Everyone calls me Howard. No one calls me Dr Wetsman. Patients call me Howard; students call me Howard; my kids’ friends and my friend’s kids call me Howard. I don’t tolerate Dr Wetsman from people who know me.
I grew up calling people Mr and Mrs and Dr. I grew up in a time of conformity in America, but, luckily, right at the end. My generation was sandwiched between WWII and Vietnam. We taught to respect people because of their past accomplishments but experienced the fallibility of great men of accomplishment.
In college and med school I was awash in a sea of hierarchy. The people above me were not only Dr, but various ranks of Dr. In the Navy too, of course, there was hierarchy. In both places I saw first-hand that because someone has a title, because someone has done something in the past, it doesn’t make them right. The Navy needs its hierarchy. Medicine does not.
In naval combat, you may fight with your team, the people that you know well, but more likely you get instructions from a person you cannot see. A disembodied voice on a sound box tells you to aim your gun in a different direction, to change your heading, or to fire your missile. There have to be rules that allow you and require you to trust that voice from someone you cannot see. For those rules to be effective, the Navy needs hierarchy.
There is combat in medicine as well. TV medical dramas are filled with examples of teams in the ER or the OR battling trauma or disease to save a life. Orders are shouted, orders are obeyed. Lives are saved. But medical teams don’t really require the hierarchy. It’s a small team and they know each other. Their hierarchy is for outsiders; when they are working, they are just the team.
My specialty of addiction medicine is a weird one. There are emergencies, but most treatment takes place with an attempt at a serene surrounding. Again, TV makes it look like addiction treatment always takes place in a rehab in the middle of a lush forest or on a beach in Malibu. That’s not the reality.
There’s an energy in addiction treatment that I have not experienced anywhere else. I didn’t see it in frantic combat drills in the Navy or in the ERs and ORs of my youth. Even in acute psych wards, though they are very high energy, it isn’t like addiction treatment.
In addiction treatment, the patients are almost all struggling with the same thing. They bring that thing with them, and it hovers over them and the staff. It is an oppressive energy that many in the field personify as “the disease.” It is constant. It is unrelenting. It is overpowering. It burns out the people who work in the field and leads to a great deal of turnover. Everyone deals with it in their own way. Some turn to hierarchy.
It is a marvelous feeling to walk into a room where everyone is in existential crisis and have them all turn to you for salvation. There is a drug–like moment of feeling as high as the pedestal they put you on. To be the one above it all. To be the one everyone looks to. To be the doctor. Oh, the dopamine that flows. It’s great. And it’s dangerous. I don’t want it, even if you need to give it to me.
And make no mistake, people want to give it. If they can place you on that infallible pedestal, then they can have hope, and at that moment hope is what they need. They desperately want you to have “the answer.” They want you to have “the cure.” They’ll believe anything you say. And there’s no place for that in healthcare.
People should believe me because what I say makes sense, not because of a piece of paper on the wall. They should believe what I say because I evidence understanding their history and can explain it with a model that rings true to their experience, not because I took a test filled with facts. They should believe me because I can explain the science to them in a way they can understand, not because I know enough to confuse them at will. People should believe me, or not, because my words convince them, not because of my position or status, not the clothes I wear, not the car I drive, not the house I live in, not even the dignity (ha!) with which I carry myself. Your life does not depend on my dopamine tone.
I’ve seen too many people die because they and their families slavishly followed the advice of the “the Doctor.” Listen to the doctor, weigh the advice, question the decisions, ask for explanation, make your own decision, and, most of all, call me Howard.
Dr Wetsman is an addiction psychiatrist living in New Orleans. He blogs at TOCDr.com and maintains a channel on YouTube where he has released his serial Ending Addiction. He is pursuing his goal of ending addiction by educating everyone about the genetics of addiction with this new venture GenEd Systems.