What do people expect from their physicians?

[Wrath of the Swarm]

why do I get the strong impression you are trying to bait people into another long argumentative thread?

Your general inability to interpret posts properly, combined with a personal dislike for me?

ThirdTwin: that's one of those pleasant little lies doctors are fond of telling, rather like "you may experience some discomfort" and similar statements. Please promise you'll never use it.

 

[Charles Livingston]

Er, yes and no. In my experience they get a junior to do the research and charge you $250 an hour for the education they are getting. Perhaps that's just my experience.

They are having the junior guy do it so it is cheaper for you (and cause hte partner doesnt wnat to do it, has other things to do, etc.), if the partner did it it would be easily $100 to $200 more an hour. They arent (assuming they arent committing fraud) billing time for the juniors work, the junior is.

 

[Lisa Simpson]

Hey Lisa Simpson, how did your mom finally get the correct diagnosis?

Was it a second opinion? Sometimes I just don't know where to get one. Most doctors around here don't see "new patients". I can go to my doctor, and then a walk in clinic. Is that a good idea though?

It wasn't a second opinion. The rash that was on her scalp crept forward to her forehead. Once it was more visible, her doctor got the correct diagnosis.

My son had shingles several years ago, and his doc got it right away, but it was on his back and easy to see.

 

[Eos of the Eons]

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.

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.

Yours hurt? Mine sure don't. They're just annoying. I used to get one every once in a while-like once a month maybe. Then I noticed I was getting them at least once a week. Next thing you know I have them every day, like I do now. You can watch the muscle twitch, and feel it of course. It kinda jumps a few times and then stops. Doesn't hurt at all. All my muscles twitch in my legs, arms and butt. One night I woke up and an arm muscle was twitching and a muscle in my calf. I tried to stretch. Didn't stop it. I waited it out for about 10 more jumps each and went back to sleep. Not all calf, arm, or thigh muscles will twitch at one time, it's just one at a time in the limbs and at random.

Once in a while I'll get a muscle in my hands or feet twitching. I can massage it, stretch it, and it just goes on until it's done. A muscle on the top part of my foot will twitch one day, and then one on the bottom of the other will twitch another day. My limbs don't move at all when it happens, just the muscle. I can't hit anyone and blame it on the muscles twitching. My movement of my limbs aren't affected either. I can still walk, write, stretch, whatever.

If I always had them I probably wouldn't worry about it either. It's to the point where I'm almost used to it.

I figure if it's stress it will go away some time. I just wish the doc could just tell me that's the case. When I looked up twitching on the net I got most sites attributing it to stress. I just figure there must be something I can do to help more than anything else. Get more sleep? I already eat pretty good. Any excuse to sleep more would make me happy I love to sleep.

You're lucky you don't get them much if you have limbs flying and it hurts. Would you see a doctor if you started getting it every day?

Why are you so afraid of anything to do with doctors? I used to hate pills. Now I think they are okay if they help. I take aspirin like only once a year still, but I will take it if I feel the need. Pain is very draining.

It seems the medical system is under attack nowadays. It also seems like a few changes wouldn't hurt to improve things.

I'm thankful ThirdTwin cares enough to ask. He'll make a great doctor, I'm sure.

 

[Eos of the Eons]

It wasn't a second opinion. The rash that was on her scalp crept forward to her forehead. Once it was more visible, her doctor got the correct diagnosis.

My son had shingles several years ago, and his doc got it right away, but it was on his back and easy to see.

Ouch. I hope to never see it, shingles sounds horrible. What did he do once he got the diagnose correct-as in how did he treat it? Can you do anything for shingles-being that it is caused by a virus?

Even if nothing can be done, at least you know what you're dealing with and what the prognosis is. That's all I really ever really want.

 

[nineinchnails_999]

Yours hurt? Mine sure don't. They're just annoying. I used to get one every once in a while-like once a month maybe. Then I noticed I was getting them at least once a week. Next thing you know I have them every day, like I do now. You can watch the muscle twitch, and feel it of course. It kinda jumps a few times and then stops. Doesn't hurt at all. All my muscles twitch in my legs, arms and butt. One night I woke up and an arm muscle was twitching and a muscle in my calf. I tried to stretch. Didn't stop it. I waited it out for about 10 more jumps each and went back to sleep. Not all calf, arm, or thigh muscles will twitch at one time, it's just one at a time in the limbs and at random.

Once in a while I'll get a muscle in my hands or feet twitching. I can massage it, stretch it, and it just goes on until it's done. A muscle on the top part of my foot will twitch one day, and then one on the bottom of the other will twitch another day. My limbs don't move at all when it happens, just the muscle. I can't hit anyone and blame it on the muscles twitching. My movement of my limbs aren't affected either. I can still walk, write, stretch, whatever.

If I always had them I probably wouldn't worry about it either. It's to the point where I'm almost used to it.

I figure if it's stress it will go away some time. I just wish the doc could just tell me that's the case. When I looked up twitching on the net I got most sites attributing it to stress. I just figure there must be something I can do to help more than anything else. Get more sleep? I already eat pretty good. Any excuse to sleep more would make me happy I love to sleep.

You're lucky you don't get them much if you have limbs flying and it hurts. Would you see a doctor if you started getting it every day?

Why are you so afraid of anything to do with doctors? I used to hate pills. Now I think they are okay if they help. I take aspirin like only once a year still, but I will take it if I feel the need. Pain is very draining.

It seems the medical system is under attack nowadays. It also seems like a few changes wouldn't hurt to improve things.

I'm thankful ThirdTwin cares enough to ask. He'll make a great doctor, I'm sure.

I have nothing against doctors. If there's something wrong with me I go and get it checked out. I usually just wait until the last possible time to do so. Yes if i got those twitches more often I would go get it checked out. I'm not too worried about it right now though.

I have all kinds of faith that doctors know what they're doing for the most part. My fear is completely irrational and I know it. Perhaps its a phobia of some kind? Perhaps I had some bad experiences when I was a kid? All I know is that I don't doubt a doctor's ability, and I even think most of them are nice people, I just hate going to get treatment of any kind. Maybe it'd be worthwhile to seek some sort of psychological treatment for this fear. The truth is I just don't know. It gives me a good excuse to take care of myself, though. And I think I'm doing a pretty good job.

 

[El Greco]

All I know is that I don't doubt a doctor's ability, and I even think most of them are nice people

Nice people they are, most of my close friends are doctors. Maybe this is why I doubt their abilities

Seriously speaking, I really do doubt most doctors' abilities. I have seen that in many many many cases a quick 30 min search around the net can give you more info than what a doctor knows about a disease of his specialty. I'm especially interested in the field of nutrition and exercise and have studied enough about these things; It creeps me out when I hear completely wrong things from endocrinologists, diabetologists and relevant doctors.

Medicine evolves very fast and a doctor has to study continuously in order to stay up to date. AFAIK, very few do.

 

[Lisa Simpson]

Ouch. I hope to never see it, shingles sounds horrible. What did he do once he got the diagnose correct-as in how did he treat it? Can you do anything for shingles-being that it is caused by a virus?

Even if nothing can be done, at least you know what you're dealing with and what the prognosis is. That's all I really ever really want.

They gave her an anti-viral drug and something for the pain. But by that time, she was almost over it on her own.

When my son had shingles, they didn't give him anything. He didn't seem to be in too much pain. Although that could just be that he also has Juvenile Rheumatoid Arthritis, so he's used to pain.

 

[TillEulenspiegel]

My fear is completely irrational and I know it. Perhaps its a phobia of some kind? Perhaps I had some bad experiences when I was a kid?

Nineinch, I think we see that most Phobias are irrational, which doesn't mean they don't both exist and have an effect on people. There is a syndrome, only given serious consideration in the past decade or two , called "White Coat hypertension". That's where a patient , in fear of doctors, disease, shots..whatever, will have elevated blood pressure because of their fear. So the doc has to wait until the patient is relaxed enough to get a real baseline BP. I know this because I experienced it first hand.

 

[Linda]

I hope you won't encourage the idea that being put under is like "going to sleep".

Well, color me stupid, but I've been under general anaesthesia 5 times...twice for surgery and 3 times for diagnostic tests, and I always thought it was just like going to sleep except I didn't dream and when I woke up it felt like no time had passed at all.

And what I want from my family doctor is to know that when he comes in to examine me, he's familiar with my history and takes the time to really listen to what I have to say. He needs to explain things in terms I can understand without being condescending, and be willing to admit when he's not sure. And always offer samples!

 

[Denise]

Well, color me stupid, but I've been under general anaesthesia 5 times...twice for surgery and 3 times for diagnostic tests, and I always thought it was just like going to sleep except I didn't dream and when I woke up it felt like no time had passed at all.

Well it's extremely rare, but some people do not remain unconscious during surgury. http://www.anesthesiaawareness.com/

 

[epepke]

Nice people they are, most of my close friends are doctors. Maybe this is why I doubt their abilities

A bit of a digression, but this reminds me of archy's reaction:

you ask if i believe in ghosts well of course i do not believe in them if you had known as many of them as i had you would not believe in them either

 

[epepke]

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

No, honestly, you do. You don't need to know it exactly. But you need to know that in a CT image that resolves to 256 by 256 (which is fairly typical of the kind of GE scanners I used to work with), the size of any structure smaller than 128 of the size of the image is pure guesswork.

It's even more important when dealing with things like virtual proctoscopy. The isosurface algorithms used in generating images give a false impression of accuracy.

This is not an engineer/physician urinating contest, unless you choose to make it one.

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.

It has nothing to do with smarts. It has to do with a genuine source of possible error in the image, which when presented to be similar to an X-ray, gives a false impression of accuracy.

The algorithms used are from the computer graphics field, which are based on using various techniques to make images look good. Because radiologists are trained in X-rays, these were adapted to make them look like X-rays.

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).

No, it isn't. Electricians don't need to do loop analysis because it doesn't affect their work. Sampling problems, however, do affect medical images; it is unavoidable.

Radiologists who interpret them have at least a basic need to know what the error is.

 

[Linda]

Well it's extremely rare, but some people do not remain unconscious during surgury. http://www.anesthesiaawareness.com/

Wow! I didn't know about that! I remember now that Luke's wife had a major problem with the anesthesia during her caesarean with the twins, but this is new to me.
Thanks Denise, for the info.

 

[Dr. Imago]

(1) The Nyquist criteria, except for radiologists possible, is basically irrelevant (and unknown) to most clinicians. We never take one test (be it a lab, a CT scan, an ultrasound, whatever) as the sole guidance for the clinical presentation of a patient. Most of the time, even with CVAs or other problems in the brain, the diagnosis is made clinically well-before any confirmatory tests are run. Tests are more helpful to pinpoint and/or monitor therapy. Clinical acumen is a far more important barometer of a good clinician.

(2) Consciousous or awareness during sedation that is not meant to happen is a problem that both the AANA and the ASA are working on. It's prevalence is miniscule, but still it happens often enough that it is concerning - especially to those patients who are unfortunate enough to have this happen. Some people who this happens to are at risk for developing post-traumatic stress disorder (PTSD), but are otherwise "unharmed" (i.e., if you discount the psychological harm... which I am not).

http://www.asahq.org/patientEducation/Awareness.pdf

-TT

(edit to clarify a concept)

 

[tamiO]

This is such a great thread. It's one of those that are just chock full of insight. Thank you for starting this discussion.

I have been figuring out how to help myself get to feeling better for over 5 years. I just found a "good" doctor 8 months ago and we have made great progress. We encourage each other's research into my symptoms and developing a plan to get me back to as near normal as possible.

He is not an GYN, so I had to go to another doctor for that. I don't have the relationship built yet with the OBGYN, so I understand his response when I told him of my symptoms and my personal diagnosis.

He told me, "Stay off the internet! Don't look there for medical advice!"

I can imagine it can be pretty frustrating to encounter patients who research their medical conditions online. It's even dangerous. I know I don't like it when my friend googles info on her condition and acts on it without checking it out well.

It seems there is a hole in the medical diagnosing industry. Doctors don't have enough time and most patients need guidance from an educated person when researching their medical conditions. For all I know, such a liason exists in more urban settings.

 

[Dr. Imago]

He told me, "Stay off the internet! Don't look there for medical advice!"

Again, I think this is more of a blanket statement, coming from frustration, where patients come in and have convinced themselves they already have a particular diagnosis because they have a particular symptom or two of one disease they've happened to have read on the Internet. It takes a lot of time to "uneducate" them and re-focus them on their actual diagnosis. A lot of "skeptical" people will still not believe the doctor, especially after they've convinced themselves that they are right and the doctor must be mistaken (just look at all of those people who are convinced they have seen a ghost and are unwilling to consider any other possibility, even in the face of overwhelming evidence to the contrary).

Personal anecdote: I had an 16-year-old girl come into the pediatric clinic convinced that she had SLE. She was so relieved that she had determined a diagnosis because she'd been having, off and on, for several weeks aches and pains in her joints, some rashes, etc. She'd read on the Internet about some of the symptoms of lupus, after coaxing by her aunt who had lupus, and convinced herself this was the problem. What she ACTUALLY had was classic rheumatic fever, after the proper medical diagnosis was made. Despite the fact that this is a rare condition now in the U.S., this girl had it and it was a great teaching case for me on many different levels.

So, this is what happens and clinicians get frustrated. Personally, I see it as an opportunity to teach. Many people don't realize that often a definitive diagnosis cannot be made simply by one brief encounter with the physician. Sometimes we have to work towards a diagnosis by eliminating other things. Unfortunately, some patients "doctor shop" and never let this process come to fruition. Other cases (which are definitely the exception and not the rule), the patient was actually right all along - whether by dumb luck or just actually knowing their body and their symptoms better than the doctor. I never discount any information a patient brings to me because there is a reason, obvious or not, and a meaning, again obvious or not, why they did so. These are avenues to explore with the patient, not to dismiss outright as this doctor you cite has done.

-TT

 

[HopkinsMedStudent]

No, honestly, you do. You don't need to know it exactly. But you need to know that in a CT image that resolves to 256 by 256 (which is fairly typical of the kind of GE scanners I used to work with), the size of any structure smaller than 128 of the size of the image is pure guesswork.

Are you trying to suggest that radiologists routinely misinterpret CT scans? Most radiologists I know have an understanding built thru experience of when an object on CT/MRI is significant vs non-significant. And you dont need to understand physics to be able to distinguish the two.

It's even more important when dealing with things like virtual proctoscopy. The isosurface algorithms used in generating images give a false impression of accuracy

Thats a critique of computer scientists, not doctors. Doctors dont develop the technology, they just look for applications. Your gripe is with teh computer scientists.

This is not an engineer/physician urinating contest, unless you choose to make it one.

All I'm saying is that doctors are not qualified (nor is it necessary) to develop imaging technology, just as engineers are not qualified to interpret clinical images. These are rough approximations; obviously there are some people who are able to cross the gap, but by and large, the domains of doctors and engineers are inaccessible to the other.

It has nothing to do with smarts. It has to do with a genuine source of possible error in the image, which when presented to be similar to an X-ray, gives a false impression of accuracy.

The algorithms used are from the computer graphics field, which are based on using various techniques to make images look good. Because radiologists are trained in X-rays, these were adapted to make them look like X-rays.

Again, your criticism is not with the doctors, its with the engineers/manufacturer who designed the protocol. Doctors (the vast majority anyways) dont design protocols, they just use built in "recipes" supplied by the manufacturer.

No, it isn't. Electricians don't need to do loop analysis because it doesn't affect their work. Sampling problems, however, do affect medical images; it is unavoidable.

Sure, sampling problems affect the images. But for MRI, this is extrapolated away from the radiologist because the computer handles all the nuts and bolts of the scan.

Radiologists who interpret them have at least a basic need to know what the error is.

Radiologists dont need to know Nyquist to be able to recognize MR image problems. All they have to do is set the FOV larger than the object. As long as they do that, there is no Nyquist violation.

Its pretty much common sense that your field of view needs to be larger than the object to get a good image for MRI. All the radiologists I've talked to know this, and some of them dont know what Nyquist is. Knowing the Nyquist criteria is NOT a prerequisite for good MRI interpretation.

 

[TillEulenspiegel]

Don't have time to read the whole thread. Are You talking about the Nyquist limits in respect to sampling and digitalization of an image or analog signal?

 

[HopkinsMedStudent]

Don't have time to read the whole thread. Are You talking about the Nyquist limits in respect to sampling and digitalization of an image or analog signal?

Both. He is arguing that a radiologist cant properly interpret MRIs unless he knows about Nyquist. My argument is that its not necessary to know Nyquist to interpret clinical MR images because the computer extrapolates that away from the radiologist.