lung cancer misdiagnosed as anxiety

[ukxmrv]

The NHS changed though Hip and that is something you probably don't know as a non-user.

Either the doctors training changed, a philosophical feeling changed, the type of people or something.

They were still dissecting corpses. A friend of mine did this in the 80's but she still is capable of compassion and treating patients with respect.

My own suspicion is that doctors at some point have been influenced and believe that it is now acceptable to attribute physical symptoms to emotional problems with no evidence.

Don't find your arguments very convincing.

 

[Hip]

The NHS changed though Hip and that is something you probably don't know as a non-user.

Either the doctors training changed, a philosophical feeling changed, the type of people or something.

I use the NHS.

What changes do you mean exactly?

Don't find your arguments very convincing.

Well, that's not my only argument.

Another strong factor in all this relates to the technocratization of medicine. Not so long ago, all a doctor could offer a patient was good bedside manner, and be a person a family can consult and turn to in times of illness. Victorian doctors were all like this. In that era, a doctor's actual ability to offer healing medicine or treatment was extremely limited, especially in times before antibiotics. All he could do was prescribe bed rest, or some similar simple advice.

Even say 50 years ago, the capabilities of medicine was still relatively limited. So a doctor could remain focused on the humanity of the doctor-patient relation — as this humanity was still a major part of what he had to offer.

Of course, nowadays, with the extraordinary inroads that science and technology have made in medicine, everything has changed. Now a doctor needs to be a complete techo-nerd just in order to deal with the immense technical complexity of 21st century medicine. And this situation is only going to get worse, as more and more technocratization of medicine occurs.

Yes, there are far more chances of being healed these days; however, the emotionally desiccating effect of technocratization on the human mind will take its toll, and doctors' bedside manners may diminsh as each doctor is forced to become more nerdy, more geek-like, and more focused on the patient's hyper-complex datafiles than on the patient's feelings.

Some complaints on this thread have been about the fact that doctors don't always keep up with the billion and one bits of new medical data that come out every year, and that they are less then perfect with their diagnoses. So we want our doctors to be informational super-geeks and analytical mega-machines. Yet at the same time, we also want the opposing characteristics: that are doctors are warm, full of humanity, and definitely not emotionally remote or geek-like!

Incidentally, this same technocratization phenomenon also occurs in our social lives. The very fact we increasingly communicate via forums such as this, via Facebook, via PM, or by peering into the inbox of our smart phones means that we may lose some of our abilities to conduct normal and meaningful face-to-face communication, and lose the ability to be affable. Human relations are in danger of becoming digitized, such that we will excel at exchanging information, but do less well when it comes to sharing emotion.


Though I have to say that the Internet has been wonderful for ME/CFS patients; better to communicate online that not all at. The Internet has also given a political voice to ME/CFS, who previously may have been to frail to express their views in the real physical world. Not to mention easy access to treatment information.

 

[Little Bluestem]

Since the doctors are convinced my utter inability to exhale that day was clearly stress induced, after just waking up from 9 hours of solid sleep.

Did this happen recently?

It sounds similar to something that happened to me a few years ago. The cause turned out to be a mold source in my bedroom. Once I cleared that up, the problem stopped. If your problem is recent, you might want to search for any type of allergen in your bedroom.

I did have better luck with the health system. When I went to a doctor and straight out asked for an asthma inhaler, I got it.

 

[Hip]

Hip, I don't think that your own case adds to this argument.

I just used my lovesickness story to demonstrate that you can have purely psychological causes for depression, and a good doctor needs to recognize when this is the case, as perhaps anti-depressants may not be the answer in these cases, and addressing the psychological causes would seem the better approach.

Though I agree that doctors might be too ready to ascribe psychological causes, just because this conveniently gets the patient out of their surgery and off their backs. In my opinion, you can only accurately ascribe psychological causes if you are a doctor that possess a lot of empathy. Empathetic abilities vary a lot from one human being to the next. Many people possess very little empathy. Most people can offer sympathy; but empathy is far deeper, far rarer ability, and something of a spiritual intelligence, I think.

 

[Hip]

In my training the dignity of the patient was drummed into us. All that went out the window with the stupid changes in training.

What kind of changes in training are these, Shell? I am interested in this.

 

[Hip]

Here is a question:

For those of you who watch the much applauded TV series House, about a doctor who enjoys provoking, belittling, and even insulting his hospital patients — but who is totally on the ball, devotes his full intelligence to solving each and every medical mystery, and (at least in this fictional series), ultimately always hits upon the right diagnosis (but usually only after having got is wrong on the first few guesses), and saves the patient.

Good doctor, or bad doctor?

 

[Shell]

Hip I am somewhat taken aback that you denegrate the basic care of protecting patient dignity and treating them with respect as "touchy-feely".
I was trained thoroughly in what you seem to have no time for. In fact it was possitively drummed into us.
Let me give you exampes;

I was trained in making a bed with patient in the bed. Two members of staff would go to the patient and explain what needed to be done. Extra pain meds would be given if required because we were touchy-feely about inducing unnecessary pain in the patient.
I would roll the patient towards me as gently as possible (touch feely as you see) The other nurse rolls up the bed sheets and tucks them under her. and sets up the clean sheet.
Then,with a loose sheet over her so she isn't flashing her bum to the rest of the ward - how touchy feely of us - we roll her over the lump to the other nurse- but only when s/he was ready as it was he patient who was suffering here not us - and pull out the dirty linen and straighen up the clean making sure she is comfortable with pillows.

All the time we are speaking with the patient.

When I was in hospt in July I watched two members of staff perform this without any communication with the very sick woman they were heaving about and speed was obviously more important than care.

Even when I worked in a children's hospice where many of the children had no language we still treated them with care and respect.
I don't see this as touchy-feely I see it as basic good human behaviour.
I've seen a vet treat my kids pets better than some doctor treat fellow human beings.

As for the changes in training I have had third year student nurses and SHO doctors work with me who did not even know how to speak with a patient. All their learning comes from books and in a Uni classroom. Placements are so short they barely get to grips with the reality of the job. Doctors training is even worse. They think nurses should do everything and helping a patient is beneath their dignity. Sadly I have seen this in qualified nurses too who won't help with patient care.
I had one student practically have a panic attack when I asked her to sit with a fairly well patient and talk with her.
This was in a psychi hospt. As far as I was concerned the number 1 skill an RMN required was talking with the patient and listening to them.

I saved someone from prison once simply by talking with her. I probably saved a life that day too as she had planned to kill someone. Sometimes what you call touchy-feely can be pretty difficult. What would have happened if I had decided talking with and listening to someone with a mental illness was too touchy-feely to be bothered with?

But then Hip, going by the behaviour of staff I've had to deal with since being ill perhaps your view of the inherent dignity of the person is the common one.

I'll say one other thing about training. I had a student nurse who was so dreadful (3rd year) that I referred her. This means I failed her placement. No matter what I or other staff did with her we couldn't get her to do the job even safely let alone with skill.(And btw patients are not stupid. They pick up on poor staff and it has knock on effects in the way the ward/unit runs)
The tutor from the Uni came down and basically leaned on me very heavily to pass her.
I stood my ground and she was referred. However six months later she was qualified. The thought that someone as frankly dangerous as she was caring for you or someone you love (if love isn't too touchy-feely) should worry you just a little.

 

[Valentijn]

Some complaints on this thread have been about the fact that doctors don't always keep up with the billion and one bits of new medical data that come out every year, and that they are less then perfect with their diagnoses. So we want our doctors to be informational super-geeks and analytical mega-machines. Yet at the same time, we also want the opposing characteristics: that are doctors are warm, full of humanity, and definitely not emotionally remote or geek-like!

I hope you don't feel that people are complaining because doctors don't know everything: I don't believe anyone has said or implied that. It's also not really a matter of lacking a nice bedside manner.

The issue is that some doctors, when presented with symptoms, do not have a clear explanation for them. And that's fine. But instead of saying "I don't know" and looking into it further or referring the patient to a specialist, they make completely baseless assumptions, often due to gender, age, lifestyle, or other largely irrelevant factors. Then someone with a medically unexplained symptom gets arbitrarily labeled as having a psychological problem, instead of attempting to find a medical explanation for the symptom.

Overlooking drastic and unintentional weight loss is not a simple failure of a doctor to know what it means. Even non-doctors know that it's a very worrisome symptom that is present in serious diseases, and does not happen to healthy people. To attribute such a problem to "anxiety" or "depression" without even considering those other serious diseases is inexcusable.

As chronically ill patients, we know by now that "Dr House" is a myth. But a lot of doctors seem to think that they can reach the appropriate diagnosis within minutes of meeting the patient, by drawing conclusions about the patient's behavior and the doctor's self-presumed knowledge of the human condition and psyche. Those doctors need to realize that they don't have all of the answers and they need to behave in a patient-oriented manner when that happens, instead of bending over backwards to protect their own egos.

 

[Hip]

Hip I am somewhat taken aback that you denegrate the basic care of protecting patient dignity and treating them with respect as "touchy-feely".
I was trained thoroughly in what you seem to have no time for. In fact it was possitively drummed into us.
Let me give you exampes;

I was trained in making a bed with patient in the bed. Two members of staff would go to the patient and explain what needed to be done. Extra pain meds would be given if required because we were touchy-feely about inducing unnecessary pain in the patient.

I would roll the patient towards me as gently as possible (touch feely as you see) The other nurse rolls up the bed sheets and tucks them under her, and sets up the clean sheet.

Then, with a loose sheet over her so she isn't flashing her bum to the rest of the ward - how touchy feely of us - we roll her over the lump to the other nurse - but only when s/he was ready as it was he patient who was suffering here not us - and pull out the dirty linen and straighen up the clean making sure she is comfortable with pillows.

All the time we are speaking with the patient.

Shell, I really did not intent my phrase "touchy-feely" to be belittle or denigrate the principle that all human persons have inherent dignity and need to be treated with respect. I just used that phrase as a shorthand.

But I just remembered now that the phrase "touchy-feely," which generally is just defined as "physical closeness and emotional openness", can also have a derogatory connotation, but I did not intent any derogatory connotation.

Treating a patient with dignity presumably really begins in the heart, so this would require emotional openness and warmth.

In any case, I completely agree with what you are saying, and the example you gave above about changing sheets has opened my eyes to how much refinement can go into maintaining the respect and dignity of a patient.

As for the changes in training I have had third year student nurses and SHO doctors work with me who did not even know how to speak with a patient. All their learning comes from books and in a Uni classroom. Placements are so short they barely get to grips with the reality of the job. Doctors training is even worse. They think nurses should do everything and helping a patient is beneath their dignity. Sadly I have seen this in qualified nurses too who won't help with patient care.

I had one student practically have a panic attack when I asked her to sit with a fairly well patient and talk with her.

It is terrible that this is happening to the new generation of students. As I mentioned in my above post about the technocratization of medicine, and the technocratization of our social lives in general — the computer information technology we surround ourselves with — may be inculcating a generation of people that have learnt to become emotionally insular, geeky, and perhaps even slightly autistic.

It is not just me who is saying that computer information technology may emotionally stunt young people; this idea has been generally discussed.

When, as you described above, a student practically has a panic attack when asked to sit with a patient, then something is not quite right with either that person, or their training. (Though mightn't that panic attack just be an individual condition — I myself developed a severe anxiety disorder after contracting IBS, and ever since then, I can get severe aversion to meeting people, as social activity can often dramatically increase my anxiety. I was never like that before.)

 

[Hip]

The issue is that some doctors, when presented with symptoms, do not have a clear explanation for them. And that's fine. But instead of saying "I don't know" and looking into it further or referring the patient to a specialist, they make completely baseless assumptions, often due to gender, age, lifestyle, or other largely irrelevant factors.

That is very true, and ideally what a doctor should ideally do is provide an indication of the level certainty–uncertainty of his diagnosis, much like a weather forecast, when it says 20% chance of rain, versus 95% chance of rain. So if they feel their diagnosis is 100% correct, and totally clearcut, they should say this; but equally, if they don't really know for sure, and are just providing an educated guess, then this should be mentioned to the patient.

As chronically ill patients, we know by now that "Dr House" is a myth.

We are chronically ill because ME/CFS is largely incurable, not because of some fault with doctors.

And only the uncured post on forums like this; those that have been cured by medicine rarely set up online forums to sing the praises of their doctor, his diagnosis, and his treatment.

Thus the Internet as a whole probably gives a bad impression about medicine, because people only come online to complain, never to praise.

Those doctors need to realize that they don't have all of the answers and they need to behave in a patient-oriented manner when that happens, instead of bending over backwards to protect their own egos.

What you say there could apply to any profession: politics, engineering, business salesmen, etc, etc. There is a very strong tendency for any professional to maintain their professional ego. Their very livelihood often depends on it, so it is a kind of survival instinct.

I am not disagreeing with you, I am just indicating the survival instinct origin of this ego.

 

[Valentijn]

We are chronically ill because ME/CFS is largely incurable, not because of some fault with doctors.

Fortunately no one was faulting doctors for not curing us. I would appreciate it if you stayed on topic and did not twist my words to imply I was saying such a thing.

 

[Hip]

Fortunately no one was faulting doctors for not curing us. I would appreciate it if you stayed on topic and did not twist my words to imply I was saying such a thing.

I am not twisting your words. You said: "As chronically ill patients, we know by now that Dr House is a myth."

I suggest the likes of Dr House are not a myth, and that there are real-life brilliant infectious disease diagnosticians like Dr House, that can figure out that you have picked up some obscure pathogen on some trip you took abroad many years ago, and then provide a cure.

Just because we happen to have a chronic disease does mean that all diseases are incurable, and that brilliant diagnosticians are a myth.

 

[Shell]

Hip I am sorry I misunderstood your use of "touchy-feely" Honestly in my sad world I've only heard it use as a derogatory term.

I agree 100% about the techno problems in our culture and it's impact on medicine. It's interesting (and rather sad) to note that Dr Osler warned fellow medics not to get over reliant on machines back around 1915.
I think machines and computers can be used so well but they have become little idols for so many people and that includes doctors and nurses.

While I agree that caring for another's dignity is "from the heart" I still think it can be taught. I learned so much from the nurse tutors and the nurses on the wards I worked in about the method of preserving dignity.

 

[Hip]

I agree 100% about the techno problems in our culture and it's impact on medicine. It's interesting (and rather sad) to note that Dr Osler warned fellow medics not to get over reliant on machines back around 1915.

I think machines and computers can be used so well but they have become little idols for so many people and that includes doctors and nurses.

My first professional job in 1987 was in mainframe computer programming, and this was at a time where computers were still very rare and exotic in the world, and most people did not have one at home. After working for 3 years very intensely in that immersive computing environment, I could feel that the emotional and human side of my personality was choking amidst all that logic, analysis and information. I left that job, even though I was good at it, because I worried that I would not mature into a balanced, feeling human being. Ever since then, I have had concerns about the effects of information technology on the human race.

I loved working with computers, but even back then I began to understand that there are negative sides to them. Nowadays computers are no longer rare, but surround us from the earliest age. We all live in an information age now, for better or for worse.

While I agree that caring for another's dignity is "from the heart" I still think it can be taught. I learned so much from the nurse tutors and the nurses on the wards I worked in about the method of preserving dignity.

No doubt that is right. Virtues are perhaps in part inate, and in part down to training and education in values. One supports the other. Such a tragedy that this refined training you mention is not being given.

 

[PhoenixBurger]

Did this happen recently? It sounds similar to something that happened to me a few years ago. The cause turned out to be a mold source in my bedroom.

Little Bluestem yes my problems all started when i moved into this new condo. Whether coincidental or not. I know that my bathroom faucet water smells *horrible* unless I let the water run for at least 30 seconds before touching it. I have no idea. I also now live across from a sewage treatment plant. Lots of changes right around the time I moved in. But that water really makes me wonder sometimes. It smells extremely strong mildew/mold/fungus. But it completely goes away if the water runs for a short while. Then it just reeks of chlorine. How did you identify that you had a mold issue? Wish there was a blood test for it.

 

[ukxmrv]

"House" is a drama Hip. I can't see why this would be relevant here. I've never watched it.

If there is a brilliant diagnostician working in the UK NHS I've never been lucky enough to see him or her. The whole ethos has become corrupt. A brilliant diagnostician would not survive using the NICE guidelines for example.

They would be told what to test for and controlled. A brilliant diagnostician is only as good as the lab that supports them with tests and a structure that gives them a free rein. That's not the current NHS.

It also needs doctors who are open minded and willing to look beyond whatever is causing this double standard. It is obviously absurd that a NHS GP can diagnose a mental illness with no tests yet at the same time refuse to diagnose other conditions without a test. Something has told them that it is acceptable and it's simply not OK.

 

[Little Bluestem]

Little Bluestem How did you identify that you had a mold issue?

I saw that I had a house plant in my bedroom that was making the carpet beneath the pot wet and stinky. Sorry, that won't do you much good.

Has anything been repainted, recarpeted, re-whatever in your apartment, especially in your bedroom?

 

[PhoenixBurger]

I'll send you a PM. Don't want to sidetrack this thread.

 

[Hip]

"House" is a drama Hip. I can't see why this would be relevant here. I've never watched it.

Shakespeare's plays are dramas, yet what you can learn about human nature from them is immense.

You should watch House. It's on a lot of the cable/Sky channels in the UK. I understand that in Spain, they worship the character of House, and the actor who plays House (Hugh Laurie). I think they admire the intensity of his intellect, and the fact that he never gives up until he has found the answer.

 

[Hip]

One news items I was watching a while back was about an independent UK organization (I forget the name) that has become a major watchdog on the NHS. One of the interesting things this organization said was that they found an enormous difference in quality and staff attitude from one NHS ward to the next (and they said that even in one hospital, you often find a huge difference in quality between wards). No doubt this is down to the staff in the wards.

Perhaps when a bad attitude creeps into a ward, in becomes endemic, and the bad attitude brings down even the good staff.

But for anyone making comments about the quality of the NHS treatment, no doubt a lot depends on where you were treated.


Undoubtedly the worst atrocities in the UK health care system were the mental health wards, circa the 1970s and earlier. The stories of staff abuse of the mentally ill in that era are horrific. God help you if you were ever incarcerated in one of these bad wards.

Interestingly enough, Margaret Thatcher was well aware of the dire state and horrific abuse that occurred in the UK mental health asylums, and she considered the situation so bad that the only recourse was to close all these institutions down, and this in fact is one of the first policy decisions she enacted when she became prime minister. Her view was that the mentally ill should not automatically be incarcerated and hidden away from society, but allowed and helped to make their way in the world. Thatcher is often considered socially insensitive, but in this situation, she undoubtedly did something good. No society should incarcerate and abuse mentally ill individuals.