A Vancouver drug center has started an unusual program: alcoholics bottle homemade beer.
The Drug Users Resource Centre, the Downtown Eastside non-profit famous for housing Canada’s first crack pipe vending machine, is also behind what may well be North America’s first program teaching severe alcoholics how to brew their own beer and wine.
Now the alcoholics just do bottling but the people behind the program intend to expand it to include other parts of the beer-making process, such as fermentation.
What’s interesting is that they are not treating severe alcoholics as passive or disabled — as recipients of treatment. At least not entirely.
This program reminds me of several things. Geel, a town in Belgium, treats people with mental illness as valued caregivers. Zeynep Ton says low-level retail employees should be treated as people who can learn many jobs, give good advice to both customers and management, make good use of free time, and so on. I treat my students as people who want to learn — who do not need to be scared into learning by threat of a bad grade — and are capable of inventing their own assignments.
Is there a general lesson to be drawn from these examples? (All are complicated, in spite of brief descriptions.) Could it be a good idea — as a default — to treat those you deal with as smart, capable and motivated? It is no great leap to treat alcoholics as motivated to make beer but it is a slight leap to treat them as capable of making beer. Is the next step is to treat them as smart?
What if doctors, before they saw a patient, told them: Please search the Internet for possible remedies. Bring a list of the ones you want to consider to our meeting. Is that crazy? The slightly subtle point is this may make the doctor happier.
My impression is that doctors are not generally happy with patients doing this. I may be wrong about that, but I feel as though I’ve heard a lot of doctors complaining about patients who self-diagnose before coming in, but have no recollection of any doctor ever speaking positively of the practice.
I do have a little bit of sympathy for doctors. One of my responsibilities at work is to troubleshoot computers. My non-techie colleagues (that is to say, almost all of them) sometimes have totally ridiculous theories about what’s wrong with their PCs and how to fix the problem.
Seth: In contrast to the completely non-ridiculous theories of psychiatrists. If you were paid by the visit you might be happy if a client wanted to test a ridiculous theory. It would mean two visits rather than one.
I’d say the general lesson is that accepting someone as they are can provide them with a foundation from which they can go on to change and to become whole.
Perhaps a lack of belonging actually propels people toward self-destruction.
I work in a histology laboratory where we have a yearly flux of new students doing clinical rotations as a part of their academic programs. Different senior histologists have different methods of teaching. Most of them train in an authoritarian manner essentially writing off any new ideas new students almost always have using the excuse that because they have no clinical experience they can’t possibly have any real world ideas that are of use. Or my favorite excuse is when I hear a student that has a good idea the senior histologist will say “we don’t do things that way at this facility”… I remember when I was a student, I had good ideas, and I remember questioning whether or not I got into the right field of work whenever I heard that kind of discouragement. I never forgot that feeling.
When I train students I always expect that they will do things a little differently or that they will have new ideas, so instead of treating them like they have something to learn from me, my first question is always show me what you have learned or show me how you’d like to do this procedure, in other words they went through the same training I did maybe at a different facility but there are a lot of different ways to approach things we do in the lab, so I let them develop their own “style”. Then after they do it in their own way I show them how I do it my way and I explain step-by-step why I’m doing it this way just as I have them explain why they choose to do a procedure in they way they choose. The entire thing is an enjoyable experience we are learning, and laughing, and undoing the dogma learned from the academic setting. In the end it makes more confident and competent histologists, they know why they do the things they do instead of just memorizing steps… all of my students end up being excellent troubleshooters and problem solvers.
That is the basis of libertarian philosophy.
The problem with bringing a list of possible remedies to a doctor appointment is that the doctor will only be familiar with the pharmaceutical options. I’ve done this with my grandmother and my cat. All I got was a glassy stare from the human doctor and complete sarcasm from the vet. Both were dismissive without even listening. The vet wouldn’t even take the paper (published in a peer-reviewed journal) that I printed off.
My teaching philosophy exactly. And over the years I have found that everyone, yes everyone, is capable of writing more and wilder and more vivid fiction– or whatever kind of writing they fancy.
Love your blog. It is always such a surprise.
article in this month’s harper’s about just this topic: https://harpers.org/archive/2014/04/diagnose-this/
i can get it for you Seth if you don’t have access.
Same experience here, Alex Chernavsky. Having been on the other side makes me more patient with doctors when they get that look of, Oh, no, another PhD from Google University.
Alex Blackwood:
I have zero patience with doctors who don’t know how to listen to their patients. And I’ve been known to walk out the door when they don’t. I’ve also had doctors thank me for providing them information they didn’t know anything about.
First, the internet is what you make of it. It’s just a tool. You can get bad information from the internet, and you can get good information there. And doctors don’t always have access to the good information, or the time to find it. I’d even go so far as to say that doctors FREQUENTLY have bad information.
An example of that (I can give you dozens of them), in my opinion, regards statin drugs. Doctors essentially get their information regarding statin drugs from the drug companies. What incentives do you think come into play there?
The vast majority of doctors don’t even know that statins have ZERO efficacy on patients without a previous history of heart attacks, yet they prescribe them anyway. For virtually everyone! Why do you think they do that? This information is available to anyone with a computer.
Frankly, I think anyone who takes the time, has the interest, etc. to do their own due diligence should be applauded, not ridiculed. If for no other reason than to be better informed.
” the general lesson is that accepting someone as they are can provide them with a foundation from which they can go on to change and to become whole.”
I agree, that’s part of it. I’d also say that treating alcoholism, retail sales, etc., are difficult tasks and that, because of that difficulty, two brains (e.g., boss and employee) are better than one (e.g., boss).
“That is the basis of libertarian philosophy.”
yes, the basic assumption of libertarian philosophy is that government consists of people who are not smart, not capable and not motivated telling people who are smart, capable and motivated what to do.
If doctors were always correct in their diagnoses and always offered the most effective known treatments, and if doctors were available 24/7 to offer their service to each patient, then, yes, this would be a crazy idea.
But, in the current environment, it may still be a crazy idea because:
1. What kind of a defense in a medical malpractice lawsuit is: “Well, my patient thought it was a good idea …” ?
2. The internet, (even with PubMed, WebMd, NIH), is not good enough, user-friendly enough, deep enough. Doctors should also tell patients to research their condition in a decent medical library at a hospital or university. A lot of the knowledge in those libraries is not yet easily and cheaply available online (e.g. I don’t know a way to access a selection of the vast number of books and journal articles housed in UCLA’s Louise M. Darling Biomedical Library online as cheaply as I can on site. It sure seems like a lot of stuff there is not available in PubMed or on Amazon, etc.)
There’s an absurd new habit sneaking into the NHS. You walk in to talk to your GP and he says “we only have ten minutes so restrict yourself to one problem”. Observe that this requires the patient to guess whether his symptoms add up to one problem or more.
Bonkers, eh?
Al:
“1. What kind of a defense in a medical malpractice lawsuit is: ‘Well, my patient thought it was a good idea …?
That’s why it shouldn’t end with that. How about: “Due to my patient’s request, I checked his information out more thoroughly, and other experts in the field thought it was a good idea. So I gave it a try, and lo and behold, my patient was very happy with the results.”
“2. The internet, (even with PubMed, WebMd, NIH), is not good enough, user-friendly enough, deep enough.”
It’s easy to find great information outside of those sites (which are often part of the very problem we’re discussing, not the solution). The internet is a very, very large (and deep) resource. It can lead you to great books, papers, journals, articles, etc. on many subjects, written by other experts or knowledgeable people. Especially if you’re looking for more information about a specific subject. One doesn’t have to graduate from medical school to learn the truth about statin drugs. In fact, medical schools may be the worst places to learn about them. Medical libraries are just tools, too. You can find good information there, and you can find very, very bad information there. Kind of like the internet.
As a Dentist, I would love it if people took some level of ownership over their problems. My least favorite patient response is an apathetic “Do whatever you think is best.” The info is all out there now. Most people don’t want to be bothered.
I always thought that the Pygmalion effect is worth thinking about. This isn’t quite the Pygmalion effect, I think, but the idea — treating everything as smart, capable, and motivated — strikes me as similar.