Is Medical Arrogance Striking Again?

Russ points to this article in the Reno Gazette Journal: "Patients claim fibers sprout from lesions and parasites crawl under their skin. Most doctors tell them it's all in their heads" The topic brings up a problem in medicine that we (oddly) find hard to acknowledge: we don't know everyting. I do have a few patients similar to the folks descibed in the article .. and I have a hard time knowing WHAT the problem is. Saying "I don't know" is often the best method. My problems escalate when a patient brings to me a hypothesis from another healthcare provider which is as reflexive and condescending as "it's in your head." Consider Dr Harvey's statement in the Gazette article I link to above: “Without understanding the skin lesions fully, I’m treating patients with antibiotics and having clinical success. Something appears to have happened to their skin immunity.” He's making a treatment decision in the absence of any rationale. Am I an arrogant physician because I wouldn't treat a problem with antibiotics unless I knew there was a clear rationale for that treatment? Dr Weil's talk at STFM yesterday touched on this a bit. He acknowledged that much of the "alternative medicine" that people are embracing is in fact garbage. We need to be thoughtful and evidence-based as we practice integrative medicine .. just as we do for "traditional" medicine. Yet there will be integrative methods without much evidence, just as there are traditional allopathic methods without much evidence. He suggests that the requirement for evidence of efficacy be dictated by the level of risk in any treatment.