Transparency and Trust in Medicine, Briefly

I literally had a patient in a very granola-y area the other day say to me, “All you doctors, you’re just paid by Big Pharma anyways. That’s why I don’t get any of your vaccines.” I was fairly aghast, but behind my mask I kept my poker face and curiously dived in a little deeper. We talked for over an hour about why I continued to recommend Vitamin K for their newborn baby to prevent life endangering bleeding and I dismantled his thoughts that I was part of some sort of “government conspiracy,” and it ultimately left with them asking me to be their Pediatrician – I was flattered, but thankfully as a locum tenens workers, I generally target my focus to inpatient medicine and was able to evade the awkardness. However, part of my conversation with them, as something I’ve always tried to have with so many people is in regards to a big issue particularly over the last few years: Transparency in Medicine.

As I discussed with these new parents, when I thought about it, in my small world I know hundred of doctors at this point, but among my high school friend group in Northern California, i’m the ONLY one that’s a Doctor. When I thought about it, among all of the media and google searches that people will do, well shoot, I wouldn’t maybe trust me if i didn’t know myself personally either. Most of my patients view me as being in some sort of distant ivory tower, and i’m hyperaware of it – more on this in another post one day. Over centuries in the United States, and also surely around the world, I can definitely understand the development of lack of transparency.

The Lay (Wo)Man

First, at the level of science itself. I went to training for 10 years to understand things at a molecular and abstract level, but very little of that was spent in formal training of how to translate that into “layman’s terms.” Ah, lay man, from what I can google is, “a person who does not belong to a particular profession or who is not expert in some field,” (Source). Not only is the depth of what i’ve hard to learn, not at the fingertips to most people, but there’s a reason it took so long to amass. Within that, the vernacular is difficult, unless you’re some sort of Latin scholar. This is 100% NOT a comment on intellect, but frankly we just speak different languages. When I go to the Mechanic or talk to someone explaining Business to me, I too have absolutely no idea what they’re saying. My choice to TRUST them, is rooted on gut feelings and hearsay, just as is my patient’s choice to TRUST me. As a Pediatrician, I pride myself in being able to take complicated concepts and that decade of experience and shrink it into understandable information for those that aren’t in my field, but it’s sometime’s hard to do. Being able to describe rare genetic disorders or minutia of mitochondria to someone that is not a scientist, isn’t always a walk in a park. I am very conscious of this gap, but for those that are not, it’s easy to get caught up in speaking “like a Doctor” and for patients to NOT understand us. It’s easy for it to be murky.

“I did my own Research

“There’s no Editor for the internet.”

– Dr. Roth (One of my Pediatric Oncology Attendings at MD Anderson)

The most frustrating catchphrase for Doctors in the last 5 years in the United States, “I did my own Research.” Part of medical training is actually understanding that there is a method to research, that there is a way to evaluate study designs and the validity of information. We aren’t trained in high school or even often in college, to decipher the truth. So, faced with an endless web of information, it is often times hard to figure out what the truth is. I’ll never forget the head Pharmacy Technician I used to work with that told me, “Trust none of what you hear, half of what you see, and all of what you feel.” Understandably, for most people, it’s easy to type in a Google search, but hard to figure out which link speaks the truth…Yet, maybe easier to understand than a doctor. Unfortunately, it is also human nature to read into or believe the darker or more pessimistic side of things. But, WHY do people search out these other truths, instead of listen to me? While the history of medical distrust is too complicated to write about right now, outside of a fundamental bias at the core, I personally believe that part of the problem is that I don’t have all of the answers. Life is simply just not black and white. From time to time, on rare occasions things fit a specific mold, but for the most part, being a doctor is Grey – Duh, “Grey’s Anatomy” anyone? So of course, if the authority, Me, doesn’t know, people try to find out on their own – this is a beautiful human trait, but causes conflicts in understanding if sources are invalid.

Over the years, I’ve actually discussed openly to families and parents Google searching. The farther i go in my career and the more I learn, I try to be preemptive. “When you go home, I know you’re going to google this. You will see X, Y, Z and these are the reasons that those are not true.” But I can’t know everything. The internet is powerful and useful in the right hands. So, I stick by what one of my mentors taught me which is, “There’s no editor for the internet.”

The System Begets Itself

Now, outside of those facts that we don’t have all of the answers and that people that don’t speak the same language try to search for those answers without truly validated resources and without knowing the resources they read from are possibly conjured up by individuals with lack of clout, there’s a whole other big issue: The System Itself. I 100% understand the father that asked me about Big Pharma, I think everyday about the several hundred dollar emergency room bill i had a as a patient in Medical School and the lack of answers from my insurance company and the way that hospitals are not always very forthright with information. These factors, I can not control at an individual level, and I am affected by them as a patient just like everyone else. Hopefully with continuing healthcare reform we see insurance companies, pharmaceutical companies and hospitals work on their own to raise the blinds and tell patients in clear terms the truth… But, these are long term hopes we dream of.


The lack of transparency at a system level is hard to dismantled; but, I work for my patients and care about their well being. Morality and ethics in the world are always points of difficulty and trust is hard to come by, but I went into medicine to help people and am as open as I can be. I spend many hours discussing the insecurities and gaps of knowledge we have in medicine, the reason I recommend things to them as if they were family and push to explain that, much to the chagrin of my student loans, I am NOT sponsored by Big Pharma. Multiple historical and present factors lead to distrust in medicine, and I try to fight it one day at a time. At the end of the day, all i can do is try to do my best for my patients and try hard to clarify and explain things in ways that everyone can rightfully understand in conjunction with the changing world of free endless information (true or not).

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