Last updated on July 9, 2019
Spoiler Alert: Contains minor spoilers for the memoir “Educated” by Tara Westover
“You seem very angry,” I say to my patient.
It’s a basic technique in our physician tool chest, but I’d forgotten to try it—reflection.
He hesitates. Surprise crosses his face. “I am,” he says. “But not at you.”
I allow the space of silence, not sure which direction the conversation will go next.
After a moment, he elaborates further. He talks more than he has at any other visit.
He shares his deep-seated mistrust of doctors. His belief of Internet rumors — including the ones about governments and pharmaceutical companies that have the cure for cancer, hidden away, but will never share it with the common man.
“But I don’t think that about you,” he says.
Well, thanks, I guess.
But how should I reply? So much to tackle, and so few minutes left in the visit.
I recently read the memoir “Educated” by Tara Westover, and through it attained new understanding of a background that might lead to these health care beliefs.
Westover writes of her childhood in rural Idaho, raised by survivalist parents, outside of the public education system. It is a story of grit and hope and how she made it all the way to attain her PhD at Cambridge.
But a particular element that fascinated me as a physician was her recollection of how the family managed (or didn’t) without modern medical care.
Her detailed description of the survivalist attitudes of her family, as led by her father, told through the lens of her childhood, gives compelling insight to the shunning of doctors and hospitals that her upbringing entailed.
Early in the memoir, Westover explains how her mother practiced as an unlicensed midwife. She recounts her mother’s embarking into “muscle testing” and “energy work” in gripping detail. And recalls her own skepticism, even as a child, to her mother’s actions.
Her paternal grandmother had “cancer of the bone marrow,” and Westover recounts her father’s attitude toward his own mother’s illness:
Once she is in college, she has access to standard medical care for the first time in her life. But she doesn’t know how to go about it.
Then when the doctor gives her antibiotics, she relates her inner struggle in taking prescription medication for the first time:
Westover then calls to “confess” to her mother that she’s taking the penicillin.
Her mother’s response? To send:
Later in the book, Westover reflects on how her father’s influence still held sway over her and her college-educated brother:
It is only at Cambridge, in studying the concepts of negative and positive liberty, that she realizes:
Other parts of her memoir are devoted to her realization that her father’s behavior fits with symptoms of mental illness that she learns about in her psychology course.
There is much more to her extraordinary memoir, and I won’t give any more spoilers. (if you do want to read more, start here with the New York Times Book Review.)
I recommend “Educated”as a must-read for all physicians, no matter where you practice in the U.S.
In reading Westover’s candid truth of her upbringing, I wonder how many of my patients had similar childhood experiences.
I think about the spouse of one of my patients, both in their sixties, who revealed he had never filled a prescription at a pharmacy before. I took a few extra minutes at the end of one visit to explain to him step-by-step what to do to fill her prescriptions.
For many rural patients, the diagnosis of cancer is the defining moment that brings them into the health care system.
Or as Westover’s family described it, the “Medical Establishment.”
For some of my patients, I am the first doctor they have seen in their adult lives.
How can I go up against a lifetime’s deep-rooted beliefs in a 30-minute clinic visit?
I can’t.
In the end, I decide not to debate with my patient. I don’t try to talk him out of his beliefs.
Mostly, I am relieved to understand that he is not angry at me.
Westover’s memoir has given me a new tool. Because with understanding, comes patience.
So this is what I say to him. “Thank you for trusting me with your care.”
It’s a start.
author’s note: originally published on Doximity’s Op-med on 6/19/19 under the title: How Can I Tackle My Patient’s Deep-Rooted Beliefs in a 30 Minute Clinic Visit? I Can’t. Minor edits here for format and content.