Author Topic: Doctor's assumptions  (Read 2359 times)

quixoticgeek

  • Mostly Harmless
Doctor's assumptions
« on: November 16, 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
--
Beer, bikes, and backpacking
http://b.42q.eu/

Re: Doctor's assumptions
« Reply #1 on: November 16, 2018, 12:12:39 pm »
That's what the mouth is for.....!

quixoticgeek

  • Mostly Harmless
Re: Doctor's assumptions
« Reply #2 on: November 16, 2018, 01:23:09 pm »
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
--
Beer, bikes, and backpacking
http://b.42q.eu/

Re: Doctor's assumptions
« Reply #3 on: November 16, 2018, 01:31:24 pm »
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.

Re: Doctor's assumptions
« Reply #4 on: November 16, 2018, 01:33:41 pm »
You are assuming that the doctor is wrong.

Maybe 9700+ km isn't enough, and you should do more  :P

Kim

  • 2nd in the world
Re: Doctor's assumptions
« Reply #5 on: November 16, 2018, 01:41:36 pm »
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.
To ride the Windcheetah, first, you must embrace the cantilever...

pdm

  • Sheffield hills? Nah... Just potholes.
Re: Doctor's assumptions
« Reply #6 on: November 16, 2018, 02:45:11 pm »
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!

barakta

  • Bastard lovechild of Yomiko Readman and Johnny 5
Re: Doctor's assumptions
« Reply #7 on: November 16, 2018, 04:25:39 pm »
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. 

ElyDave

  • Royal and Ancient Polar Bear Society member 263583
Re: Doctor's assumptions
« Reply #8 on: November 16, 2018, 05:47:34 pm »
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.
“Procrastination is the thief of time, collar him.” –Charles Dickens

quixoticgeek

  • Mostly Harmless
Re: Doctor's assumptions
« Reply #9 on: November 16, 2018, 06:40:06 pm »
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
--
Beer, bikes, and backpacking
http://b.42q.eu/

Kim

  • 2nd in the world
Re: Doctor's assumptions
« Reply #10 on: November 16, 2018, 06:49:43 pm »
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.
To ride the Windcheetah, first, you must embrace the cantilever...

Re: Doctor's assumptions
« Reply #11 on: November 18, 2018, 02:26:55 pm »
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.
Quote from: Kim
^ This woman knows what she's talking about.

Gattopardo

  • Lord of the sith
  • Overseaing the building of the death star
Re: Doctor's assumptions
« Reply #12 on: November 18, 2018, 03:00:09 pm »
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.

Ben T

  • What you saying, then?
Re: Doctor's assumptions
« Reply #13 on: November 18, 2018, 04:39:34 pm »
Whenever I've been to the doctor they've pretty much told me to bugger off.

Unless you put on overalls, boots, and a helmet with a high tech pre fitted lamp - and you dig coal - nope, you don't know me.

Re: Doctor's assumptions
« Reply #14 on: November 18, 2018, 07:05:15 pm »
Did you bonj them?

 ;)

Ben T

  • What you saying, then?
Re: Doctor's assumptions
« Reply #15 on: November 18, 2018, 11:08:56 pm »
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
Unless you put on overalls, boots, and a helmet with a high tech pre fitted lamp - and you dig coal - nope, you don't know me.

Re: Doctor's assumptions
« Reply #16 on: November 19, 2018, 09:27:03 am »
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.
"Yes please" said Squirrel "biscuits are our favourite things."

ian

  • fatuously disingenuous
    • The Suburban Survival Guide
Re: Doctor's assumptions
« Reply #17 on: November 19, 2018, 09:47:16 am »
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.
!nataS pihsroW

Re: Doctor's assumptions
« Reply #18 on: November 19, 2018, 09:49:50 am »
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.

ian

  • fatuously disingenuous
    • The Suburban Survival Guide
Re: Doctor's assumptions
« Reply #19 on: November 19, 2018, 10:25:20 am »
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...
!nataS pihsroW

pdm

  • Sheffield hills? Nah... Just potholes.
Re: Doctor's assumptions
« Reply #20 on: November 19, 2018, 10:31:43 am »
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!)

ian

  • fatuously disingenuous
    • The Suburban Survival Guide
Re: Doctor's assumptions
« Reply #21 on: November 19, 2018, 10:35:52 am »
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.
!nataS pihsroW

Ben T

  • What you saying, then?
Re: Doctor's assumptions
« Reply #22 on: November 19, 2018, 11:31:07 am »
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.

Unless you put on overalls, boots, and a helmet with a high tech pre fitted lamp - and you dig coal - nope, you don't know me.

Re: Doctor's assumptions
« Reply #23 on: November 19, 2018, 11:55:16 am »
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.

barakta

  • Bastard lovechild of Yomiko Readman and Johnny 5
Re: Doctor's assumptions
« Reply #24 on: November 19, 2018, 01:10:48 pm »
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.