When we are sick and do question a respected physician's advice, we feel ourselves standing not only beyond his protective embrace, but against the weight of an enormous establishment of people far more expert than we. If we choose to disregard the choices that thousands or millions of other equally sensible people have made -- people who have considered the same decisions as carefully and value their lives no less than we do -- we have to doubt our motives, and even our sanity. "What makes me think I know so much? Is this wishful thinking or a plausible choice? Am I being intelligent or masochistic? Am I pitching my life or my child's life in some petulant ideological quarrel with the medical establishment?" And if we voice our doubts, the cautionary chorus of family and friends inevitably weighs in.
The pressure against physicians who question accepted practice or make use of unconventional therapies is, if anything, greater. We risk the derision of teachers and colleagues, and, in a professional world finely tuned to nuances of pathology, we expose ourselves to questions about our competence and, indeed, our mental health. And should a therapeutic experiment fail, should the patient who follows advice which goes against accepted practice do poorly, the physician is horribly vulnerable, not only to doubt and self-doubt, but to accusations and ostracism and exhausting, costly, and humiliating malpractice suits. "Doctor," one imagines the lawyer for the plaintiff intoning, "did you really think that mental imagery -- or acupuncture or herbs or homeopathic remedies -- could really cure uterine cancer?"
On the other hand, because the personal stakes are higher, the pressure against the dam of perceived authority can also be far stronger than it is in the pure sciences. A man who has reached the end of the establishment's capacity to offer help for a metastatic cancer, a woman with migraines intractable to conventional treatment, may well be willing to accept any therapy that promises to relieve suffering or prolong life. At a certain point, fear of death or disability overwhelms our fear of questioning those who are scientifically credentialed and socially sanctioned to care for us. Drowning people do grasp any hands that are extended.
And if some of those who reach out are pulled out, if, against all the odds of authoritative precedent and fear, derision and self-doubt, someone gets well, then the rules of the game are irrevocably altered. In science an anomaly raises a small doubt in the minds of the initiated. In medicine an anomalous recovery is a truth seared into the body and mind of the one who is now well.
Someone so helped knows in his bones the limits of received medical truth. He will never again listen uncritically to solemn pronouncements about what works and what doesn't. And, inevitably, he will share the good news with others who are suffering in similar ways. One of my patients says he just can't help himself. "It really troubles me," he told me not long ago, "to see people suffering the way I did from arthritis, crippled up and popping non-steroidals or puffed up from Prednisone. And listen, most of the time I don't have to say a thing to get them interested in alternative medicine. They just take one look at me and say, `What have you done? You look fifteen years younger,' and then I have to tell them."
If the person who is helped is a health professional, the process is both more complex and far reaching. It probably requires more energy, pain and frustration to prompt those of us who are health professionals to turn from conventional biomedicine and its theories to other healing practices, to allow ourselves to mistrust received medical authority. We risk a loss of certainty about our own profession and the ridicule of our colleagues. But once we've stepped outside the bounds of conventional medicine and found help, there is no going back, for ourselves, or our patients.