Disappointing/Depressing/What?

[arTistapple]

Has anyone seen the public message from Dr Petros Perros? I find it shocking.

[diogenes Remembering]

I'm afraid it is completely to be expected. It's an easy get-out to a) allege that patients are conducting "a war" with conventional endocrinologists and b) that patients are being misled by "alternative practitioners ". The smug paragraphs resound to the "dismissive silence" of the conventional endocrinologists, who are advising incorrectly precisely because they are conventional and haven't grasped how far thyroidology has recently progressed or its implication for them. Patients are NOT conducting a war; they are asking for better treatment. As for "alternatives" horning in on the holy ground of the "expert thyroidologist", this is merely an outright smear , that no one can study and be influential unless they belong to the out-of-date club of present day thyroidologists. "We are correct because of who we are" not because of considered self-analysis.

[arTistapple in reply to diogenes]

Diogenes thank you for your articulate observations. I really needed them, such is my shock. If this was my ‘expert’ it’s made up my mind not to waste yet another year yearning for help from that direction.

[DippyDame in reply to diogenes]

Might he, instead, be quietly challenging that "dismissive silence"?

Yes, patients are asking for better treatment....and if a " war' is perceived then it's because polite requests have fallen on deaf ears and desperation has kicked in.

Does he recognise this? He should!

He states that Another challenge is attracting the brightest doctors and scientists to our discipline.

Challenge! Is that not a clear recognition that all is far from right in thyroid towers?

He writes of self-appointed experts from the dark alleys of alternative medicine,

It is undeniable that such people exist....the Internet is strewn with claims of alternative remedies as I alluded to in my earlier response. He refers to alternative medicine rather than alternative ( thyroid) treatment ( e g to include T3, NDT etc)

Annoyingly he appears to be lumping the knowledgeable approach of concerned individuals with those in the dark alleys of alternative medicine, when he refers to

self- appointed experts.

Perhaps I'm wrongly giving him the benefit of the doubt!

It does sounds smug.....but can we judge from a few words if this is actually what he intended.

I wasn't there so I find that difficult to judge.

He admits, that new knowledge gained from scientific investigation should help resolve some thyroid issues....that's positive.

Until medics in high places dismount from their high horses, admit they have been wrong and listen to the scientists nothing will change.

I saw this as a drip towards hollowing out old Ovid's stone rather than as an essay titled, "We endocrinologists know best".

Apologies if this offends anyone.... my inner rebel has escaped!!

[diogenes Remembering in reply to DippyDame]

The basic problem is that the conventional endocrinologists want to straddle two horses - they recognise now that there are a group of patients whose current treatment appears to be insufficient, but at the same time will not let go of the conventional approach to solving this problem. It simply can't be done - the accepted paradigm is incapable of solving these difficulties. As Tania Smith demonstrates, using ranges as a catch-all and thereby implying that "anywhere in the range will do" as a diagnosis, is simply a convenient way of freeing up time for general examinations and saving money. Doctors are busy people with a host of different presentations to unravel. It is truly unfortunate that the real way to go about things is far more complex than a cursory glance at some numbers. This is for me the real stumbling block: not the refusal to face the science but the lack of willingness to reconsider treatment on behalf of the patient.

[DippyDame in reply to diogenes]

Agree!

First the will! Then recognise, admit and eliminate errors, then change... facing the science.

All with more face to face patient time

Doubt I'll see any change in the rest of my life though.

[tattybogle]

".....Another challenge is attracting the brightest doctors and scientists to our discipline, and strengthening the links between endocrinology as a clinical speciality and as a scientific area. ......"

Is this an admission that most of the current bunch are:

a) not very bright.

b) don't read much. (of the latest scientific research)

[greygoose in reply to tattybogle]

🤣

That, at least, is true!

[DippyDame in reply to tattybogle]

It's an "admission" that seriously needs to be addressed... and high time somebody voiced it loud and clear in public

We as patients are on the receiving end of what appears to be/are the products of dumbed down (medical) education etc etc.

[Gingernut44 in reply to tattybogle]

The problem I see here is, you can have a bright new Doctor who has his hands tied by the Senior Consultant and his CCG. I have experience of that with a very nice young Doctor, only been in the job 18 months who told me (2020) that he was afraid for his job and career if he went against guidelines and prescribed T3 for me but was happy to monitor me if I bought my own. It certainly wasn’t BTA or NICE guidelines he was following but …..

[DippyDame]

Admin please confirm.....I'm nor sure we can discuss individual medics on the forum but I guess discussing an article in the media written by one might be acceptable!

Link to the full interview -

endocrinologyblog.org/2018/...

I know nothing of Dr Perros but absolutely agree with this comment that he made during the interview

Another challenge is attracting the brightest doctors and scientists to our discipline, and strengthening the links between endocrinology as a clinical specialty and as a scientific area.

I can also understand the following, having recently read of an alternative practitioner, a self styled thyroid expert, who recommended a strict diet for " thyroid issues" which resulted, it seems, in muscle wastage

....self-appointed experts from the dark alleys of alternative medicine, who exploit human suffering and desperation.

Sorry, I don't find it "shocking/depressing/ disappointing/what?"

Just my opinion, since asked

The medical profession must listen to the scientists if any progress is to be made

[RedApple Administrator in reply to DippyDame]

DippyDame 'discussing an article in the media written by one might be acceptable'

Confirmed!

[1tuppence in reply to DippyDame]

DippyDame, do you think he realises just what he says here? ........"exploit human suffering and desperation". Surely he's admitting that human suffering and desperation is actually happening? In which case, why isn't he concerned about dealing with this desperation and suffering himself? It's not correct to say something doesn't exist, and then lay the blame for exactly that at any others feet.

[nellie237]

"We need to reverse the tide of unnecessary investigations and treatments relating to endocrinology"

I'm glad he considers it a tide..........I hope this indicates that he thinks he's losing the war.

[humanbean]

The link to the blog :

endocrinologyblog.org/2018/...

Some decades ago, we thought that we had solved the problem of thyroid hormone replacement. Yet, some patients remain dissatisfied, seek alternatives, and have recently launched a war against “conventional” endocrinologists.

The above quote from the blog reminds me of the anecdote given by Max Planck who spoke to his advisor in physics in the 19th century. The advisor told Planck to choose a field of study other than physics because almost everything in physics had already been discovered and all that was left was to fill a few holes.

en.wikipedia.org/wiki/Max_P...

en.wikipedia.org/wiki/List_...

hsm.stackexchange.com/quest...

The Munich physics professor Philipp von Jolly advised Planck against going into physics, saying, "In this field, almost everything is already discovered, and all that remains is to fill a few holes."

[DippyDame in reply to humanbean]

Von Jolly got that wrong then!!

My elder son did his post doc in astrophysics at the MP in Munich....now as a prof, (elsewhere) doing far more than " filling in a few holes".

This "thyroid war" must be won... but the first skirmish has barely succeeded so far.

I guess we need to look to Ovid...

Dripping water hollows out stone, not through force but through persistence

[Hedgeree]

It seems if I've read it properly that the interview was published in 2018; I'm wondering if the Dr has changed his opinions with it now being 2022 so four years later?

Also it appears that you can comment on the blog following the text! Could it be an opportunity for informative and constructive opinion?

Also he has left his academic email address in the comments section so if he is still at the same institution...

[HowNowWhatNow]

These words could mean very different things to different audiences.

The comment about the problems of attracting the brightest and best is interesting.

Some fields of medicine attract people who are very bright, some attract those who want to make the most money, some those who want a work-life balance .. and medical students have to make these decisions very early on in life.

As a first guess, I would think that the amount of time / detail / complexity accorded to the subject in medical school will be very influential in making endocrinology a sought-after rotation. Likewise numbers / eloquence of role models in senior positions. And also availability of funding for research and PhDs.

What else - that can be controlled - helps?

And what are the unhelpful stereotypes that afflict the profession?

[arTistapple in reply to HowNowWhatNow]

“These words could mean very different ….” AND they clearly do reading the replies. I think now after my initial shock at first reading this and reading the following comments, it has allowed me to enlighten myself from a different angle. Look at some benefits that I might have missed due to my shock. Now maybe I see the possibility of some movement on his thinking, as others have mentioned. However I have just had a reply from his department showing that nothing appears to have changed. It reminds me of that old joke amongst medics. “If you have not got a clue, go into Dermatology. No-one is expecting you to do anything there and you can just sit there and pick up your pay packet.” It seems (perhaps because all the problems have been solved in the treatment of hypothyroidism re: “Some decades ago …”) that it could be Thyroid is the new Dermatology. So if you have not got a clue, go into Endocrinology specialising in Hypothyroidism. No-one is expecting you to do anything there (it’s all been done) and you can just sit there and pick up your pay packet. I don’t think that is sexy enough for most young bucks or whatever is the female equivalent. So four years have passed since this piece was written and they are paying no attention to more recent research. Why not? P.S. Doctors get a lot longer to consider their career path/specialism than any other profession. They do have to pack a lot in to their journey but the actual timeline is quite long.

[HowNowWhatNow in reply to arTistapple]

I agree that doctors get longer than many other professions. In the US they get EVEN longer than here, too.

It would be interesting to know whether endocrinology is a more dynamic branch of the medical profession in any of the countries where we can get the medication we need than here in the UK, where we are treated like unworthy fantasists.

[arTistapple in reply to HowNowWhatNow]

That is an interesting observation.

[HowNowWhatNow in reply to arTistapple]

There are lots of people here who travel to Greece, Germany and elsewhere to find medics who will treat their symptoms and not tell them it’s all in their mind. What happens when U.K. endos meet all of these other endos (who we would all like to see because they are on board with T3 etc) at conferences? And are there ever patients who suffer from thyroid conditions at these medical conferences, to talk about their own experiences, I wonder.

[arTistapple in reply to HowNowWhatNow]

You raise good questions and I have no idea. Cynically I am thinking since they know it all, why would they bother and invite patients? No on your Nellie! They don’t want to listen to us at all. Why invite us to one of their jamborees?

[HowNowWhatNow in reply to arTistapple]

All things considered, I have encountered specialists from many, many medical disciplines over the last 20 odd years and there is no one branch that shines as a model of discipline, diligence and excellence over all of the others.

There are specialists in most fields that are 100% fantastic: they listen to what the patient has to say and go the extra miles and don’t fall back on pat sayings when they are out of ideas, and write letters than answer all the questions a patient would have, once they know what the doctor’s verdict and opinion are. And who don’t start their letters with “it was lovely to meet this pleasant / well-organised / [other infuriating adjective] woman”.

Do we really have to find such a reductive box to put any woman with a need to see a doctor and their quaint, womanly ideas in? At the beginning of every medical letter? A lot of specialists would appear to think so. And they surely don’t start their letters of advice to male patients “it was lovely to meet this charming / well-prepared / thoughtful / fragrant / nice man”.

Then there are the other specialists, who have poor admin skills / build no rapport with the patient / are focussed on the patient progressing to the exit door ASAP / who only go by what the previous doctor said and so add no value or interest to the appointment you have arranged to have with them. And whose letters do all of the above and more.

And of course then there is thyroid endocrinology, and there appear to be no rules here, except that it is sensible to treat as suspect every fact about their life that a patient tells you. I have met a good endo and he said, in brief, that he had had to ignore what his training told him because what so many of his patients told him about their health did not tally with the medical zeitgeist and after seeing so many of these patients he had to believe them. If you train doctors poorly in one area, I expect it’s much harder to then meet a good one.

[arTistapple in reply to HowNowWhatNow]

100%

[LindaC]

Oh, I've seen him! This is why I posted... below.

Apparently, within a recent paper, he has conceded to the effect that 'some patients may need T3 to be above range'!? Does anyone have diogenes post on that paper?

The Ducking Stool of Hypothyroidism