Why Doctors Hate Science

[T.A.M.]

As I said in a previous thread, I have had a DRE some years ago. Wasn't the most pleasant of experiences.
anyway, I was at the doc because of the following reasons.
1. I have type 2 diabetes.
2. I contracted influenza, which turned to a bacterial infection as I was taking viral based meds I suppose.
3. this had some unpleasant side effects for me as I had spent 3 days without my diabetes meds, due to unavailability at the pharmacy.
4. I passed out twice in 3 days at work.
5. Glucose levels spiked very high (16) and increased blood pressure, BP normally 120/80 went to 150/100 and experienced intense nausea.

so, off I go to the doc.
couse of action by doctor.

1. Treat the bacterial infection
2. Investigate newer meds for diabetes.
3. Takes blood samples for glucose 3month average, kidney function, liver function, WBC and then the PSA as I have only had 1 PRE before.
4. Results due on wednesday.

I was in no mood to argue with the doctor re the PSA test, so I succumbed. She tells me that the PSA was developed as men don't like the PRE. Can't say I disagree.

Anyway, I feel relatively positive about not being screened as cancer positive as I have a very healthy sex life and have not presented any other related problems.

As for the follow up being painful, I suppose that depends on your personal pain threshold. Mine is quite high as I often tell myself that pleasure and pain are divided by a very thin line.

1. Sorry to hear you became so ill.
2. She is right, that in part the test was developed in hopes that it might eliminate the need for DREs. We often develop tests in order to simplify or reduce the testing needed for condition X.
3. You can read most of my comments in the other thread (on Prostate CA), so I will leave it at that.

TAM

 

[fls]

I think it would tell me something about the reasoning processes employed by physicians.

Like they generate more diagnoses for complicated cases with multiple problems?

What do you think to the suggestion made in the AJoM supplement I linked to for patients being 'watchdogs for cognitive errors during a consultation'?

Sounds reasonable.

How do these behaviours fit in with the paternalistic model of patient care you are suggesting may be superior to one in which patients take more responsibility for decisions about their healthcare?

Why would there be any conflict between beneficence and autonomy in those guidelines?

Oh, I thought of an example. Some possible diagnoses may cause undue and ultimately unnecessary duress. So, one might not mention the possibility of cancer until it has been ruled-in.

Linda

 

[Ivor the Engineer]

Like they generate more diagnoses for complicated cases with multiple problems?

Yes, and I was thinking of the shape (e.g., rate of decay, oscillations) over time.

<snip>

Why would there be any conflict between beneficence and autonomy in those guidelines?

From my understanding of the meaning of 'beneficence' I'm not sure there would be, but you seem to want to use it to describe something I still think would best be described as 'paternalism'.

Oh, I thought of an example. Some possible diagnoses may cause undue and ultimately unnecessary duress. So, one might not mention the possibility of cancer until it has been ruled-in.

Linda

I think that's a bit of a weak reason to keep the patient excluded from the diagnostic process, especially since many patients already believe they (or their children) have the worst disease they can find on the internet which sort-of matches some of the obvious (and possibly imagined) symptoms without any expert to guide them.

Should medical information about illness only be disseminated by physicians at their discretion to avoid members of the lay-public becoming unduly distressed and demanding diagnostic tests which are inappropriate?

 

[fls]

From my understanding of the meaning of 'beneficence' I'm not sure there would be, but you seem to want to use it to describe something I still think would best be described as 'paternalism'.

Nope, I'm describing beneficence.

I think that's a bit of a weak reason to keep the patient excluded from the diagnostic process,

Yeah, I imagine it would only be relevant to someone who takes the feelings of others into consideration.

especially since many patients already believe they (or their children) have the worst disease they can find on the internet which sort-of matches some of the obvious (and possibly imagined) symptoms without any expert to guide them.

Yes, you discover what sorts of things the patient is already worried about. It's usually better to address their specific concerns. It's a delicate procedure, since people don't always want to say their worst fears out loud (somehow it will make it real). But I also take into consideration the value of avoiding needless duress and the problems that come from information overload. Although I admit that I tend to err on the side of too much information.

Should medical information about illness only be disseminated by physicians at their discretion to avoid members of the lay-public becoming unduly distressed and demanding diagnostic tests which are inappropriate?

Of course. That is why the contents of medical journals are not available to the public, medical textbooks and reference materials are protected by secret societies, medical institutions never put up websites with copious quantities of medical information, and you never find physicians taking part in online forums.

Linda

 

[paximperium]

Of course. That is why the contents of medical journals are not available to the public, medical textbooks and reference materials are protected by secret societies, medical institutions never put up websites with copious quantities of medical information, and you never find physicians taking part in online forums.

Hey, I just got back from my secret lab while secretly experimenting on infants. The crying was getting annoying. Our plans are almost complete. Bwahahaha...
Anything new on this thread?

PS: Are you going to the International Medical Cabal meeting(sponsored by Pfiizer) this summer?

 

[T.A.M.]

Hey, I just got back from my secret lab while secretly experimenting on infants. The crying was getting annoying. Our plans are almost complete. Bwahahaha...
Anything new on this thread?

PS: Are you going to the International Medical Cabal meeting(sponsored by Pfiizer) this summer?

I would go but Merck already has me flying down to Ferrari headquarters to pick up my new ride.

TAM

 

[BillyJoe]

Ivor,

I don't know about you, but, if I have a headache which I suspect may be due to work overload I have been experiencing lately, and I haven't immediately jumped to the conclusion that I have brain cancer, I would not appreciate the doc telling this is one of the possibilities, especially as I will now want a CT scan to rule it out and that test, from a medical point of view, may be totally unjustified.

BJ

 

[T.A.M.]

Ivor,

I don't know about you, but, if I have a headache which I suspect may be due to work overload I have been experiening lately, and I haven't immediately jumped to the conclusion that I have brain cancer, I would not appreciate the doc telling this is one of the possibilities, especially as I will now want a CT scan to rule it out and that test, from a medical point of view, may be totally unjustified.

BJ

http://www.medscape.com/viewarticle/496297

TAM

 

[BillyJoe]

Are you going to the International Medical Cabal meeting(sponsored by Pfiizer) this summer?

I would go but Merck already has me flying down to Ferrari headquarters to pick up my new ride.

Hmmm...not to derail, but do you actually attend pharmaceutical company sponsored events?

 

[BillyJoe]

http://www.medscape.com/viewarticle/496297

Thanks, that's what I was thinking when I wrote: "and that test, from a medical point of view, may be totally unjustified".
Or do you mean I should have a MRI scan instead?

You found that link pretty damn quick though!

 

[fls]

http://www.medscape.com/viewarticle/496297

TAM

Which takes me to a sooper-secret-secure-enter-your-password page...

I hope that was deliberate.

Linda

 

[T.A.M.]

That is odd...anyway, google "ct radiation" and it is the 3rd link on the page.

Must have an automatic redirect for people linking the article.

TAM

 

[T.A.M.]

Thanks, that's what I was thinking when I wrote: "and that test, from a medical point of view, may be totally unjustified".
Or do you mean I should have a MRI scan instead?

You found that link pretty damn quick though!

yah, it was the 3rd one on google, under CT radiation. I am well aware myself of the large amount of radiation that a single CT can provide, but figured if I posted such without at least a reference, I would be sent to the corner.

TAM

 

[T.A.M.]

Hmmm...not to derail, but do you actually attend pharmaceutical company sponsored events?

lol...of course. They are one of many ways of providing me with continued medical education. I do not attend many, as 90% of my CME is through the Canadian College "Self Learning" modules and online CME, but I do go occasionally.

Why do you ask?

TAM

 

[BillyJoe]

Well, 10% is not bad I guess. And even the college would tend to bias you towards doing PSA and DRE on everyone males that is (;

 

[Ivor the Engineer]

Nope, I'm describing beneficence.

Then could you point me to a source which more fully explains what you believe the word 'beneficence' mean please?

Yeah, I imagine it would only be relevant to someone who takes the feelings of others into consideration.

Are they the 'feelings of others', or are they feelings you have projected onto them?

Yes, you discover what sorts of things the patient is already worried about. It's usually better to address their specific concerns. It's a delicate procedure, since people don't always want to say their worst fears out loud (somehow it will make it real). But I also take into consideration the value of avoiding needless duress and the problems that come from information overload. Although I admit that I tend to err on the side of too much information.

Has the alternative even been tried? Do medical students fail if they don't follow a particular model of interacting with patients? Are the problems caused because the public expects doctors to treat them in a certain way - if doctors switched to the interactive model would patients get used to it after a while? Would patients then be distressed if a doctor decided to not share information with them about how she was thinking? i.e., is this just resistance to change in spite of likely benefits for patients (and probably doctors too)?

Of course. That is why the contents of medical journals are not available to the public, medical textbooks and reference materials are protected by secret societies, medical institutions never put up websites with copious quantities of medical information, and you never find physicians taking part in online forums.

Linda

Right. So we agree that there is a benefit for the public being more aware of medical conditions and their symptoms.

BTW, it's refreshing to chat to physicians with their hair down.

 

[kellyb]

Must have an automatic redirect for people linking the article.

TAM

No, you just have to be registered and logged in, I guess, to see it. It worked fine for me, but I was in medscape last week for something.

 

[Ivor the Engineer]

Ivor,

I don't know about you, but, if I have a headache which I suspect may be due to work overload I have been experiencing lately, and I haven't immediately jumped to the conclusion that I have brain cancer, I would not appreciate the doc telling this is one of the possibilities, especially as I will now want a CT scan to rule it out and that test, from a medical point of view, may be totally unjustified.

BJ

Funny you should mention that. My last visit to the doctor was for persistent headaches I couldn't understand the cause of.

I couldn't get to see my regular doctor and had to see a locum, who just happened to be the doctor from the hospice who looked after my father. Who died of a brain tumor. Though we hadn't met face to face before, I'm sure she recognised my surname.

Yeah, that wasn't too much of an arse-clenching consultation, with me thinking: 'she's thinking I'm some hypochondriac moron who believes Glioblastoma Multiforme is hereditairy', as well as the usual: 'I'm wasting the doctor's time and taking up a slot which someone who is actually sick could be being helped in'. Oh, and I sound even thicker in person than do on the forum*.

After explaining the symptoms and why I didn't think it was caused by eye strain or tiredness, she took my blood pressure (pretty pointless for headaches), looked in my ears and then gave the reassuring doctors act, telling me they were tension headaches (I'd already guessed that the night before) and I was probably inducing them myself (i.e. 'the patient is a hypochondriac and thinks he's got a brain tumor') and should take ibuprofen each day until they go off.

I think I have eventually figured out what was causing them. I often sit with my left hand supporting my chin with the elbow on a table. This makes me clench my jaw, which I presume was causing muscle strain on the top of my head. I've stopped sitting like this for so long and the headaches have gone off. On the other hand it could just be a coincidence and it was something else altogether.


*You should see the shock on medical professionals' faces when I ask something intelligent, such as: 'Is that the fovea on my fundus image?' while pointing.

 

[RationalVetMed]

My impression is that some people resent not being able to find a provider to reinforce their woo beliefs. Some of those people also project the problem as being the provider's desire for control, rather than the fact the person with the unsupportable belief could possibly be wrong.

Brilliant, just brilliant.

Yuri

 

[fls]

Then could you point me to a source which more fully explains what you believe the word 'beneficence' mean please?

http://en.wikipedia.org/wiki/Medical_Ethics#Beneficence

The article that KellyB referenced earlier also covered the same points about the conflict between beneficence and autonomy.

Are they the 'feelings of others', or are they feelings you have projected onto them?

My feelings. I am, of course, completely devoid of insight.

Has the alternative even been tried? Do medical students fail if they don't follow a particular model of interacting with patients? Are the problems caused because the public expects doctors to treat them in a certain way - if doctors switched to the interactive model would patients get used to it after a while? Would patients then be distressed if a doctor decided to not share information with them about how she was thinking? i.e., is this just resistance to change in spite of likely benefits for patients (and probably doctors too)?

This description is simply too far removed from reality to address.

Linda