Text of a letter to a doctor

 

A few days ago I sent you a copy of my letter of 20th April to which I still hope for an answer. It does appear to me that the medical profession should feel some responsibility for helping even those who regard it with abhorrence to make the necessary contact with one of their number, without which they have no chance at all of obtaining any of the forms of medication to which they are denied free access. 

There is certainly a curious imbalance in a situation in which every member of the population must gain acceptance by some member of the profession in order to ask for medication, while every member of the medical profession may reject any particular person as a client. Clearly it is an easy matter for any particular individual to find it impossible to obtain a doctor from whom he can even ask for anything, uncertain as it is whether any of his requests will be granted.

A friend of mine was recently refused a prescription for HRT because the doctor wished her to submit to a test for some condition (thyroid deficiency) which even he considered most unlikely. My friend wrote to him that she did not consider the risk serious enough to wish to submit to the test in question, and expressed the view that it should be up to her whether or not she was prepared to accept the risk involved in not doing so. After considerable delays the doctor asked her to go for another interview with him. She replied that she did not want to see him again, as she had already done so, and asked him whether or not it was the case that there was no possibility at all of her being given the prescription which she had asked for unless she agreed to submit to the test in question against her will. The doctor replied that this was in fact the case, the possibility of her obtaining a prescription was dependent on the test.

This seems to me an amazing admission. Since doctors control the supply of certain things to all members of the population, one would have thought that a doctor in this position, granted that he had a client with the individual characteristic of being unwilling to submit to tests, would have to make the best probabilistic guess he could whether or not it was in the best interests of the client to have the prescription or not, even though he had to make a probabilistic guess in the absence of a certain piece of information, rather than with it.

In many cases, of which this one is an example, it would seem likely that the probability of the medication requested being in the client's interests is very great, so that by refusing to provide it the doctor is acting an a way detrimental to her interests. Which, in a very vague and doubtless over-optimistic way, one would tend to assume doctors should not do. 

And, in a general way, it would seem that the population of those who have an aversion to submitting to tests, being examined, or answering questions against their will, is likely to be at a severe disadvantage. Always supposing, of course, that the medications prescribed by doctors, when they are willing to prescribe them, and on the terms on which they prescribe them, actually do good more often than harm.