tag:blogger.com,1999:blog-32053362.post7869698155572743298..comments2024-03-29T06:37:18.029-04:00Comments on Not Running a Hospital: Diagnostic skillsPaul Levyhttp://www.blogger.com/profile/17065446378970179507noreply@blogger.comBlogger6125tag:blogger.com,1999:blog-32053362.post-82858222957975353632007-11-14T17:27:00.000-05:002007-11-14T17:27:00.000-05:00Sometimes the hardest thing is finding a doctor wh...Sometimes the hardest thing is finding a doctor who will plainly *say* that it doesn't matter. You go to the doctor wanting to make sure that the stomachaches you've been having aren't an ulcer or the little rash your kid has that isn't really bothering them isn't a food allergy. They order some blood work, don't really see anything and refer you to a specialist. The specialist doesn't see anything but asks you to come back in few months or a year, and meanwhile there's a note with the name of whatever disease that you haven't exactly been diagnosed with in your medical record, so now you pay more for insurance or, if it's your kid, the school gets nervous and wants to treat her differently. This has happened to me more than once and it's just Kafka-esque, all the anxiety you go though because the doctor won't exactly say you're healthy. And maybe it's just because they can't really ever say you're healthy, because then they'll be liable for malpractice if someone ever finds anything wrong, but when do you stop worrying about if the professional doctor won't give you a clean bill of health?Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-63331533142614369122007-11-13T21:46:00.000-05:002007-11-13T21:46:00.000-05:00I know a woman who had this very problem as a chil...I know a woman who had this very problem as a child. Her constant wetting was blamed on her parents divorce, and she was sent to a psychiatrist (no offense, in this case it just wasn't the correct thing to do.) She was forced to wash her own sheets and other things to "correct her behavior!" Thank goodness a new primary care doctor decided to order more tests and discovered the reflux. She is still scarred by the experience.Betsy B.https://www.blogger.com/profile/13845070665906953016noreply@blogger.comtag:blogger.com,1999:blog-32053362.post-43931613707119701412007-11-13T17:54:00.000-05:002007-11-13T17:54:00.000-05:00Marc,Thanks. We don't do pediatrics at our hospit...Marc,<BR/><BR/>Thanks. We don't do pediatrics at our hospital -- except for newborns -- so I don't have anyone here to ask -- but thanks for the thoughts.<BR/><BR/>Sorry, soccer posts are likely to continue from time to time!<BR/><BR/>Anon,<BR/><BR/>I'd like to recommend Jerry Groopman's book, in that he discusses exactly those kinds of issues.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-1367648341140586682007-11-13T10:35:00.000-05:002007-11-13T10:35:00.000-05:00As a reader of your blog who has been a patient in...As a reader of your blog who has been a patient in your hospital, I would like to respectfully note another side of the statement that "85% of the symptoms that he sees in patients don't matter." As a patient, sometimes one sense that the primary care is not taking what you are going through seriously for this reason. As an example, I recently had a bout with very bad headaches. Because I had experienced migraines all my life and was going through a very stressful period, the headaches were initially written off as stree-related or possibly sinus-related. It took a specialist to find a bone spur in my sinus cavity, and even after that diagnosis I had to wait an extended period of time for surgery and recovery. During all of that time I was in a great deal of pain, but because I presented as a stressed individual, I often felt that my pain was somewhat written off as something that "didn't matter" because it wasn't life-threatening. I spent many weeks in unnecessary pain due to delays in getting specialist appointments and attention to my problem. I don't fault any particular person, necessarily, but sometimes pain "matters" a great deal to the patient even if the doctor does not consider it seriously. It was a huge relief, after switching primary care doctors, to find one who said to me, "pain is serious because it is affecting your life, period."Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-31233765212512476322007-11-13T09:20:00.000-05:002007-11-13T09:20:00.000-05:00Nice stories, but not necessarily shining examples...Nice stories, but not necessarily shining examples of amazing health care.<BR/><BR/>Story 1 makes you wonder a bit about the quality of the examination part of the well child visit. Why did the pediatrician not pick up this <I>gross</I> cardiac abnormality (which you seem to be describing) at the examination stage of the visit? Or earlier, when the doctor asked about feeding? Yeah, good that it was picked up, but not really something to pat yourself on the shoulder about.<BR/><BR/>Story 2 isn't that clear cut either - actually far from it. The attributed role of UTIs in the development of renal impairment / chronic renal failure (to which you are referring) seems to be constantly shifting. Also, the value of prophylactic antibiotics to prevent UTIs in children is questionable at least <I>(compare Conway et al, JAMA 2007;298(2):179-186)</I><BR/><BR/>Just for fun ask your general pediatricians and pediatric nephrologists about the controversy around the latest NICE guideline (UK National Institute for Health and Clinical Excellence) on <A HREF="http://www.nice.org.uk/guidance/index.jsp?action=byID&r=true&o=11624" REL="nofollow">urinary tract infections in children</A><BR/><BR/>And while am on a rant: Hardly any pediatric patient is noncommunicative. Most of them are far more communicative than your average geriatric patient (just guessing, I only treat pediatric patients). The fact that the younger ones or children with severe developmental delay don't talk does not mean they don't communicate.<BR/><BR/>Anyway, thanks for your interesting blog! (Could do without the soccer bits, but then again - I don't have to read them if I don't like them).<BR/><BR/>Cheers,<BR/>MarcAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-47346221449326786822007-11-12T18:46:00.000-05:002007-11-12T18:46:00.000-05:00These are great stories. How little it takes for ...These are great stories. How little it takes for the health care practitioner to ask, "Is there anything else you're concerned about?" Yet what an important, and too often overlooked, question.Anonymousnoreply@blogger.com