What's Up With Doctors These Days?

[Mal12345]

If there are any medical doctors in the audience, I do respect your profession. Mankind as we know it would literally cease to exist without you guys and gals.

But why can't we get a diagnosis without spending thousands on tests, and then sometimes they come up with a blank anyway?

Yes I know they do give diagnoses. A simple blood screening diagnosed my wife with diabetes type 2. And I realize that things like a broken arm or a sprained ankle or an ulcer are not problem diagnoses.

But when I go in with a strange rash on my arm, and you stand at your computer for 14 out of 15 minutes not even looking in my direction, what's the point of me coming in?

Isn't "rash" one of the known symptoms of fibromyalgia?

You were hemming and hawing over a diagnosis during the 30 seconds that you actually viewed my arm without touching it. Finally, just to get some closure out of you, I said "maybe it's folliculitis," so you turned back to the security of your computer screen and typed in "folliculitis without pus." Is it proper for a doctor to allow ME to make the diagnosis for YOU? And how the hell does someone get folliculitis without pus?

So you prescribed an antibiotic for one week. One week later, the rash was still there. Two weeks later it apparently vanished on its own power, coming and going with a strange purpose all its own. I didn't go back to the doctor, there's really no point except to waste money.

And how about this other doctor who hand-waved away my complaint about neck strain by saying, "Everybody gets that." Really? Everybody has chronic neck pain? Everybody has a pain that never completely goes away and requires daily stretching to relieve some of the pain? Wow. I must live on a different planet or something, because very few here seem to have that issue. Just one other guy I knew years ago who wore a neck brace. His neck surgery, of course, had just made matters worse.

If I was a doctor, maybe I would do the same things. Maybe I should walk a mile in their shoes. Imagine living under the burden of a $100,000 student loan. What would I do? Get a kick-back clinic job, work as fast as I can to get to the golf course a little early, knock the ball around until it gets dark, then go to my nice home and check on stock prices. Then, as soon as I get the loan paid off and my IRA is nice and fat, I will retire at 45.

Realistically, if I started now, maybe I could retire at 75. But as things are looking now, economically speaking, I will never be able to retire. I should become a doctor.

 

[Giggly]

They are not God but people expect them to be. They do their best.

 

[Mal12345]

They are not God but people expect them to be. They do their best.

God doesn't charge anything.

 

[Intricate Mystic]

It sounds like that doctor was pretty clueless about skin rashes. Maybe he/she should have referred you to a dermatologist instead of trying to google the answer! I try to find doctors that are affiliated with top teaching hospitals that have medical schools attached who also train medical residents and interns. You tend to get better care at those places because they're forced to stay on top of the latest medical knowledge so they can do a good job teaching medical students, interns, and residents.

 

[Mal12345]

It sounds like that doctor was pretty clueless about skin rashes. Maybe he/she should have referred you to a dermatologist instead of trying to google the answer! I try to find doctors that are affiliated with top teaching hospitals that have medical schools attached who also train medical residents and interns. You tend to get better care at those places because they're forced to stay on top of the latest medical knowledge so they can do a good job teaching medical students, interns, and residents.

He didn't Google it, he got the diagnosis from something I blathered about folliculitis.

Here's the part I didn't think I had to explain:

I don't know about the rest of the world, but around here doctors are using either wall mounted monitors linked to a central computer, or a wireless laptop linked to a central computer, as a replacement for their old-fashioned clipboards. Every bit of my medical information has been digitalized. In this particular clinic, the doctor spends 99% of his time facing the computer monitor on the wall typing in information. That doesn't mean all doctors are like that. But 3 people I know, including myself, were examined by this doctor and he didn't even do a routine cardiovascular check-up or test reflexes. When it came to examining my arm, all he did was stare at it.

 

[sprinkles]

What would you have him do? Cut it off and send it to the lab?

Doctors pretty much make their best guess about everything (except the obvious, like cuts or broken bones, organ damage etc.)

Could he have a blood test? Sure. Blood test doesn't necessarily tell why you have a rash, though. It only finds possible indicators and then they pretty much guess - some times with quite reasonable certainty, and some times not. They always have, and probably always will for the foreseeable future anyway.

There's good reasons that it is like this, and actually how you act and your medical history often tells them more about you than your symptoms do.

Take the rash with fibromyalgia for example. Maybe it's true that it's a symptom, I don't actually know. But a rash is not an indicator of fibromyalgia, and even if you have fibromyalgia that doesn't mean it caused that particular rash.

There's overlapping symptoms for everything which makes diagnosis problematic. For example, I have arthritis and it leads to progressive joint deformity in my fingers. (it isn't severe yet, but is just now becoming slightly noticeable) My pinky on my right hand is all gnarled and bent - but you know what? It's not bent because of the arthritis. It's deformed because I broke it before and it didn't heal right. Coincidental symptom.

 

[Mal12345]

What would you have him do? Cut it off and send it to the lab?

Doctors pretty much make their best guess about everything (except the obvious, like cuts or broken bones, organ damage etc.)

Could he have a blood test? Sure. Blood test doesn't necessarily tell why you have a rash, though. It only finds possible indicators and then they pretty much guess - some times with quite reasonable certainty, and some times not. They always have, and probably always will for the foreseeable future anyway.

There's good reasons that it is like this, and actually how you act and your medical history often tells them more about you than your symptoms do.

Take the rash with fibromyalgia for example. Maybe it's true that it's a symptom, I don't actually know. But a rash is not an indicator of fibromyalgia, and even if you have fibromyalgia that doesn't mean it caused that particular rash.

There's overlapping symptoms for everything which makes diagnosis problematic. For example, I have arthritis and it leads to progressive joint deformity in my fingers. (it isn't severe yet, but is just now becoming slightly noticeable) My pinky on my right hand is all gnarled and bent - but you know what? It's not bent because of the arthritis. It's deformed because I broke it before and it didn't heal right. Coincidental symptom.

Rash is listed somewhere on this huge checklist. http://www.anapsid.org/cnd/files/bernechecklist.pdf

Fibromyalgia is a tough diagnosis to make. The symptoms do overlap with other syndromes. I'm not saying he should have called it a fibro-rash. But I do have a medical history to take into consideration before jumping to a diagnosis - that the patient himself made? I thought patient-driven medical care was a thing of the past. haha.

Oh well, the rash is gone. Then an itch appeared on my left forearm which I google-diagnosed as brachioradial pruritus, and no rash this time unless I scratched it. The itch was relieved with ice or cold water. This probably means it was nerve-related since this treatment makes the nerves switch from sending an itch sensation to a cold sensation. But even before that I've been having a peripheral neuropathy behind my left armpit which sometimes grows into a bigger patch of invisible hypersensitivity. And there have been other odd things that come out of nowhere.

Faced with these and many other ongoing symptoms, I feel very helpless against a medical system gone hay-wire.

 

[sprinkles]

Rash is listed somewhere on this huge checklist. http://www.anapsid.org/cnd/files/bernechecklist.pdf

Fibromyalgia is a tough diagnosis to make. The symptoms do overlap with other syndromes. I'm not saying he should have called it a fibro-rash. But I do have a medical history to take into consideration before jumping to a diagnosis - that the patient himself made? I thought patient-driven medical care was a thing of the past. haha.

Oh well, the rash is gone. Then an itch appeared on my left forearm which I google-diagnosed as brachioradial pruritus, and no rash this time unless I scratched it. The itch was relieved with ice or cold water. This probably means it was nerve-related since this treatment makes the nerves switch from sending an itch sensation to a cold sensation. But even before that I've been having a peripheral neuropathy behind my left armpit which sometimes grows into a bigger patch of invisible hypersensitivity. And there have been other odd things that come out of nowhere.

Faced with these and many other ongoing symptoms, I feel very helpless against a medical system gone hay-wire.

Yeah, that's understandable.

Maybe he was being neglectful, it's hard to say without knowing about you and having been there.

Some doctors really do suck, and I sympathize if you meet the ones that do. It just helps to give more of the situation so that we can differentiate between what's often common practice and what's actually a grievance that we can relate to.

 

[Mal12345]

Yeah, that's understandable.

Maybe he was being neglectful, it's hard to say without knowing about you and having been there.

Some doctors really do suck, and I sympathize if you meet the ones that do. It just helps to give more of the situation so that we can differentiate between what's often common practice and what's actually a grievance that we can relate to.

I checked him out on the net and his record looks clean after 20 years of practicing medicine.

And that other doctor who told me "everybody gets that" neck strain: duh. I'm old enough to know that and I don't live in a cave. But they don't get it constantly.

Hmmm. I think the problem is money related. Maybe these docs are used to being handed big fat hundreds under the table.

 

[sprinkles]

I checked him out on the net and his record looks clean after 20 years of practicing medicine.

And that other doctor who told me "everybody gets that" neck strain: duh. I'm old enough to know that and I don't live in a cave. But they don't get it constantly.

Hmmm. I think the problem is money related. Maybe these docs are used to being handed big fat hundreds under the table.

Might be over work/having too many patients as well. Where I live you typically don't even see a doctor - they only have time to walk in and say hello pretty much, if you're lucky, some times not even that. The practitioners and techs do all the actual work and examining while the doctor just kind of buzzes around from room to room all day every day almost non stop. They simply don't even have enough time in a day to see everyone that comes into the office.

 

[Mal12345]

Might be over work/having too many patients as well. Where I live you typically don't even see a doctor - they only have time to walk in and say hello pretty much, if you're lucky, some times not even that. The practitioners and techs do all the actual work and examining while the doctor just kind of buzzes around from room to room all day every day almost non stop. They simply don't even have enough time in a day to see everyone that comes into the office.

They're busy getting done fast so they can hit the golf course early. The last guy I saw was a PA and he actually did an exam, amazingly. I predict that in the upcoming years American healthcare will go the way of every effort to socialize healthcare, and take a nosedive in quality. Please God, I don't want British teeth.

 

[kyuuei]

But when I go in with a strange rash on my arm, and you stand at your computer for 14 out of 15 minutes not even looking in my direction, what's the point of me coming in?

Isn't "rash" one of the known symptoms of fibromyalgia?

Or a slew of other things. Literally anything and everything causes a rash.. Coming and going at will sounds more like eczema than something curable. Eczema hasn't a cure at all -- you can take auto-immune suppressants, which cause more problems than the rash itself.

My mother had a 'rash' that turned out to not be a rash at all--it was a rare muscle condition and her muscles were literally bleeding, the blood surfacing to the skin irritated it and caused itching and pain. If we had not found a doctor who's dealt with that particular disease before my mom could have died from the misdiagnosis. A rash is caused by too many things. You can't really come in with a rash, no real explanation, and expect a diagnosis. It just isn't going to happen, whether you had a competent doctor or not.

In this case, I'd say you didn't. Most general practioners aren't there to help you fix a problem outside of "I need medicine for this identifiable illness." They're gateways to specialists.. they steer you in, hopefully, the right direction. Jack of all trades, master of none. Good general practioners and family doctors have a lot of experience in several fields, but some just learn enough to help the masses and try their best for the cases that fall in their lap.

And how about this other doctor who hand-waved away my complaint about neck strain by saying, "Everybody gets that." Really? Everybody has chronic neck pain? Everybody has a pain that never completely goes away and requires daily stretching to relieve some of the pain? Wow. I must live on a different planet or something, because very few here seem to have that issue. Just one other guy I knew years ago who wore a neck brace. His neck surgery, of course, had just made matters worse.

Lots of people actually do deal with chronic pains. I don't think I agree with the doctor waving it off and not sending you further down the chain, but in that case simply get a new doctor, or research a specialist yourself and explain the situation to your insurance. (if you live in a socialist country, just go anywhere else, even easier.) I don't think civilians mention it as much, but the number of people who have carpal tunnel vs the people seeking to fix it is astounding. Back pains are more common than neck pains, but this is the age of computers and technology.. those things are very common symptoms of the general public.

It is really easy to get cynical about doctors after running into some bad ones.. I know, trust me. But you don't hate teachers just because you had a bad one, right? You know there's good ones that care and love their job out there.. so it's easy to think that you can just keep probing until you find a good one.

 

[Mal12345]

I like doctors, as a profession. But something has definitely changed from when I was a child.

I told a PT guy about my neck and he unhesitatingly went through a complete diagnostic. (Without doing an MRI however, it's more questionable that way.) But then he is a specialist, rattling off names of tiny muscles and identifying my areas of muscle stress. You're right in that the GP should have given me a referral to a dermatologist. Anything, but don't simply stand there at the monitor clicking away at the keyboard with your back turned.

One of my basic psychological issues is knowing what my needs are and then getting them met. Is that related to type?

 

[Intricate Mystic]

I probably should have put the word Google in quotes. I was using it as a metaphor for the Dr having to look up info online (from whatever source they use) instead of knowing the answer. I'm familiar with doctors spending a lot of time in the visit with you typing on the computer. They also do this at top-notch places like the Mayo Clinic. The difference between those Drs and the one you saw is that they actually spend time examining their patients, talking to them, listening to them, and have an institutional focus/culture of putting the patient first. In reading your other posts, it sounds like there's something a little complicated going on with your health that a GP may not have the skills to diagnose. Is there a teaching hospital or clinic with a top-notch reputation anywhere near you that you could visit?

He didn't Google it, he got the diagnosis from something I blathered about folliculitis.

Here's the part I didn't think I had to explain:

I don't know about the rest of the world, but around here doctors are using either wall mounted monitors linked to a central computer, or a wireless laptop linked to a central computer, as a replacement for their old-fashioned clipboards. Every bit of my medical information has been digitalized. In this particular clinic, the doctor spends 99% of his time facing the computer monitor on the wall typing in information. That doesn't mean all doctors are like that. But 3 people I know, including myself, were examined by this doctor and he didn't even do a routine cardiovascular check-up or test reflexes. When it came to examining my arm, all he did was stare at it.

 

[Mal12345]

I probably should have put the word Google in quotes. I was using it as a metaphor for the Dr having to look up info online (from whatever source they use) instead of knowing the answer. I'm familiar with doctors spending a lot of time in the visit with you typing on the computer. They also do this at top-notch places like the Mayo Clinic. The difference between those Drs and the one you saw is that they actually spend time examining their patients, talking to them, listening to them, and have an institutional focus/culture of putting the patient first. In reading your other posts, it sounds like there's something a little complicated going on with your health that a GP may not have the skills to diagnose. Is there a teaching hospital or clinic with a top-notch reputation anywhere near you that you could visit?

It doesn't look like they have internet access from the examination rooms. After he looked at my arm for a while I said something about folliculitis, and that's apparently what he typed in because he said "folliculitis without pus" when he turned back to the keyboard.

I also think I should have gone back the next week when the antibiotics failed. The blister-like things were there for two more weeks. This could get expensive.

I only know the reputations of the bad clinics. They're bad. Why does the front desk lady have to state out loud, so that everyone in the waiting room can hear it, something personal and medical that I wrote on the paper I filled out while waiting? And why did the front desk girl at the other clinic hold on to my debit card until my visit was through? Do I look like someone who might sneak out without paying?

What's up with doctors AND clinics these days?

 

[funkadelik]

Well, it took months and months before I got properly diagnosed with rheumatoid arthritis. And by then I could barely get up to go to the doctor so it didn't take a real stretch of the imagination to realize something was wrong with me.

It started out as an awful, chronic pain in my foot that I just got painkillers for. And when the swelling started they said it was allergies so I got prescribed an anti-allergen for it. None of those things helped. I progressed. Eventually it was like "OHHH we should give her some arthritis blood tests!"

So I can empathize about how frustrating doctors can be, but to be fair to them, before my symptoms were more pronounced they were pretty generic. Foot pain and swelling could have been anything.

And I'm not saying what you're experiencing is or isn't anything, but you gotta be patient. Yes, doctors should be more attentive and understanding, but they also see a lot of generic symptoms every day. And probably only 1% of those are BIG problems. Statistically, their best bet is to just give you something to treat the immediate symptoms, hope that works and address any additional symptoms that might arise after the fact later on.