• Quick note - the problem with Youtube videos not embedding on the forum appears to have been fixed, thanks to ZiprHead. If you do still see problems let me know.

What do people expect from their physicians?

TillEulenspiegel said:
The maintenance of one's body is a two sided affair it is neither the sole responsibility of the Physician nor is there a pill, shortcut, quick fix for chronic disease.
Your responsibility is to educate yourself and engage, be involved with your health and any remedy that is prescribed to help you or your condition.
Click to expand...

I want to say "no kidding", but I'm also sure more people need to hear that. It sucks that they'd rather go to sCAM and get what they think IS a quick fix (free of side effects) when a medical doctor cannot give them one.

I just want to make sure I'm fine and if there is nothing that can be done for me because of that, then I'll be ecstatic.
 
I think people want certainty from their doctors, as El Greco and Boo said, albeit in different ways. They want to know that there is a definite cause for whatever is bothering them and that it can be fixed.

Sue also alluded to this when she mentioned CAM. CAM folk are totally certain of themselves, and the patient appreciates that. They leave feeling that they have been understood, and that the problem will soon be taken care of. And because, as HopkinsMedStudent said, the human body is vastly complex. Doctors spend four years in med school and then min. three years in residence and still don't know anything near the whole body of knowledge, let alone the whole story of how we work. Maybe the best thing a doctor can do is to a) let the patient know that they have been heard and understood and b) explain how frighteningly complex the system is.

What I want from a doctor depends on the situtation. For family practice doc, my regular physician, I want someone who understands the choices I make in life and can be gentle (no fat person is going to take action when a doctor says "you're fat, lose weight").

On the other hand, if I'm in emergency trauma surgery, the surgeon is welcome to be the biggest butthead in the world, but his hands better be steady and he better be awake.

Any idea what field you want to into TT? How do you like med school?
 
Boo said:
Most people are stupid, but you can't treat them that way. If they ask questions give them the real deal. If they sit there, nod and give you a blank look, use plain english and expect them to understand less than half of what you say.
Click to expand...

Actually, everyone is stupid. The thing is that different people are stupid in different ways depending on the context.

I have yet, for example, to meet a radiologist who even knows what the Nyquist theorem is, let alone why it is important in the interpretation of CAT and MRI scans, let alone simple X-rays.
 
epepke said:


Actually, everyone is stupid. The thing is that different people are stupid in different ways depending on the context.

I have yet, for example, to meet a radiologist who even knows what the Nyquist theorem is, let alone why it is important in the interpretation of CAT and MRI scans, let alone simple X-rays.
Click to expand...

Are we going on about the Nyquist theorem again?
 
My onley gripe with doctors is that they dont listen to me when I tell them whats wrong with me and give me the prescription Im asking for.

Having lived in an area where malaria and bilharzzia were very common, I moved to Cape Town where both were unheard of. I spotted blood in my urine one day and knew perfectly well it was bilharzzia (had it before), so went to a doc and asked for the relevant prescription. Three weeks of buggering about with repeat blood tests before I found a 'tame' doctor who gave me the prescription I needed (he still couldnt work the dose out correctly though :rolleyes: ).

I guess that sometimes a doctor must just realise that a patient sometimes know more about what hes got than the doc does.

PS- I developed a very low opinion of medics, something that has been helped enormously by actually working with them recently. It came from the fact that I had a broken wrist that went undiagnosed for 4 months despite a doctor looking right at the relevant x-ray. Later in university I found that the medics only had to do really 'mickey-mouse' physics and chemistry courses that were faaaaar easier than the bog-standard BSc courses that I was taking. In spite of this, every doctor I met behaved like they were the king and I was a peasant. Muchos loss of respect.

Treat ordinary patients like they are stupid but if he makes a pointof saying 'Im a heamatology research technician' he probably knows a few things so treat him at least as an equal.

/rant.
 
One of the reasons that poeple seek out "alternative medicine" is that the peddlers spend time talking to the patients. Doctors should spend time talking to the patients.

Don't tell the patient what the patient already knows. People who are overweight know it already without being told. Don't say, "You need to lose some weight" or "Your weight is really a problem." Remarks like these border upon insult, and make the patient want to deliberately avoid going to the doctor. And for heaven's sake, don't lecture the patient. Instead, you can ask, "How successful have you been in trying to lose weight?" or "I imagine that you've tried dieting in the past; what in your opinion makes dieting difficult for you to do?" or "Have you tried the Weight Watchers program?"

The same holds true with smokers. People who smoke already know they should quit. Instead of lecturing them about it, try asking them if they are interested in joining a stop-smoking program.
 
Wrath of the Swarm said:
I'll bite: what's the Nyquist theorem?
Click to expand...

Nyquist criterion deals with sampling rates required to accurately sample/reproduce the most basic "features" of a signal.

Formally, Nyquist says that in order to accurately sample a signal, the sampling frequency must be at least twice the highest frequency component of the signal.

For example, lets say that you are sampling a signal composed of f(t) = sin t + sin 2t + sin 3t

The highest frequency component of this signal is based on the sin 3t waveform, which translates into a frequency of f = B/2*pi = 3/(2*3.14) = 0.47 Hz.

Nyquist states that you would have to sample this signal at a minimum of 2*0.47 Hz = 0.95 Hz to capture the fundamental shape of the waveform.

Nyquist is just a bare minimum to avoid aliasing the signal; obviously as you increase the sampling frequency beyond the Nyquist threshold, the signal reproduction gets better and better (i.e. the reconstructed signal is less "rough" and more of a smooth curve approximating the original signal).
 
epepke said:
I have yet, for example, to meet a radiologist who even knows what the Nyquist theorem is, let alone why it is important in the interpretation of CAT and MRI scans, let alone simple X-rays. [/b]
Click to expand...

You dont need to know what the Nyquist criterion is in order to interpret MRI/CT images.

MR physicists are usually the guys who actually develop new MR pulse sequences. Some radiologists do it too, but to the vast majority of them, MRI is a "black box" and they dont know what goes on inside except for the most basic physics.

Likewise, you can have all the science/engineering smarts in the world and not have a clue as to how to interpret a clinical MR image. I work with GE physicists who design scanners and pulse sequences who can run circles around me in math, but give them a simple chest x-ray and they dont have a clue whats going on in terms of diagnosis or pathophysiology. Physicists and radiologists work together; each has their own purpose and role.

Your critique is similar to me saying that electricians are stupid because they dont (usually) understand what loop analysis or mesh analysis is (electrical engineering techniques used to analyze circuits).

Electricians DONT NEED to know how to do loop analysis in order to perform their role, just as radiologists dont need to know Nyquist in order to practice their profession.
 
Wrath of the Swarm said:
And I don't see how understanding the Nyquist criterion aids the interpretation of scan data at all.
Click to expand...

Your instinct is correct. From a radiologist's perspective, Nyquist is irrelevant.

Its irrelevant for the same reason that an engineer who designs motherboards for computers doesnt need to know the doping characteristics of the semiconductor material. IN both cases, the minute details are extrapolated away. After all, if a radiologist had to be concerned with those details, it would require MUCH more overhead to run and interpret clinical studies.

Now, if a radiologist wants to design a new MR pulse sequence (new type of scan) then it would be critical for him to understand it. But radiologists usually dont get into that stuff and leave it to the physicists.
 
I would be much more concerned with whether the radiologist was willing to admit that we're still not certain whether MRIs have any negative consequences; or, for that matter, if they're willing to admit that CAT scans and X-rays in general involve non-trivial radiation exposures.
 
I expect to live forever and its gonna be your fault when anything goes wrong with me ;)
 
Eos of the Eons said:


*snip

Okay, an experience I am going through right now. I have these muscle twitches. I get told it is PROBABLY due to stress. That's fine, but how does stress make your muscles twitch? Tell me that, and I'm not wondering how that is possible. I'm frustrated because he also tells me there is not much I can do to make them go away, so just do my usual things to help me deal with stress, and add on some calcium (that makes me constipated). So how does calcium help, and muscle relaxants won't? He also tells me there is no way to know if or when they will stop. Why? I just get the stock answers that I just need to give it some time.

*snip*
Click to expand...

I have muscle twitches too. I've never seen a doctor about them, I just assumed automatically that they were from stress of some sort. The thing is that they don't come very often, but when they do, MAN does it hurt. The last time I got one I thought my shoulder was going to rip out of its socket. I figured that they'd go away once things started to calm down in my life and I began to relax more. I haven't been keeping track of how often they occur though. If I had to guess I'd say I get one ever couple weeks, if not longer. One time I even hit my girlfriend who was sitting right next to me because of one. It took a long time to explain to her that I didn't hit her on purpose. She didn't believe me, and honestly I don't think she does now. :D

As far as doctors go, its pretty irrational, but I expect doctors to tell me whatever will get me out of their office as soon as I possibly can. I'm terrified of them. I try to take good care of myself so that I'll never have to go see one. I HATE shots and needles with a passion. I don't like taking pills either. It's not that I don't think that any of that stuff will work or help me get better; I know that it will. I'm just scared of it. I've only been to the hospital twice in my life, and the first time I was there was when I was born. I don't plan on going ever again. I can't stand it.
 
epepke said:


Are you sure? My understanding of the reason for his long absence, admittedly from the popular press, was that he had an outbreak under his eyelid, which is dangerous as well as painful. This could be related to shingles, I suppose, but it could also be related to one of the other herpes viruses.
Click to expand...

Pretty sure. Not positive. We talked about this during one of my rotations.

And, thanks to everyone else for their comments. I think what patients want and what they expect should be the same thing.

As far as where I've been... well, I'm in the middle of my core clerkships. This is Spring Break right now for me. I start OB/Gyn next week. So, probably won't hear from me again for a while.

And, as far as ultimate career goes, I'm sort of steering towards anesthesiology right now. So, I guess I ultimately won't have to worry too much about dealing with patients because I'll be knocking them all out! :hit:

:D

-TT
 
Brown said:
One of the reasons that poeple seek out "alternative medicine" is that the peddlers spend time talking to the patients. Doctors should spend time talking to the patients.

Don't tell the patient what the patient already knows. People who are overweight know it already without being told. Don't say, "You need to lose some weight" or "Your weight is really a problem." Remarks like these border upon insult, and make the patient want to deliberately avoid going to the doctor. And for heaven's sake, don't lecture the patient. Instead, you can ask, "How successful have you been in trying to lose weight?" or "I imagine that you've tried dieting in the past; what in your opinion makes dieting difficult for you to do?" or "Have you tried the Weight Watchers program?"

The same holds true with smokers. People who smoke already know they should quit. Instead of lecturing them about it, try asking them if they are interested in joining a stop-smoking program.
Click to expand...

Exactly, a lot of people stop going to doctors because they lecture them constantly. I'm a smoker and I know I should quit. Been able to quit for a few months at a time and am going to give it another go this spring. But it seems that every malady these days are caused by smoking... I've had a doctor who wouldn't give me antibiotics for bronchitis because I smoke. I've had doctors lecture me when I'm in for something like a torn muscle. I rarely go to doctors unless I am really really sick. Or else they lecture about weight. I had a doctor tell me I should lose weight after losing 30 pounds in six months. Geez, I am losing weight why do you have that chart when you don't read it? :)
 
Wrath of the Swarm said:
I hope you won't encourage the idea that being put under is like "going to sleep".
Click to expand...

:confused:

Why would I do that? Having experienced general anesthesia 5 times myself, I know it's nothing at all like "going to sleep." I believe I said "knocked out" in my post above. :D
 
Denise said:


Exactly, a lot of people stop going to doctors because they lecture them constantly. I'm a smoker and I know I should quit. Been able to quit for a few months at a time and am going to give it another go this spring. But it seems that every malady these days are caused by smoking... I've had a doctor who wouldn't give me antibiotics for bronchitis because I smoke. I've had doctors lecture me when I'm in for something like a torn muscle. I rarely go to doctors unless I am really really sick. Or else they lecture about weight. I had a doctor tell me I should lose weight after losing 30 pounds in six months. Geez, I am losing weight why do you have that chart when you don't read it? :)
Click to expand...

You're right. However...

Many times (as was noted above) patients don't get the "soft approach" that is suggested. And, as was stated as well, this is a fairly sophisticated audience more intelligent than the average Joe. But, you're still right. People ultimately will listen, but hear only what they want to - no matter how you say it.

My general approach, so far, about smoking has been to say this: "The single biggest thing you can do to improve your overall health is to quit smoking." I don't lecture. I don't ask questions I already know the answer to. I just say that and leave it at that. I think this has a bigger impact on people. And, it's a true statement.

I have also found that if people want to talk about quitting or are ready to quit, they'll tell you. Many people, like yourself, want to quit but just aren't ready to quit. And, if someone starts to say to me, "You don't understand how hard it is" or whatever, I ask them to tell me. This tends to get a dialogue going. And, at the end of that dialogue, I usually say, "Well, that's the advice I have. Take it or leave it. You have to live your own life. Whatever you ultimately do isn't going to affect mine." And, I mean that.

I think many people are afraid of their doctors opinions of them. In actuality, I see (even now) about 15-20 people a day in the clinic by myself. Sure, I'm supervised, but I still take the history, examine the patient, do the work-up, order tests, etc. This is part of my training. And, I go home at the end of the day and don't worry about people's personal lives. I'm their consultant, nothing more. If they don't want to take my advice (or my attendings advice), trust me when I say that it doesn't affect me. Most doctors feel this way.

-TT
 
You must log in or register to reply here.

Back
Top Bottom