The Information Gatekeepers
I come from a DIY family. Mom and Dad preached the doctrine of sweat equity, the idea that what you put into something yields all you can take out of it. In 1968 they bought a house that could never get a certificate of occupancy by today’s standards, and then spent years fixing it up. The sweat equity in the house made possible an improving lifestyle, ballooning wealth, and a secure retirement for Mom and Dad. But there was more.
Mom made a lot of our clothes, and we never ate out. All we kids got jobs early and what we wanted we earned. We went at it with the certainty that we could do what we set out to do as well as anyone else, and for a lot less money and much larger returns.
That do it yourself attitude can take you very far, and result in an awful lot of damage.
Home repairs and inseams are fixable if you screw them up. Other things are not, or are not fixable without an awful lot of pain. Things like financial decisions, legal matters, and medicine.
Today big decisions seem so simple. All of the information in the world is at our fingertips, so who needs to pay a professional to tell us what to do? One can set up a retirement account, choose the investments in it, and change it whenever he desires without ever consulting a financial advisor. One can log on and write a will, creating a legacy and a trust without a lawyer. One can even walk into a doctor and tell her that after a careful review of symptoms the patient has diagnosed himself with a particular disease, all based on web searches, and a surprising number of doctors will say “OK” and write a script.
Many of us do it. Many of us seem quite adept at our DIY activities. Many of us end up eventually at a point where our interpretation of the information we find online can fail, and we’re left without someone with real knowledge that eclipses our limited understanding. Someone who can help bail us out. When we get to this point it feels too late. For a very long time we fumble about in a world that, because of the ease of information to make decisions we are not actually qualified to make, leads us to doubt true experts, to insist we know better, and to discard the information gatekeepers, the professionals of knowledge and action that charge us for their services, because we can do it just as well for free. That is, until we can’t.
Maybe in medicine this combination of easy access to information and doubt of experts leads us into the greatest trouble.
I remember sitting with other patients in the dayroom of a psych ward where someone on staff had left the Diagnostic Statistical Manual, the index, encyclopedia, and bible of psychiatric diagnosis criteria, on the coffee table. We all paged though it and in very little time we discovered our doctors were wrong as we read of unfamiliar diseases with symptoms that better fit our suffering and diagnosed each other with obscure, exciting ailments. Luckily for us, the staff laughed, the doctors frowned, and someone took the book away.
Today it’s easy to sit and type symptoms into a search engine and return a diagnosis. Then turn on the TV and see ads for drugs that can help us. Then march into the doctor’s office and demand this diagnosis and these drugs. Many doctors just go along. Many doctors just can’t say no. Especially in psychiatry, where almost all symptoms are self-reported, impossible to verify outside of the patient’s descriptions. With very little effort a person who has diagnosed himself at home and already determined what drugs they need to treat it can get an official diagnostic code, a trip to the pharmacy, and have it all paid without question by an insurance company.
Sound far-fetched? Consider depression. According to Johns Hopkins University, 9.5% of the population of the US has depression. Explain this: 13.2% of the US population are on antidepressants. And anxiety. The World Health Organization says 4% of the population currently suffers from generalized anxiety disorder. In the US 16% of us are on anti-anxiety medication.
For the sake of the medical profession I hope someone other than the prescribing doctor is presenting with information they found online and convincing the physician to write that prescription. As it is, psychiatry is failing to accurately assess, diagnose, and treat an awful lot of people who must be taking meds for conditions they don’t really have.
Medicine is one of the last places where we still must use information gatekeepers. Doctors. Those drugs our web searches and TV ads tell us we need? We can’t get them without a prescription, and we need a licensed physician for one of those. The glaring evidence that doctors acquiesce to patient demands rather than tell patients with limited knowledge who think they know it all no, that, in fact, the doctor actually knows better. That, very often, you don’t have what you think you have and you don’t need meds.
Understanding limits is a key role of an information gatekeeper. In a world of unlimited information we need doctors who have the guts to tell us we’re not that bad and we don’t need meds. Yes, they’ll also tell us when we do. A good MD trumps webMD every time. Find a doctor you trust, find a financial advisor you trust, find a lawyer you trust, find a contractor you trust, find teachers you trust, and stop spending so much time down rabbit holes scrolling for things you can get better from a qualified human being.