Doctor criticises modern medicine

[MeSci]

I don't usually cite the Daily Mail, but I think that this article provides interesting insights into some difficulties faced by doctors.

I part company with the writer when he starts advocating:

Medical care should be about delving into patients' lives, listening to their stories and paying close attention to what's said between the lines - how their marriages are going, what's going on in the family and with friends, how their sex life is, what's happening at work, what stresses them, what they eat and drink, if they exercise and if they sleep well.

If the patient has clearly come in relation to physical problems, the focus should be on these unless the patient indicates that something psychological is underlying them. I would be tempted to tell a doc to mind his/her own business if s/he started asking about my relationships.

If the doctor is going to ask about diet and sleep s/he should ensure that s/he is in fact up-to-date on the science relating to these, which rarely seems to be the case in my experience.

As for patients being assertive, I think that most UK patients will know that that is pointless with a doctor who thinks that s/he is a god, and will just make him/her angry.

 

[worldbackwards]

Medical care should be about delving into patients' lives, listening to their stories and paying close attention to what's said between the lines - how their marriages are going, what's going on in the family and with friends, how their sex life is, what's happening at work, what stresses them, what they eat and drink, if they exercise and if they sleep well.

Medical care should be about being really creepy and poking your nose in where it isn't wanted. I'm sure that'll go down a treat.

 

[msf]

Medical care is about trying to find a solution that doesn´t require the state to spend any money.

 

[helen1]

Interesting article MeSci.

But I think there is some merit to doctors asking about your personal life and lifestyle. For example in the article the man who suffered a perforation due to an unnecessary procedure had heartburn from eating a spicy lunch.

If simple things like heartburn had been considered instead of focusing on complicated health conditions he would have been asked what he'd eaten and would not have been harmed by the procedure.

I'm also thinking of how stress can cause chronically high cortisol with the resulting inflammation and symptoms or chronically low cortisol if the stress goes on for long enough with the resulting symptoms.

Of course many doctors as we know focus on personal issues and lifestyle to blame the patient to avoid the patient blaming them, the doctor, when they don't have answers.

Just saying I can think of situations when the personal can be pertinent.

 

[MeSci]

Interesting article MeSci.

But I think there is some merit to doctors asking about your personal life and lifestyle. For example in the article the man who suffered a perforation due to an unnecessary procedure had heartburn from eating a spicy lunch.

If simple things like heartburn had been considered instead of focusing on complicated health conditions he would have been asked what he'd eaten and would not have been harmed by the procedure.

I'm also thinking of how stress can cause chronically high cortisol with the resulting inflammation and symptoms or chronically low cortisol if the stress goes on for long enough with the resulting symptoms.

Of course many doctors as we know focus on personal issues and lifestyle to blame the patient to avoid the patient blaming them, the doctor, when they don't have answers.

Just saying I can think of situations when the personal can be pertinent.

Yes - there are. Common gut problems can cause chest pain. A doctor should know this and it would be logical to ask what someone had eaten or drunk.

Cortisol actually reduces inflammation. This article discusses the effects of stress, but I know that it's a controversial subject, especially here!

I don't have a problem with doctors listening to what patients say, as long as they are not over-keen to jump on psychological explanations, which all-too-many are.

 

[barbc56]

I don't have a problem with doctors listening to what patients say, as long as they are not over-keen to jump on psychological explanations, which all-too-many are.

This is an important distinction. If a doctor is asking questions to get a sense of the whole picture that is very different than when a doctor is assuming a psychological reason and this drives the questions asked.

Thanks.

Barb

 

[Woolie]

To me the tone of the article was kind of self-congratulatory. For example, our author was the only one to discover that patient "Mark" had eaten a "spicy meat and cheese sandwich"! Well, then everyone knows that such a meal is likely to cause chest pains and vomiting up blood, its obvious isn't it? Why would you even need to run tests? And he's overweight and on antidepressants - no place for someone like that in acute care, he needs to learn to mend his ways first.

Better hope there's no fatsos with serious acute emergencies on this guy's watch...

I'm also with @MeSci on the "delving into lives" thing. I think questions that relate to health practices (diet, exercise, sleep) are fine. But a GP would be wise to know the limits of his expertise, and it begins and ends with medicine. He/she is not all knowing about the way people should and should not conduct their lives. If you ask us about our relationships, etc., without a clear understanding of how that information is relevant to our health, you risk going well beyond your remit.

Despite the references to "patient empowerment", here's a kind of patronising element to this narrative. All patients need is to be educated on how to live well, and I'm the person to do it.

 

[Sean]

Medical care should be about delving into patients' lives, listening to their stories and paying close attention to what's said between the lines - how their marriages are going, what's going on in the family and with friends, how their sex life is, what's happening at work, what stresses them, what they eat and drink, if they exercise and if they sleep well.

Hmm.

Been there, done that, more than once, (and before it became fashionable too). Never worked out too well. Mostly just became fodder for open-ended biopsychosocial speculobabble.

and paying close attention to what's said between the lines

Enough holes and wiggle room in that to sail a fleet of aircraft carriers through with clearance to spare.

Sorry, not good enough.

 

[heapsreal]

When examining a patient it seems its all about lab results, they dont really listen to symptoms etc. If labs are normal??? One will probably get diagnosed with depression and given an antidepressant . They dont seem interested in investigating things further and many gps wouldn't understand alot of the tests out side the normal few they do anyway.

If sent to a specialist , they are only helpful if u fit into one of their tight criteria. If u dont its go back to gp again.

Cfsme doesn't fit into any specialty and gps have limited weapons to help us. Usually gps are restricted in what they can do due to red tape and arent allowed to practice above a certain level of care.

 

[MeSci]

and paying close attention to what's said between the lines

Enough holes and wiggle room in that to sail a fleet of aircraft carriers through with clearance to spare.

Sorry, not good enough.

Approximate examples of my doctors reading between my lines:

My muscles are weak, [depressed] especially in my legs.

I have really bad [anxious] diarrhoea.

I can't walk and am [panic attack] having trouble breathing.

I have polyuria [psychogenic polydipsia] and it makes it very hard to sleep and live a normal life. I do not drink an abnormal amount of fluid [yes you do]. Here are my fluid charts as requested - as you can see - polyuria, [psychogenic polydipsia] normal fluid intake [psychogenic polydipsia].

I get a pounding pulse [anxious] when I lie down at night. This is my calmest time of day [no, definitely anxious]. I am sure that it is not psychological. [Yes, you are anxious]

 

[Strawberry]

Approximate examples of my doctors reading between my lines:

My muscles are weak, [depressed] especially in my legs.

I have really bad [anxious] diarrhoea.

I can't walk and am [panic attack] having trouble breathing.

I have polyuria [psychogenic polydipsia] and it makes it very hard to sleep and live a normal life. I do not drink an abnormal amount of fluid [yes you do]. Here are my fluid charts as requested - as you can see - polyuria, [psychogenic polydipsia] normal fluid intake [psychogenic polydipsia].

I get a pounding pulse [anxious] when I lie down at night. This is my calmest time of day [no, definitely anxious]. I am sure that it is not psychological. [Yes, you are anxious]

YOU were that fly buzzing around the room when I saw that doctor? Amazing how they can't see how ridiculous they sound.