We are also Them.

I am nearly through Gayle Greene’s book, Insomniac, which is part memoir, part science writing, about insomnia. Greene identifies her target audience in the first chapter: people who experience insomnia, physicians and others who treat people with insomnia, and people who conduct research on insomnia.

As such, those who are not in her target audience might find themselves nodding off while reading the book. She describes the nightly (and daily) experiences and effects of insomnia, the known science and research of sleep, and available treatments. There’s a fair amount of neuroscience in the book—though, thankfully, Greene is a literature professor and writes with skill and clarity. If only all scientists could write like literature professors.

Her descriptions of physicians who expressed disbelief towards patients with insomnia caught my attention. She gives examples of physicians who blame patients for their symptoms. Others suggest that patients must be “wrong” because their reported symptoms don’t match what physicians learn in textbooks… or because the symptoms don’t show up in textbooks at all.

Those physicians imply that patients are making stuff up. They sound like arrogant windbags. I winced when I read their comments.

Of course, we physicians would like to think that we would never say things like that. Those physicians are the big jerks. We’d like to think that we are always empathic, compassionate, and nonjudgmental.

I would be a fool to believe I am never one of them.

The further I progress in my career, the more I realize how little I know. Older, wiser physicians who have mentored me have consistently commented, “As you get more experience, in some ways you will have less confidence. You will wonder what the heck you are doing.”

True dat.

We physicians should strive to accept what our patients tell us. If we don’t know the answer, if we don’t know what’s going on, if we aren’t sure how to proceed, we should acknowledge and accept that uncertainty as ours. Blaming patients—directly or indirectly—doesn’t help anyone. The vast majority of patients don’t make stuff up. They want to get better. And if they could get better without us, they would certainly choose to do so.