I needed my neuro diversity to write that software; I could do all that stuff in my head. That takes a lot of concentration."

Said Bill Gates, quoted in "Bill Gates: 'I would be diagnosed with autism if I were a kid today'" (Yahoo News).

Just because there's a treatment doesn't mean you need to take it. There's a balance between eradicating symptoms and unleashing side effects, and we should be careful not to pathologize human behavior.

Where the treatment doesn't yet exist — like Gates's anti-autism pill — it's easier to decide I wouldn't want it anyway. The unreachable grapes looked sour to the fox in the old fable. It's harder to think critically when the pill is right there — the pill or the surgery. Is effeminacy in a young boy a condition that ought to be treated, or can we embrace human diversity and discourage medical treatment? There might be something parallel to "I needed my neuro diversity to write that software." I needed my effeminate maleness to.... What? What is lost in the pathologizing? What sort of highly valuable person are we medicalizing out of existence?

This made me think of that classic of Critical Race Theory, "The Michael Jackson Pill: Equality, Race, and Culture" by Jerome McCristal Culp, Jr. (Michigan Law Review, 1994). I tried to get Grok to talk about it, and it engaged in blatant censorship: "There is no well-known or credible critical race theory article that discusses or imagines a pill to turn black people white...."

"Britain is to ban indefinitely the use of puberty blockers for young people under 18 with gender dysphoria, except in clinical trials..."

"... the government said on Wednesday, making permanent a set of temporary restrictions put in place earlier this year.... The country’s National Health Service stopped the routine prescription of puberty blocker treatments to anyone under 18 as treatment for gender dysphoria following a landmark review into gender identity services undertaken by Hilary Cass, one of the country’s top pediatricians. Her report, published in April, concluded that gender medicine was operating on 'shaky foundations' when it came to the evidence for some medical treatments, including prescribing hormones to pause puberty or to change physical characteristics.... Young people who already had a valid prescription for puberty blockers before a certain date this year — depending on where they live — will be able to continue to receive them...."

From "U.K. Bans Puberty Blockers for Teens Indefinitely/A freeze placed this year on their use to treat gender dysphoria will remain in place for young people under 18, except in clinical trials, Britain’s government said" (NYT).

"Someone who has biomarker evidence of amyloid in the brain has the disease, whether they’re symptomatic or not."

"The pathology exists for years before symptom onset. That’s the science. It’s irrefutable."

Said Dr. Clifford R. Jack Jr., an Alzheimer’s researcher at the Mayo Clinic, quoted in "Apparently Healthy, but Diagnosed With Alzheimer’s? New criteria could lead to a dementia diagnosis on the basis of a simple blood test, even in the absence of obvious symptoms" (NYT)(free access link).

But Jack and his colleagues are not saying to test everyone.

A 2015 Dutch study estimated that more than 10 percent of cognitively normal 50-year-olds would test positive, as would almost 16 percent of 60-year-olds and 23 percent of 70-year-olds. Most of those individuals would never develop dementia....

What's the point of knowing you technically have this dreaded disease if you don't have the aspect of it that is dreaded — the outward symptoms?

"Generally speaking, innovation is what weaker individuals do in order to overcome their relative disadvantage."

"From a scientific perspective, female primates have more to gain—and more to lose. Most are smaller and more vulnerable than the males. Given that their bodies are the ones that have to build, birth, and nurse children, females also have more urgent food and safety needs than males. So if our female ancestors were also good problem solvers—as higher primates are—then it makes sense for them to have been inventors who adapted around their limitations.... Gynecology is absolutely essential for our species’ evolutionary fitness.... To invent gynecology, protohumans needed to be able to trust one another enough to be around one another at those crucial moments of vulnerability: labor, birth, and early nursing. That’s why the arrival of midwives is one of those moments in hominin history for which we can truly say, 'This is when we started to become human.' It would have required a profoundly cooperative female society and a social structure that rewarded helpful behaviors...."

Writes Cat Bohannon, in "The Greatest Invention in the History of Humanity/The very reason we’ve managed to succeed as a species is gynecology" (The Atlantic). 

That article was adapted from Bohannon's book, "Eve: How the Female Body Drove 200 Million Years of Human Evolution."

"[W]e are dependent on a vast array of interconnected social institutions, especially expert institutions, which involve 'faceless commitments' to those we do not (and usually cannot) know personally."

"It is characteristic of these abstract systems that we cannot opt out, at least not entirely. Sustaining trust in them therefore becomes a basic requirement for the functioning of modern societies. Essential to this process [are]... interactions between lay citizens and individual members (or representatives) of abstract systems — think of experts such as Dr. Anthony Fauci or even your family physician. Such interactions provide opportunities for experts vested with authority not only to exemplify the requisite skills, but also to exhibit the character traits — rectitude, professionalism, disinterestedness — needed to generate and sustain the trust of those lay individuals who depend on them.... A politics suspended between radical skepticism and uncritical trust would become unmoored from common reference points.... Experts would be either angels or demons.... Restoring public trust... is therefore necessary for not only expert institutions but arguably democratic society itself...."

Writes M. Anthony Mills, in "Why Science Is Losing Americans’ Trust" (NYT).

ADDED: I think people realize this but the hare-brained solution seems to be to accuse those who are mistrustful of destroying democracy: You must trust or there will be chaos.