A day of disbelief

Have you ever seen the Scrubs episode where JD is working with an older doctor, who's quite likeable but doesn't practice the appropriate level of care for his patients? I felt like I was living through that very episode today.

It was an odd enough of a day to start with. This week is the beginning of my time in gynecology clinics, and it seems like none of the doctors in the clinic I'm in are willing to take me as a student; the ones that usually take students are either on vacation or already have students. Finally, I was put with a doctor who didn't realize I'd be tagging on with him, but was willing to take me around during his clinic.

This doctor is great in the respect that he lets me do a lot, and he treats his patients well. However, the whole day, I was in disbelief as I saw him practice a standard of medicine I've never seen any physician practice, ie. completely non-evidenced based.

I thought it was kind of unusual after the first couple of patients when he was discussing things like saliva tests for measuring certain hormone levels (the first time I've heard you could do that with reliable effect) and complementary medicine in general and how it was so much superior to the 'western' medicine. Then things got really weird when he started practicing what I consider an unacceptable standard of care. There's a long list, but here's what stuck out in my mind:

1) letting it slide when he asked a patient about breast cancer screening, and her telling him that she was getting a 'thermascan' done instead of a mammogram
2) telling a patient that she didn't need sunscreen because her base tan would be sufficient protection against the sun
3) telling patients that he doesn't believe in the relationship between breast cancer and estrogen exposure (in spite of the considerable evidence showing it)
4) prescribing birth control pills to a 36-year old smoker (if you're 35 and a smoker, it's absolutely contraindicated because of clotting risk)

It's one thing to be your everyday person telling this advice to your friends or colleagues; but when you are a physician, certain guidelines need to be followed, especially ones that have been shown to reduce morbidity and mortality. It's fine to encourage patients to try other treatments, but to not encourage mammograms or to provide incorrect information almost seems like negligence to me. It worries me that if I saw this much today, how many patients has he already misinformed?