Do you feel there is good communication bet... - Changing Faces
Do you feel there is good communication between you and your healthcare professionals regarding your needs?
Healthcare in the states is not unlike the proverbial elephant where each Physician specialty is evaluating their separate portion of the animal. For example MRI imaging reveals a G.I. problem, G.I. performs a colonoscopy but did not visualize a problem. G.I. says they can't help you further, as they did not locate the problem. Moving on to a third doctor: "Boy is she a doctor shopper!" this retired Surgeon's acquired full records read.
Is it asking too much for some insight into the radiologist's findings, short of going to a half dozen doctors and getting dumped by most along the way? State of the art healthcare in the states.
Hi Clarrisa,
Thank you for your insight! Much appreciated. It is always good to have insight into other ways of handling the same problem, i.e, providing healthcare to the public.
In work, I'm a systems analyst. My job is too look at systems, to troubleshoot them, and see where they can improve. It is pretty thankless. All systems can be improved somewhere. If it can't, then holy cow! We have found the Holy Grail, the perfect system.
It is sad that that is never true.
And what is sadder, and more frustrating, is that people sometimes go through a minefield of individual pieces of hell, until they get anywhere with medical treatment.
You would not be alone in wishing a for a better way.
My wife has a bad back. She only ever spoke to a physio.... by phone. What ?! Physios often need to put their hands on you and see what you can and can't do to assess the problem.
Medicine does seem to be so complicated that no-one knows enough to have an overall realistic assessment of the journey a patient needs to be on.
I don't know if part of the problem is that we as patients EXPECT a doctor to know everything. I get this in my day job. "Hey, computer person, why doesn't this work?". I literally will often not know, There is so much TO know, I can't know everything, and I'd look foolish if I claimed that.
That isn't to blame the patient. Far from it. Its often because our conditions are happening to us, and we just want them sorted. Its hard to hear "I don't know".
But it is still sad we often have to endure a real wilderness walk sometimes before we find the beautiful soft paved path to the eventual solution.
In the meantime, I just ask one thing of Doctors, please listen to me. Don't talk at me, talk with me .... and all of my friends, who are just like me.
The preface to Cope's Early Diagnosis of the Acute Abdomen (older 21st edition) discusses the overreliance of testing, and the resulting atrophy of the clinical skills of history taking & physical examination. This may be due to provider(s) immediate time restraints. Consequently when test results stray from textbook, doctors can seem at a loss. What doctors are not appreciating is many patients, thanks to online resources can now diagnose many slam dunk textbook cases on their own. For example I thought I was having trouble with gluten. Would my doctors consider testing me for it? No. Years later they decided I needed to be tested for a gluten problem. I told them the test would not be accurate because I have been gluten free for years. Did that stop them? No. Patient's seek a higher level of expertise. Those fortunate patients who got to see a master, Sir Zachary Cope (1881-1974)!
Do I believe in overreliance on improved technology reduces skills? You bet you I do.
A quick check on Google maps says fewer people now know how to navigate!
So I don't disbelieve for a second an overreliance on testing for anything will result in Doctors being less able to assess.
But I do think this.
I know this isn't the same as troubleshooting a technology / systems problem is not medicine, I'm not saying it is. But they share a lot of the same symptoms / diagnosis traits.
And I know one thing.
If I listen to everything my client ever say, I'd never make a successful diagnosis of any system issue.
Often, clients report things which are not relevant, because they don't know those facts aren't related. But knowing about those allows me to rule them out. They don't report things they should, because again, they didn't see the link. Those would have been helpful to know., and then, I'm working with half the picture.
So i am fully in agreement with you in taking a full case history on any issue. This is where the dialogue starts. A good Doctor should be asking all the right questions to fill in those gaps (Which will be massive, because the patient didn't think to mention them) and to filter out the noise (the bits the patient mentioned which tehy didn;t need to) in their understanding of your scenario.
I have, at times, to remember to switch on what I call "sceptical thinking". I must never take at face value what my client says. It may be wrong. Indeed, it frequently is.
The relationship between IT consultant and client is not unlike that between Doctor and patient.
It is important to listen, but at the end of the day, it is my job to determine the right course of action.
If the client diagnosed the system issue themselves , and I went with it unquestioningly, and then it turned out that the client was wrong, well, the responsibility for any damage done is then on me and not the client. It would have been in my powers to refute what they were saying,
And that is true too for Doctors. While I hate the lack of communication (that needs to be improved), I must remember that if I diagnose myself, then it is THEIR medical licence and registration which is at stake when for example, I try to get that made official. If they don't have the evidence to back that, they won't sanction it.
We live, sadly, in very litigious times. Suing is an ever present occupational hazard.
We need to move to a less adversarial model.
I would never suggest anyone tries to self diagnose. I know we all want answers. But the internet is full of fake news, horror stories and all sorts of nonsense. Why I should I trust the internet, with no pedigree, over someone who 5 years at Uni plus one year on wards, to qualify as a junior Doctor?
I wish it were clearer when Doctors are truly assessing what we as patients say. It does seem at times that they don't listen. But I can also see their perspective, and it isn't easy for them either.
To which I can only add. If you have a medical condition, I'd definitely suggest making it your business to know ever bit of science, symptom, treatment going, I suspect many of us do, I see cases of people going to the Doctor on UK TV, and half the time, i just see whining, and moaning, and no specifics from the patient. For some conditions, sure, that may be normal. But it makes the Doctors life harder nolt having hard data to support a diagnosis.
Know your specifics, If you have a lump, when did you spot it, has it gotten bigger, what does it feel like (solid or liquid contents), that stuff helps focus the troubleshooter, the Doctor, in. In this community, I believe most of us know that much better than most.
It is a difficult situation. But in ever conversation with a Doctor, if you are seeking treatment, you must consent to it. And therefore, do not consent until your concerns are addressed.
And when you feel they are, then follow Doctors orders!
Treatment is not, for me, done by Doctor to patient. It should be done jointly between patient and Doctor.
Its hard. It just is. and yes, I wish it were easier!
I know little about computer systems other than I read that early on they were programmed by and large by men, and were thus set up to their ways of thinking. Hopefully things have changed.
As for medicine I think the patient in the U.S. is expected to give their chief complaint at the time they make a their appointment. Due to time constraints the doctor only wants to address this complaint. That being the case it seems the patient has already self diagnosed themselves by having to pick the body system they want their doctor to address.
For example my father after dragging his feet for months would go to his doctor for something like a pain medication renewal when no further phone renewals where offered. So his doctor allotted 20 minutes to discuss his shoulder pain. But you could never get this patient to present themselves to their doctor to discuss the need for home help assistance with activities of daily living. Even the doctor would become agitated due to his time constraints if you mentioned the patient's difficulty with overall activities of daily living. This would be less of a problem if his doctor had even realized and DOCUMENTED that his shoulder pain was interfering with his ability to but on a long sleeved sweater or jacket. This way the family could have bypassed using any of the precious doctor's time by sending their prior visit summaries to his long term care policy insurance carrier. In prior notes this doctor even though they had been seeing a over 90 year old patient, they were not spelling out in documentation (that insurance companies would accept) their ability to perform activities of daily living.
Then you have the doctor venting their anger at you for seeking assistance for your parent (that the doctors are saying should not be going up and down stairs caring things) but they have to navigate stairs where they live this is abusive. What do U.S. families end up doing? Making and sending videos to the insurance companies, I kid you not.
Ha! have you never seen the movie "Hidden Figures" ?!
This is not a politically correct thing to say, and I ask forgiveness from any that take this the wrong way. It is not a dig either way.
I can actually tell we whether a man or a woman wrote code I work with, and sometimes (though not often) I can tell exactly who wrote it!
Let me justify that.
There is a big difference in Men's and women's thinking. This is FAR from a bad thing. Men have an aggressive edge that women generally don't have.
I often find Male code can be more experiential and take us new places. Women's code tends to be more defensive, more accurate and less prone to error.
Blokes write code like they are flying a fighter jet, at the edge of what can be done. \women tend to code more like they are flying a business jet, ensuring passengers are safe above all
Depending on the project, if I want edgy experimental but prone to error code, give it the bloke.
If i want code for something that needs to more fault tolerant, where the consequences of an error are serious, then give it a female programmer.
I have formed that view over 20 years in the IT industry,
i think a lot of difficult stuff, writing code or diagnosing a health condition, can be highly influenced by the individual making the diagnosis. After all, they have their research interests, which may unconsciously prejudice them. Whether they communicate well or not is also down to the individual.
Sometimes i think, if you don't like what you hear, or the way you hear it, change the record. You may still hear the same message, but if you, then you may be more onboard as to why.
CB
Have we passed the dinosaur age of computers yet? Oh I get the doctor's message, they want a yearly bonus (based on incentives like low utilization of patient services). They plan on going home on time too. In order to accomplish that they had to blindly prescribe the narcotic to my narcotic addicted father for his shoulder pain. In wonderful hindsight he should have been referred to a specialist for a steroid injection to the painful area. He also could have been referred to a Pain Specialist Nurse Practitioner at this V.A. (Veteran's Health Center) to help him manage his pain more successfully. Utilizing resources = no yearly bonus plus you have to be troubled to use your God given brain.
