It is with a deep sigh of relief that I welcome the electoral victory of the Obama-Biden ticket as a symbol of the (majority of the) general public’s acceptance of intelligence as an asset. While I know of no scientific evidence or study proving a link between the anti-intellectualism and charismatic ignorance of the Republican presidential administrations in the recent past (Nixon, Reagan, and the Bushes) and the public perception of higher education (or any education) as being undesirably “elitist,” I would be willing to wager that the public celebration of outwardly unsophisticated leadership to some degree inspires a lack of confidence in doctors in the level of intelligence of their patients, a sampling of the general public. I’m not sure I know of any doctors who generally think of most of their patients (if they see a variety from all walks of life) as being on par with themselves. By necessity, even if they try to repress the outward impressions and implications of their educational background, physicians are generally very well-educated and are almost automatically counted in the ranks of the intellectual elite. Some patients do overcompensate for their prior lack of knowledge by becoming experts on their diseases or those of their loved ones (courtesy of the internet and bookstores). However, as one might expect, the educational differential between doctors and their patients is often vast: during the past two months, most of my patients have been either on Medicaid or lack insurance, and their highest level of education has usually been either sometime in junior high or in high school. Despite my lack of exposure to Obstetrics and Gynecology before November and the notion that some of my veteran patients knew much more about the physiology and management of pregnancy than me when I first started this clerkship, I should not have been surprised that recently I have often had to abandon any assumptions about what my patients know about their own bodies.
There does seem to be a decent correlation between level of education and intelligence, but I do not think that my patients lacking higher education do not have the ability to understand the information I can offer them about their health and diseases: rather, I just have to try harder, and perhaps all physicians should. I think some people forget that progression through the American education system does not select only for intelligence; socioeconomic status and cultural attitudes toward higher education play significant roles (or perhaps even more important roles) in the decision-making process. I think physicians shouldn’t take their own educations for granted: it would do themselves (or those who paid for those educations) a disservice to waste the opportunity to build a bridge of knowledge between the patient’s current understanding and the functional stage between the doctor and patient.
At some points, I have felt a little frustrated trying to break through barriers of ignorance and incomprehension, but it is stories like this that convince me to keep trying. Patients don’t need to know as much as doctors do: we’re here to help them make decisions with our specialized knowledge of health and disease as well as provide treatments and counseling. However, we do need to make sure that they know enough to make intelligent decisions. I hope that the next four years (and hopefully, beyond) will help dissolve the cultural attitudes that celebrate the uneducated maverick, the rebel without a clue: there’s no reward in being ignorant and stupid when it comes to life-changing decisions. In the meantime, it’s my job to educate: to help women select the right method of birth control for them, to convince them to keep taking their prenatal vitamins during pregnancy to prevent birth defects and anemia despite the common complaint of nausea, and to help them figure out how concerned they should be at this time about irregular bleeding and what we plan to do to figure out the cause. Even though it takes up more of my time, it’s the least I can do.
Fight the stupids! – Maple Street Bookstore bumper sticker, New Orleans