Is there a doctor in the house?

[jcranmer]

By continuing to read this thread, you certify that you are a non medical professional. If you are in the medical field, you agree that you will only reply if you are in full agreement with me. If you do not agree to these terms you must click here rather then continue to read. Failure to comply means you are breaking the terms of this EULA.

RANT
Why is it whenever I see a new doctor, specialist or not, I start thinking the medical education system in this country is completely broken. A person with only a high school education should not feel as if they know more then their very highly paid doctor.

I'm a diabetic, I was diagnosed in the early 80's and have mostly taken care of it on my own with limited help from my family doctor for the past 10 years. I'm trying to get more serious about my health and since I'm really starting to have issues controlling my blood sugar, I agreed to see an endocrinologist for the first time in over 20 years.

I went to this guy for one reason only; to get an order for an Insulin pump. I want to try one and see if I am a good fit for it. I'm a generally smart person and like to do much of my health care on my own. Of course there are somethings you just can't get without one of these very educated persons signature.

The conversion went like this:
DR: I see you are a type II
ME: No I'm a type I
DR: Are you sure??
ME: Um...Yeah I've been insulin dependent for nearly 30 years, and when I was diagnosed they called it juvenile diabet....
DR: (interrupting me) That doesn't mean anything. We must test you.

Yeah....

Then we started the next conversation:
DR: Your face is red, have you ever been tested for Cushings?
ME: Yes, I just had a complete blood workup for several generic issues, including Cushings. (It was negative)
DR: (interrupting me yet again!) That's not good enough! I need to test you again.

Of course the fact that my BP was 170/109 just moments before wouldn't have had anything to do with my face being red. :banghead:


You folks still reading all of this??

ARGHHH...Nothing annoys me more then arrogance, except maybe continually interrupting me when I am trying to answer YOUR questions.

Word of advice to new doctors, don't be an ass. Listen to the people you are trying to help. Try to understand that some of them are more educated then a 1st grader. If you don't, It's a sure fire way to get your medical school loans paid back much slower as you lose patients.

/RANT

 

[Tech_Junkie]

I've found that their are 2 types of doctors. First one really cares about people, and wants to help push forward medical science. The second is in it just for the money. They were usually rich kids and their parents made them go to either medical, or law schools.

My mom was on a sliding scale with her insulin. Depending on the level would dictate how much to take.

 

[rhd]

By continuing to read this thread, you certify that you are a non medical professional. If you are in the medical field, you agree that you will only reply if you are in full agreement with me. If you do not agree to these terms you must click here rather then continue to read. Failure to comply means you are breaking the terms of this EULA.

Best of luck getting that to hold up

I'm a diabetic, I was diagnosed in the early 80's and have mostly taken care of it on my own with limited help from my family doctor for the past 10 years.
(...)
I'm a generally smart person and like to do much of my health care on my own.
(...)
ME: Um...Yeah I've been insulin dependent for nearly 30 years, and when I was diagnosed they called it juvenile diabet....
DR: (interrupting me) That doesn't mean anything. We must test you.

Hate to tell you this, but I think your Doctor probably behaved appropriately given the information you've relayed here. Your diagnosis is old, 3 decades old, to the point that the actual terminology has even changed. You admit to having been responsible for much of your own health care, and that you've had limited involvement with your doctor over the past 10 years. Updating your tests, even if you think it isn't necessary, was probably the right thing to do. Tests get better, technology improves, and medical knowledge keeps evolving. From that perspective alone, when a patient with diabetes comes in and hasn't had much interaction with the professional medical system for 10 years, you'd expect a Doctor to want to get an updated palette of tests run.

From your doctor's perspective, he has to sign HIS name on any diagnosis / prescription / treatment he orders. It's not the previous doctor signing off, and it's not a patient's "memory of previous tests" signing off, it's your current doctor. It's his reputation, and his insurance premiums that are on the line. Given the state of malpractice litigation in North America, you can't expect a professional who has invested so much of his life into medical practice, to risk it all just to save a patient the hassle of a few potentially (though not necessarily) redundant tests. They certainly wouldn't do so in a scenario where that patient really hasn't had a lot of recent documented professional medical consultation regarding a substantial medical condition like diabetes.

From your perspective, this is what you SHOULD be hoping for. This is how medical issues that may have gone uncaught for years, get caught. Time and time again new doctors catch things that the previous doctors hadn't. If you've had as little interaction with the medical field as you say, then you're even more likely to benefit from this rigorous attention. You're in Canada, most of this testing will be free. You said you're "trying to get more serious about your health". This is how you do it.

Word of advice to new doctors, don't be an ass. Listen to the people you are trying to help. Try to understand that some of them are more educated then a 1st grader. If you don't, It's a sure fire way to get your medical school loans paid back much slower as you lose patients.

Two comments here:

1) You can be substantially more educated than a first grader, and yet nowhere near as educated as a medical specialist. Most specialists will have done 4 years of undergrad, 3 years of med school, and then between 2 and 7 years of residency depending on whether they specialize in something like diabetes, cancer treatment, etc. So they're looking at between 9 and 14 years of school after highschool, which means 20 to 25 years of education after 1st grade.

2) In Canada, there's no such thing as losing patients, at least not in the numerical sense. There's such an immense under-supply of doctors relative to need and ability (for our government) to pay, that believe it or not, doctors don't need to stress about patient count. Similarly, med school graduates don't need to stress about finding jobs. If they graduate, they'll find a residency position, and if the fulfil residency, they'll find a job, period. And unfortunately, bed-side manner / social skills aren't covered on the MCAT

 

[JBTexas]

(EDIT) When I started typing this, it WOULD have been the first reply... 2 replys were deposited during my ranting.

<- kinda qualified to discuss and "opine" on this; I was in the Army for 22 years, became a health / exercise nut for the last ~ 9 years or so (except for smoking like a steamboat and eating some junk food); ran a lot, backpacked, dated (civilian) women in the Appalachian Mountain Club (and OH BOY..); ALWAYS > maxed the physical fitness tests; I was "healthy as a horse" when I retired (and I kept up wit da jogging and working out); (summer of '96);

... and in the spring of '98, had an unexpected, freekin uncalled for, major heart attack that almost killed me. I've had at least a 2nd heart attack, and possibly a 3rd. I have *started* to develop early, mild-to-moderate COPD (Chronic Obstructive Pulmonary Disease); from smoking so many years + mild congestive heart failure after my 2nd cardiac event (sometimes the fluid buildup around the heart destroys a few lung cells here and there)... (BTW I *think* I've finally given up smoking, it's been... wot... 9 days now... but I'm still getting short-term memory loss, some hyperactivity, and general crankyness/orneryness, so I haven't precisely kept track of how many days it's been).

ANYWAY (!) My Cardiologist. Same thing. (not so much my pulmonary specialist). She is Indian BTW ("East Indian", not Native American), and she has an "attitude". Yes, it seems like arrogance (but more on that later). She lectures me like a child. I can SEE that, really, I would expect a Cardio Doc to lecture a little on lifestyle changes. But (in my opinion) does so excessively. There is an old Monty Python skit... a guy seeks out an "argument clinic" to pay for an argument, but accidently walks into the "abuse room" (and later being-hit-on-the-head lessons)... I feel like that EVERY time I see her. Like I walked into the "Department of Verbal Abuse". Because I smoked (at the time), and tended to eat quite a bit of mexican food. DESPITE the fact that I THINK I indicated to her that I jogged, went swimming frequently, did calisthenics daily... nitpic nitpic nitpic.

Anyway... I think perhaps they are all CONDITIONED to be that way, perhaps without realizing it. I know that television is often NOT a good reflection of real life, but from watching E.R. and other shows, I have to wonder what years of medical school (incl. advanced specialized training) will do to a person's psychology.

Doctors were TRAINED by doctors, during the formative years of their lives. Most don't learn to "gear down" and treat their patients as human beings. They are very focused in what they do on a day to day basis... they do not (can not) see that other people have minds of thier own, so they "talk down" to people.

As for me ... ONE OF THESE DAYS ... I'm bringing a whoopee cushion and a water pistol to an appointment. It will either help, or my cardiologist will die of shock (MUUuuuaaa!) :eg:

 

[Tech_Junkie]

Good point RHD, but the doctor shouldn't be interrupting you while you are telling them your medical history. A person with no social skills shouldn't be applying for jobs working with the public IMO. How are you suppose to communicate your thoughts to someone who will not let you finish a sentence? He works for you, you dont work for him. Some doctor seem to forget this.

The US is not like Canada.

 

[jcranmer]

Wow, I knew this would spark some debate, but I'm surprised how quickly. I agree and disagree with some of your points RHD, unfortunately I'm heading out the door for work, so won't be able to provide some detailed responses until later. I may have given you the wrong impression on a few points. :na:

I was going to also try not to bring race into this, as I figured someone would slam me for it. However this guy is also an Indian, and I have to say there is something cultural I think going on as well. I've had this experience with others from that same part of the world. Although my vision doc is also from that part of the world and is on of my 2 favorite docs. Although I'm pretty sure he was actually born in the US, so I guess technically that doesn't make him Indian.

Anyway, more later.

And come on, no points for a Dougie Howser reference? LOL

 

[Tech_Junkie]

My moms doctor was from India and he was a great man, and doctor.

 

[rhd]

Good point RHD, but the doctor shouldn't be interrupting you while you are telling them your medical history. A person with no social skills shouldn't be applying for jobs working with the public IMO. How are you suppose to communicate your thoughts to someone who will not let you finish a sentence? He works for you, you dont work for him. Some doctor seem to forget this.

The US is not like Canada.

I think your point about the US not being like Canada WRT medicine is the most crucial distinction to be aware of here. OP was also in Canada.

One of the biggest differences, apart from the fact that our healthcare is free, is that we have to wait for it - often for many hours in a waiting room, after already having waited several months for the appointment.

As a patient, I would much rather a doctor interrupt me (and by implication interrupt previous patients) if it means seeing me faster, and seeing more patients in a day. As long as they aren't interrupting the actual medically relevant info, or as long as they interrupt it once enough of that information is conveyed for them to reach the specific conclusion they need to reach, then in my mind - interrupt away.

I've been in scenarios (non medical) where I've had to do intakes of people who needed to convey the history related to a serious issue or situation. You have to interrupt people. It's hard to really appreciate this until you've been in that situation. People don't generally relay their own history in a concise manner. Most people preface and pad the meat of what needs to get communicated.

In Canada, medicine is free, but it's also scarce and over-used. The reality is that doctors here need to interrupt patients. It may not make them social butterflies, and indeed it may not make some of their patients like them too much, but it does maximize the social utility of scare resource.

 

[Tech_Junkie]

OP is in the US bro, and I completely agree.

 

[jcranmer]

Sorry RHD, TJ is right. My rant it strictly US health care. You've been selling too much stuff and forgot where I'm located. It's even over there right under my avatar.

 

[rhd]

You're right, my bad, lol.

If you guys are paying for your health care, I'd expect a chocolate on the seat when I walk in, and a cute assistant to hold my hand whenever the doctor gives me bad news

 

[Kevlar]

Its called medical PRACTICE for a reason guys... :crackup:

 

[Tech_Junkie]

Well my doctor gets $675 a visit and $5100 a procedure to "practice" on me.

 

[jcranmer]

< Start of long winded, poorly thought out, unable to withstand debate, rant >

I've found that their are 2 types of doctors. First one really cares about people, and wants to help push forward medical science. The second is in it just for the money. They were usually rich kids and their parents made them go to either medical, or law schools.

My mom was on a sliding scale with her insulin. Depending on the level would dictate how much to take.

I've often said this many times to anyone that would listen, so I can't agree with it more. Fortunately my family doc fails into the first category.
I've had quite a few others that just don't seem to care.

I'm actually on a sliding scale as well, mostly because of talking to my family doctor so much. The fact that we are able to communicate so well helped me get my diabetes under much better control when I started seeing her about 10 years ago. She switched me from the concept of eating to fulfill a predetermined dose of insulin to taking my insulin to meet what and when I was eating. It's was a life changing moment for me, it really made me feel like I was in control of the diabetes instead of the other way around.

This is the most important thing with me. I *need* to fell like I am playing some role in the treatment. This goes for anything medical for me. I don't make snap decisions on treatments or even tests. I need to understand as much as I can about what it going on and only then make a decision.

Your diagnosis is old, 3 decades old, to the point that the actual terminology has even changed.

This is a very good point, but please keep in mind this was the original diagnosis. Even though I am certain that my body no longer (and hasn't) produces insulin. I went though the entire routine, including what was termed the "honeymoon period" where my body kick started itself for a few weeks / months and starts producing insulin on it own again, before fading into oblivion. THAT was a rough time period in my life. It's just fates way of REALLY kicking you in the teeth.

I've also worked with my family doc in the past 2 years and tried some oral medications on the off chance they would help. I think it was Metforman. It
did nothing for me. I was also checked into intensive care at the local hospital about 7 years ago. I had the flu and let things get way out of control. I had expired test strips that were reading abnormaly low, so the entire time I thought my BG was low it was really though the roof. I nearly killed myself with the sugar trying to raise up an already crazy high BG level.

My point being, I know they also did many tests at that time, and I would assume they would have mentioned the fact if there was any confusion on Type I vs Type II. All of this information would have been given to this doctor had he taken the time to do a proper medical history and listen to what I was trying to tell him.

You admit to having been responsible for much of your own health care, and that you've had limited involvement with your doctor over the past 10 years. Updating your tests, even if you think it isn't necessary, was probably the right thing to do. Tests get better, technology improves, and medical knowledge keeps evolving. From that perspective alone, when a patient with diabetes comes in and hasn't had much interaction with the professional medical system for 10 years, you'd expect a Doctor to want to get an updated palette of tests run.

This isn't quite right, and it may have even been what I said, but I was ranting after all. I've had A1C's run every 3 - 4 months like clockwork for years. I've even kept them as low as 6.8 at one time
Anymore they are bad though, the last was a 9.2 about a month ago. This doctor didn't even want to take the time to get these results from my other doctors.

These elevated blood sugars are completely in my control and are entirely my fault. I know what to do, I'm emotionally not in a good place any more, and don't' test or eat like I should. The concept of a pump sounds like it might be able to help me, since some of these readings are the result of things so simple as me forgetting my insulin at home and going out to eat. If it's attached to me, I'm hopefully not going to forget it, and I will hopefully not be too lazy to turn a dial and push a button. I know it's not some kind of magic that's going to fix everything, but I think it will help me take back the control of my condition.

From your doctor's perspective, he has to sign HIS name on any diagnosis / prescription / treatment he orders. It's not the previous doctor signing off, and it's not a patient's "memory of previous tests" signing off, it's your current doctor. It's his reputation, and his insurance premiums that are on the line. Given the state of malpractice litigation in North America, you can't expect a professional who has invested so much of his life into medical practice, to risk it all just to save a patient the hassle of a few potentially (though not necessarily) redundant tests. They certainly wouldn't do so in a scenario where that patient really hasn't had a lot of recent documented professional medical consultation regarding a substantial medical condition like diabetes.

I fully understand him putting his neck on the line. However since my previous doctor is a part of the same hospital group and the lab work was done at the same hospital, I do have an issue with paying for tests
that were just recently run. A1Cs are good for a 90 day period and doing this and a bunch of genetic tests that I just did, do nothing but cost me money. This is where the US vs CA thing really plays a role.
Even with private insurance, medical costs are skyrocketing in the US. Ordering these tests just costs everyone more.

You're in Canada, most of this testing will be free. You said you're "trying to get more serious about your health". This is how you do it.

It's a much different situation in the US. This is how you end up in the poor house and then our government will take care of you.

1) You can be substantially more educated than a first grader, and yet nowhere near as educated as a medical specialist. Most specialists will have done 4 years of undergrad, 3 years of med school, and then between 2 and 7 years of residency depending on whether they specialize in something like diabetes, cancer treatment, etc. So they're looking at between 9 and 14 years of school after highschool, which means 20 to 25 years of education after 1st grade.

My statement really was more of a rant then to be taken verbatim. I do think though that the only part of all that education that counts is the years of residency and beyond. This is a pet peeve of mine in the IT field. Certs mean nothing other then you can read a book. The part that counts for me is the hands on work. Although I admit it's a necessary part of medicine, since I know I don't want to be the human guinea pig.

2) In Canada, there's no such thing as losing patients, at least not in the numerical sense. There's such an immense under-supply of doctors relative to need and ability (for our government) to pay, that believe it or not, doctors don't need to stress about patient count. Similarly, med school graduates don't need to stress about finding jobs. If they graduate, they'll find a residency position, and if the fulfil residency, they'll find a job, period. And unfortunately, bed-side manner / social skills aren't covered on the MCAT

I think we are going to be in the same boat before much longer in the US. If you think this is a rant, don't get me started of "health-care reform" in the US.

< End of long winded, poorly thought out, unable to withstand debate, rant >

Sorry about the formatting and typos, I've fixed some of them, but I'm too lazy to fix it all. :wave: Here is a good case of what I am talking about, I just got in the door from work, eat some crap food that I got on the way home, and instead of taking insulin and testing my blood sugar I'm over here posting. If I could get a pump I could do both at the same time.

 

[rhd]

It's interesting - I think of med school as the ONE field of study where the actual education does count. Those 3 years of med school, they're learning real, practical, fundamental stuff. It's not like undergrad / masters / phd / law school, etc.

Med school takes some real brains to get into, and some real brains not to fail out of.

 

[jcranmer]

The more I think about the more I may come around to your thought. The fact is I can take care of myself given access to some basic tests and drugs. Where I really need a doctor is when I am in the ER dying from a truma of other medical issues. These are when all the book learning comes into play. Needing to make snap decisions based on some hopefully not too obscure fact.

Taking this type of issue out of the equasition, given a handfool of tools and lab tests with a small amount of medicines to choose from I could very well live with out a doctor.

I've always wanted to do something in the medical field. Most likely not a doctor as I don't want to deal with all the years of school and training, not to mention my general dislike of people!