Yet Another Cycling Forum
General Category => The Knowledge => Health & Fitness => Topic started by: quixoticgeek on 16 November, 2018, 12:02:38 pm
-
Does anyone else get really annoyed by Doctors making assumptions about lifestyle etc... without actually asking?
This week I had an appointment with the occupational health doctor. Without even asking if I get any exercise, he told me I should get more. I've cycle 9700+km so far this year. I should break the 10000km mark on Monday or Tuesday. Yet I need more exercise apparently? This isn't the first doctor that has made the same assumption (last time was after I'd ridden 3x200km rides in the previous week.
Seems doctors just look at the overweight depressed geek and assume no exercise.
Anyone else had similar experiences? What's the best way of explaining to the doctor to remove stick from arse and listen to the patient?
J
-
That's what the mouth is for.....!
-
That's what the mouth is for.....!
Defending yourself from the poor assumptions of a doctor? When they could instead find out a little about their patients by asking "Do you get much exercise?" Or "How much exercise do you get?"
I've also had a podiatrist telling me that I'm over weight, and should consider walking for weight loss, while treating me for a foot injury that means I couldn't walk...
Just wondered if anyone else had similar experiences.
J
-
All I meant was to tell the doctor that you DO get exercise (probably a lot me than the doctor does) and see what the reaction is!
I agree it's pretty insulting.
-
You are assuming that the doctor is wrong.
Maybe 9700+ km isn't enough, and you should do more :P
-
The best approach to doctors' assumptions - like most people's assumptions - is to conform to the right stereotypes.
But this stuff happens all the time, sadly. My GP's computer[1] and asthma nurse know exactly how much exercise I do, because I'm explicitly asked for a quantitative value as part of my yearly asthma review. No, what they managed to get wrong was my height. :facepalm:
I had a physioterrorist refer to me as an 'athlete' once. That was quite hilarious.
And I had a trapped gall stone for a week because three different sets of medics misdiagnosed it. Apparently because I wasn't screaming enough - the consultant said the presentation was otherwise classic. That was type 3 fun.
Barakta could probably win the thread on this stuff, on account of seeing so many arrogant specialists for awkward edge-case problems.
[1] My GP herself emits bogons, and generally shouldn't be allowed near the computer, so probably hasn't picked up on this. But she's got better things to do than nag people about exercise.
-
Sadly, we are dealing with humans....
There are good ones, bad ones, clever ones, stupid ones, arrogant ones, virtuous ones and all other manner of ones in all walks of life including the "caring" professions.
Unlike the publicly expressed diktat of a previous secretary of state for health, you cannot expect all doctors to be "above average" :facepalm:
Most people I know will make assumptions and prejudgements - it is the exceptional doctor that does not and does things in the time consuming "proper" way as they were originally taught to use.
Taking "short cuts" by considering such assumptions may be necessary to be able to cope in dealing with complex and multiple problems, sorting them out and documenting them all in the space of 8-10 minutes average (not that I think there is any excuse not to do all that!).
All we can do is remind them in as gentle a way as possible to reflect on their practice!
-
I don't get the weight crap cos my BMI is under 25 box-ticked. I do sometimes get the disinterested and not listening types, I think partly cos I scare them by being complicated and sometimes clinicians don't know how to handle that, so get awkward and funny.
-
There seems to have been an outbreak of sensibleness at my gp surgery, prescribing me more painkillers over the phone, and when I said I was going to swim as rehab for my current injury, it was a question " what stroke were you thinking of?"
When I replied, "well, not breast stroke obviously"
The response was "good idea, just be careful and manage the pain".
So there are good ones out there, in my experience anyway.
-
There seems to have been an outbreak of sensibleness at my gp surgery, prescribing me more painkillers over the phone, and when I said I was going to swim as rehab for my current injury, it was a question " what stroke were you thinking of?"
When I replied, "well, not breast stroke obviously"
The response was "good idea, just be careful and manage the pain".
So there are good ones out there, in my experience anyway.
There are some good ones out there. Finding them can be hard tho. I had to get a new GP (Huisarts in local), and I went in needing a refill of a drug I've been taking for 10 years, I know works for me, but I also know is not the standard one given for the same condition in .NL. I took an empty box with me, making sure not to take any actual medication in the box. I was expecting to have a whole exchange where they question what it is, why, etc... And maybe try to suggest an alternative. But she simply said "whats it for?" *Brief history* "it works for you?" "Yup" "here's 90 days worth."
I did have to ask her on the next refill to request a specific brand. As the default brand in .NL comes in blisters of 10, where as the brand I've used for years comes in packs of 28. This makes it much easier to keep track of if I've taken a days dose or not. Huisarts was fine prescribing it. Pharmacist was a bit grumpy about dispensing it. Tho i got it in the end. And they now know not to argue with the Brit with the weird drugs...
Said same Huisarts also gave me Tamazapan straight of for sleep issues, which surprised me.
There are good doctors out there. I've been lucky with the ones I've had. I guess that's why I was so surprised by this guy being an arse. Esp as I don't have a choice in seeing them, it's occupational health, I have to see them. I am going to ask if I can have a different human tho. Coming out feeling worse than I went in, isn't really part of the deal.
J
-
I am going to ask if I can have a different human tho. Coming out feeling worse than I went in, isn't really part of the deal.
The "I want to see a lady doctor for ladies" ruse can be a good way to avoid a known cockwomble, at least when the cockwomble is male.
-
I am going to ask if I can have a different human tho. Coming out feeling worse than I went in, isn't really part of the deal.
The "I want to see a lady doctor for ladies" ruse can be a good way to avoid a known cockwomble, at least when the cockwomble is male.
Yes, that's how I subsequently avoided the dr who decided I was anaemic when I went to see him about continued exhaustion, didn't follow up the negative blood test and completely missed the fact that I was pregnant. Tired women are ALWAYS anaemic, you know.
Lady doctors for ladies are less likely to dismiss you as unimportant as well.
-
I am going to ask if I can have a different human tho. Coming out feeling worse than I went in, isn't really part of the deal.
The "I want to see a lady doctor for ladies" ruse can be a good way to avoid a known cockwomble, at least when the cockwomble is male.
Yes, that's how I subsequently avoided the dr who decided I was anaemic when I went to see him about continued exhaustion, didn't follow up the negative blood test and completely missed the fact that I was pregnant. Tired women are ALWAYS anaemic, you know.
Lady doctors for ladies are less likely to dismiss you as unimportant as well.
Some doctors are a bit cockwomble. Had a lady doctor recently and she asked twice if I was ok seeing a lady doctor. My reply was are you a doctor, then we are good to go. Wonder why she siad that, I think it is a picture about what the locals are like.
-
Whenever I've been to the doctor they've pretty much told me to bugger off.
-
Did you bonj them?
;)
-
Oh and then there was the time my brother complained of some condition to the doctor. Doctor starts tapping away on his keyboard. After a bit my brother peers round at the screen thinking he's going to see his medical notes or something. No. The doctor was googling the condition. :o :o
-
What's the problem with that? No different from my IT job.
I don't expect my doctor to have detailed knowledge of every possible condition.
Their years of training would help them dismiss the misinformation amongst a bunch of google results and pick out the relevant/useful information.
-
Doctors are (I'm reliably informed) people. Like any profession a few a good, a lot are middling, and a few are bad at their jobs. They're under time and other pressures. If you turn up overweight, I don't think it unreasonable they ask about exercise. I don't think it unreasonable they look up a condition online – a previous generation would have looked in a book, after all. It would be unreasonable for them to know everything about medicine (a fast-changing field). I'd hope they look up as many things as possible.
My main gripe about British GPs (no idea about Europe) is that they're often patronising and aloof and it creates a us-and-them with patients, which isn't a good thing if you want patients to open up. Admittedly that may in part just be a British thing. But I also think its selection and training, it's a still a very closed profession. Certainly, seeing doctors in US and Canada was a lot more of a discussion and they expected you go off and do your own research and come back. Could have been the individuals, of course, but I found it a very different (and far better) experience.
-
Been pretty lucky with the doctors in our practice over the last 40 odd years, but the male doctor who is now the most senior is utterly useless. From the moment you enter his surgery, he is just trying to get rid of you as soon as possible.
Since he is the one most available for appointments, I guess most patients have the same experience and avoid him.
He has also rubbished the previous treatment other doctors in the practice have prescribed, and once laughed at my then teenaged daughter when she expressed worries about a rash spreading.
I really don't understand how he has lasted, the other doctors must be aware of his shortcomings, especially now we get a text after each visit asking for a rating.
-
Sadly, the requirements for re-validation aren't onerous (it's been a while since I was involved in a project that looked at this, but I don't think any specific requirements for professional development exist, doctors just have to show they've done something) and probably not fit for purpose in modern medicine. I think some more old-school doctors view even that as an undue burden. The structure where GPs are sub-contracting their services to the NHS is a bad one for enforcing standards, of course. Which makes finding a good doctor a bit of a crapshoot. If you've got good healthcare coverage in the US, for instance, you wouldn't put up with a crap doctor (Americans generally not being reticent about complaining). I think American doctors expect you to turn up with your own diagnosis and treatment plan (because you saw it on TV) and then having to spend their time dissuading you...
-
And, I am sure you will all be very happy to know, the hoop jumping, tick boxing, draconian, confrontational, abusive, expensive and time consuming "appraisal" and "revalidation" system the politicos have imposed on all medics will do absolutely nothing to improve things, let alone trap another Shipman....
It is, needless to say, convincing the good ones to emigrate, reduce their commitments or retire early. :P
Rest assured, there are plenty good ones still left, you just need to find them and get appointments with them.
(Partial cross post, it seems!)
-
Actually, I meant to say they're not onerous in demonstrating developing skills and knowledge, but yes, an emphasis instead on box-ticking and bureaucracy, I don't doubt.
-
What's the problem with that? No different from my IT job.
I don't expect my doctor to have detailed knowledge of every possible condition.
Their years of training would help them dismiss the misinformation amongst a bunch of google results and pick out the relevant/useful information.
No, no different from mine either, but the difference is sort of that I can try it out, and if it fails, lob it in the bin and try something else. ;D
If he had to look it up, I would hope at least it to be an official NHS repository or knonw reputable source rather than just the raw internet.
-
Sadly, the requirements for re-validation aren't onerous (it's been a while since I was involved in a project that looked at this, but I don't think any specific requirements for professional development exist, doctors just have to show they've done something) and probably not fit for purpose in modern medicine. I think some more old-school doctors view even that as an undue burden. The structure where GPs are sub-contracting their services to the NHS is a bad one for enforcing standards, of course. Which makes finding a good doctor a bit of a crapshoot. If you've got good healthcare coverage in the US, for instance, you wouldn't put up with a crap doctor (Americans generally not being reticent about complaining). I think American doctors expect you to turn up with your own diagnosis and treatment plan (because you saw it on TV) and then having to spend their time dissuading you...
Please note the following is a reasoned supposition, I stand to be corrected by those with direct experience if I have got it entirely wrong.
I think part of the problem here is the assumptions that have to be made about the patients capability to comprehend and analyse the information provided by the medics and the patients research. A UK GP sees everyone, in the US the doctor will typically only see those who have sufficient insurance to see them. As the insurance is often work related there is a degree of segregation of the population based on their employment and subsequent cover. A US doctor may therefore only see Professionals who will have a level of education and competence that encourages self directed research, where the UK GP probably gets habitualised with patients who may find this difficult and so pitch to the lowest common denominator.
As an aside when I recently saw my consultant to get the results of my MRI I pulled a chair round so that I could see the screen with the scan and was promptly told to put it back and sit where I couldn't easily see the screen. I should have pulled him up about it but didn't.
-
I think there is some truth in that, one of the skills a UK medical practitioner has to have is to work out the 'level' their patient is at. I can imagine there are clinicians who I find excellent who others struggle with because they don't have my level of education or indeed background medical knowledge. In the US if your insurance isn't "great" you get no choice cos your provider only has Dr Crap or Dr a-bit-shitty in their network approval list - I suspect people here who've spent time there have tended to have the better insurance policies or funds to top them up as needed. It is horrifying how many US folk have no insurance.
One reason I've found student-heavy medical practices are good is that they are geared up for 1) younger people's issues and 2) a population with some degree of education and ability to understand stuff. They are probably making snapshot judgements to guess stuff but I do also notice clinicians asking me what my job is which I think is a way they're calibrating my education/knowledge level.
-
Not a GP, but a neurologist . . .
"Why are you continuing to take that medication if your symptoms have stopped?"
Er, maybe because they come back when I start to reduce my medication?
Same neurologist refuse to have me tested for epilepsy, on the grounds that:
A) If I tested positive, I'd lose my driving licence
B) The fits I was having were going on too long for it to be epilepsy
C) I was taking such a low dose of anti-spasmodic medication (and having a good response) that it was unlikely for it to be epilepsy.
-
"Why are you continuing to take that medication if your symptoms have stopped?"
Er, maybe because they come back when I start to reduce my medication?
They seem to like doing this to asthmatics too. Fortunately not something I've been on the receiving end of yet.
-
I had a pharmacist do that to me. I pointed out that most people don't suddenly recover from T1 diabetes.
-
What's the problem with that? No different from my IT job.
I don't expect my doctor to have detailed knowledge of every possible condition.
Their years of training would help them dismiss the misinformation amongst a bunch of google results and pick out the relevant/useful information.
No, no different from mine either, but the difference is sort of that I can try it out, and if it fails, lob it in the bin and try something else. ;D
If he had to look it up, I would hope at least it to be an official NHS repository or knonw reputable source rather than just the raw internet.
What's wrong with the "Raw Internet" if you have the intelligence to parse the results? I would suggest much better than any single curated site. You would very quickly see if there was a consensus of opinion from sites you trust from the first results page, and be able to choose what seems to be the most relevant results. I'm sure you use <whatever search engine> in that manner on subjects on which you are informed.
-
Sadly, the requirements for re-validation aren't onerous (it's been a while since I was involved in a project that looked at this, but I don't think any specific requirements for professional development exist, doctors just have to show they've done something) and probably not fit for purpose in modern medicine. I think some more old-school doctors view even that as an undue burden. The structure where GPs are sub-contracting their services to the NHS is a bad one for enforcing standards, of course. Which makes finding a good doctor a bit of a crapshoot. If you've got good healthcare coverage in the US, for instance, you wouldn't put up with a crap doctor (Americans generally not being reticent about complaining). I think American doctors expect you to turn up with your own diagnosis and treatment plan (because you saw it on TV) and then having to spend their time dissuading you...
Please note the following is a reasoned supposition, I stand to be corrected by those with direct experience if I have got it entirely wrong.
I think part of the problem here is the assumptions that have to be made about the patients capability to comprehend and analyse the information provided by the medics and the patients research. A UK GP sees everyone, in the US the doctor will typically only see those who have sufficient insurance to see them. As the insurance is often work related there is a degree of segregation of the population based on their employment and subsequent cover. A US doctor may therefore only see Professionals who will have a level of education and competence that encourages self directed research, where the UK GP probably gets habitualised with patients who may find this difficult and so pitch to the lowest common denominator.
As an aside when I recently saw my consultant to get the results of my MRI I pulled a chair round so that I could see the screen with the scan and was promptly told to put it back and sit where I couldn't easily see the screen. I should have pulled him up about it but didn't.
Yes, I am sure this true, I had good a good insurance plan intended for, amongst others, medical professionals. I have no idea how much she got to 'regulate' who she saw however, she was attached to the university medical centre but that also covered one of the main hospitals. But anyway, she knew she was getting someone with a doctoral education. That said, it was a very different experience from seeing a GP in the UK (actually, the ones at our local practice are OK). Not that this should be taken as an advert for US healthcare.
That said, UK doctors don't often seem to pick up on cues from the patient, their level of knowledge, etc. and sometimes information is delivered in a medical-bot rote fashion that doesn't seem to vary whether you're five or 55, failed to pass a GCSE or have umpteen doctorates. It's not just me, I know a number of ex-GPs, and despite them explaining that yes, they were a doctor, their GP carries on. A couple of them have questions 'did I do that?' The thing is, the result is that yu don't feel part of your treatment, and to be honest, I think most people avoid their GP as 'one of those experiences.' OK, you're not supposed to look forward to it, I suppose, but you know what I mean.
This post contains gross generalizations, of course.
-
What's wrong with the "Raw Internet" if you have the intelligence to parse the results? I would suggest much better than any single curated site. You would very quickly see if there was a consensus of opinion from sites you trust from the first results page, and be able to choose what seems to be the most relevant results. I'm sure you use <whatever search engine> in that manner on subjects on which you are informed.
Might as well just do that myself and cut out the middleman. ::-)
-
What's wrong with the "Raw Internet" if you have the intelligence to parse the results? I would suggest much better than any single curated site. You would very quickly see if there was a consensus of opinion from sites you trust from the first results page, and be able to choose what seems to be the most relevant results. I'm sure you use <whatever search engine> in that manner on subjects on which you are informed.
"Raw Internet" can't give you a prescription for the drugs you need to deal with the diagnosis...
J
-
What's wrong with the "Raw Internet" if you have the intelligence to parse the results? I would suggest much better than any single curated site. You would very quickly see if there was a consensus of opinion from sites you trust from the first results page, and be able to choose what seems to be the most relevant results. I'm sure you use <whatever search engine> in that manner on subjects on which you are informed.
Might as well just do that myself and cut out the middleman. ::-)
OK, my bad, I said "intelligence" when I meant and implied training, experience and intelligence, I was thinking that if you had intelligence you would realise you needed training and experience as well.
-
What's wrong with the "Raw Internet" if you have the intelligence to parse the results? I would suggest much better than any single curated site. You would very quickly see if there was a consensus of opinion from sites you trust from the first results page, and be able to choose what seems to be the most relevant results. I'm sure you use <whatever search engine> in that manner on subjects on which you are informed.
"Raw Internet" can't give you a prescription for the drugs you need to deal with the diagnosis...
J
A good doctor is far more than a drug dealer
-
What's wrong with the "Raw Internet" if you have the intelligence to parse the results? I would suggest much better than any single curated site. You would very quickly see if there was a consensus of opinion from sites you trust from the first results page, and be able to choose what seems to be the most relevant results. I'm sure you use <whatever search engine> in that manner on subjects on which you are informed.
"Raw Internet" can't give you a prescription for the drugs you need to deal with the diagnosis...
The "Raw Internet" can't give you a prescription for them (well, it probably can), but the drugs themselves will be available on the Internet somewhere.
(Not recommended obviously.)
-
I'd certainly prefer a doctor who bothers to look things up rather than rely on what they might remember from medical school a few decades earlier.
-
Well today was an interesting appointment, not my usual GP, went in wanting a refill of meds that were previously prescribed in the UK by my NHS GP.
She didn't actually do any examination of the relevant complaint, just took my word for it that what I had been prescribed before. She didn't check that the treatment was working, or that it was the best solution to the complaint at hand.
I'm not feeling crap after this appointment like I was with last weeks Occupational Health doctor, but I'm kinda thinking that if you go in with a physical complaint, the doctor should at least look at the patient...
J
-
Oh and then there was the time my brother complained of some condition to the doctor. Doctor starts tapping away on his keyboard. After a bit my brother peers round at the screen thinking he's going to see his medical notes or something. No. The doctor was googling the condition. :o :o
To me that would be reassuring. If it a disease or condition that they have not seen before or recently, then a quick check is a good thing
-
Oh and then there was the time my brother complained of some condition to the doctor. Doctor starts tapping away on his keyboard. After a bit my brother peers round at the screen thinking he's going to see his medical notes or something. No. The doctor was googling the condition. :o :o
To me that would be reassuring. If it a disease or condition that they have not seen before or recently, then a quick check is a good thing
It's also worth remembering that Google is a damn good search tool. ISTR that the last time I went to the Quack's, the GP used Google, but the results she selected from the list were all official (for want of a better term) sites: Starting with NHSDirect and drilling down from there. I know from my own work that the built-in search algorithms in many specialist databases are rubbish, and if Google has indexed them then it's often better to just go that route.
-
What's wrong with the "Raw Internet" if you have the intelligence to parse the results? I would suggest much better than any single curated site. You would very quickly see if there was a consensus of opinion from sites you trust from the first results page, and be able to choose what seems to be the most relevant results. I'm sure you use <whatever search engine> in that manner on subjects on which you are informed.
"Raw Internet" can't give you a prescription for the drugs you need to deal with the diagnosis...
J
Not yet - but they(re working on it!! ;D
-
Back to the OP, I have never had a man as an médecin du travail, only women (sorry, lady doctors). However I should point out that my experiences with said lady doctors seems to have been considerably better than that of female colleagues - and I can't even claim to be especially smart or handsome! Must be seduced by my awful french accent 8)
-
Certainly, seeing doctors in US and Canada was a lot more of a discussion and they expected you go off and do your own research and come back. Could have been the individuals, of course, but I found it a very different (and far better) experience.
That's a British attitude thing, historically doctors were seen as near god like creatures with immense knowledge.
The reality is quite different.
Managing your doctor when you go to see them isn't encouraged by that attitude and the fact we can go twenty thousand times until the right answer is hit on at random without anyone really questioning it... Where as the Americans in particular are handed a rather large bill for being there so are damn well going to make sure they get the right diagnoses at minimal cost, particularly
when the insurance cover limits what it'll pay out each year.
One of my friends qualified in Denmark, she was telling me that no matter what you have to manage the doctor, they are doing something for you, so you're in charge.
I've also heard similar from a long qualified Diabetes Specialist Nurse I used to work with, but he was a right dour bugger that had got into Nursing from being a Mechanic.
Oh and then there was the time my brother complained of some condition to the doctor. Doctor starts tapping away on his keyboard. After a bit my brother peers round at the screen thinking he's going to see his medical notes or something. No. The doctor was googling the condition. :o :o
The GP practice computer systems do have links to medical encyclopaedias in them in some form of other, but nothing says that because they have EMIS/Vision/Torex/Whatever is they have to use the one that is there. It's also possible that they looked at it and decided to find other sources to confirm that option... OR they saw the cost of the drugs that the practice system's encyclopaedia was recommending and decided to find out what other drugs are available.
The thing to remember is that GPs are basically general problem solvers;
Got something really common, easy they see it daily or at least weekly.
Turn up with something they see once a month, year, decade and they're digging into what ever info sources they have at hand; if it happens to look like something they see every week then a miss-diagnosis is almost inevitable.
-
If you want sound treatment don't go to a doctor, go to a vet. They are used to treating patients with a real value so generally try harder to get it right ( or so my dad used to say, he was a farmer). The best ones earn a lot more than doctors in consequence.
-
If you want sound treatment don't go to a doctor, go to a vet. They are used to treating patients with a real value so generally try harder to get it right ( or so my dad used to say, he was a farmer). The best ones earn a lot more than doctors in consequence.
A friend, who is a vet, insisted that vets are cleverer, and have better memories, than physicians. Her reasoning was that doctors only treat one species, whereas vets usually train to treat six. Those six have very different physiologies.