Article - unnecessary medical care

[TranquilMind]

I thought some here might be interested in this this New Yorker article on medical care - it's one of the better ones I've read.  It is largely about the American system but speaks to many other countries practices as well.

 

Overkill - America's Epidemic of Unnecessary medical Care

Interesting article.  I took charge of our health decades ago, when my chronically ill sibling, still a teen,  had to point the team of specialists to a new treatment, which they had not heard about (this one was a researcher). 

 

You really have to do your work on this and never blindly trust what you are told or what is recommended. I can't tell you how many times they have been wrong, even in just my own family experience. 

 

Whatever they "know" today will be entirely wrong or at least incomplete in 5, 10, 20 years. 

[JumpyTheFrog]

Whatever they "know" today will be entirely wrong or at least incomplete in 5, 10, 20 years.

I think part of the problem is that so many doctors don't read the medical journals, so it takes 10-20 years for the new information to become common knowledge. I once read that this is one reason why generally new doctors are better than older doctors. The exception was surgeons since they get better over time.

 

My dad was an engineer who worked on building plus-sized mammogram equipment. He told me to avoid CT scans unless it was a life or death situation. There have been so many hospitals where they weren't calibrated properly and patients were being dosed with many times the radiation they should've gotten.

[TranquilMind]

I think part of the problem is that so many doctors don't read the medical journals, so it takes 10-20 years for the new information to become common knowledge. I once read that this is one reason why generally new doctors are better than older doctors. The exception was surgeons since they get better over time.

 

My dad was an engineer who worked on building plus-sized mammogram equipment. He told me to avoid CT scans unless it was a life or death situation. There have been so many hospitals where they weren't calibrated properly and patients were being dosed with many times the radiation they should've gotten.

Well, that's scary.

 

 I once read that the best thing you can do after the age of 50 to stay well is to avoid medical settings.  I think it was in AARP, and it may well be true. 

[Bluegoat]

Last year I read two books by two different psychiatrists about the overdiagnosis and drugging of people, especially kids. One or both of them mentioned that studies of antidepressants show that they are about 70% effective, but the catch is that the placebos are about 60% effective. In other words, they have some of the highest placebo effect of any treatment for any condition.

 

And from what I understand the long term outlooks for recovery may be better for people who don't take the drugs.

 

It suggests that it isn't something that should be prescribed casually.

 

[creekland]

My dad was an engineer who worked on building plus-sized mammogram equipment. He told me to avoid CT scans unless it was a life or death situation. There have been so many hospitals where they weren't calibrated properly and patients were being dosed with many times the radiation they should've gotten.

 

I definitely hope this isn't the case... considering daily CT scans were part of the regimen of my life for a bit - in addition to the radiation.

 

It could add to my suspicion that radiation might be the underlying culprit for many or all of the more current issues I'm dealing with.

 

Or it could be my other top choice - a disgruntled ex-student with a voodoo doll and pins...

[sassenach]

I'm currently reading an excellent book titled Being Mortal that hits on this issue as it pertains to the elderly and end of life. 

[Bluegoat]

I know that there was some study done on calibration of ultrasound machines in hospitals and such.  It wasn't unusual for them to be outside their specifications.  They also talked about the ones in places like malls and such - I can't remember if they said they were worse, or they might be worse because there was no oversight for them.

[EmseB]

Edited to omit personal details:

 

We have recently experienced the opposite with local HCPs and PCMs. 

 

A lack of resources (PCMs and available appointments) and willingness to take symptoms seriously literally cost our government thousands of dollars in an unnecessary hospital stay.  The only people to take DH seriously were ER docs after he was already too sick, when a PCM and follow up appointments would have taken care of his problem early on.  This is often my experience with our government-provided health care -- the ER becomes the only option to see a doctor in a timely fashion, even if symptoms look relatively benign but could be something serious.  I can't take my babies in to their PCM for acute care (no available appointments), and I don't know if they are spiking a fever as part of a run-of-the-mill virus or something more serious, so the ER becomes default care.  Their ped has even said as much.  It's not effective at all and definitely doesn't control costs.

 

Edited November 21, 2015 by JodiSue

[Alice]

I'm currently reading an excellent book titled Being Mortal that hits on this issue as it pertains to the elderly and end of life. 

 

Being Mortal is by the same author as the article in the OP. Atul Gawande. He has several other excellent books I highly recommend (Better, Complications and The Checklist Manifesto).

[sassenach]

Being Mortal is by the same author as the article in the OP. Atul Gawande. He has several other excellent books I highly recommend (Better, Complications and The Checklist Manifesto).

Oh, hay! Check that out. I do really like his writing style.

[Guest]

 

Well, that's scary.

 

 I once read that the best thing you can do after the age of 50 to stay well is to avoid medical settings.  I think it was in AARP, and it may well be true. 

 

 

I was told the same by friends in their 50s when I was in my 40s. It's good advice, especially if you are (let's put this as politely as possible) a person who pays a smaller percentage of your income to the federal government.

 

I noticed an extremely shocking change in the way I was treated by my eye doctor and my dentist after my 50th birthday. They both needed to be fired. I'm just glad they weren't my oncologist, cardiologist, and dialysis center.

[creekland]

I was told the same by friends in their 50s when I was in my 40s. It's good advice, especially if you are (let's put this as politely as possible) a person who pays a smaller percentage of your income to the federal government.

 

I noticed an extremely shocking change in the way I was treated by my eye doctor and my dentist after my 50th birthday. They both needed to be fired. I'm just glad they weren't my oncologist, cardiologist, and dialysis center.

 

Now, now, now... remember... oodles of things are merely caused by stress.  ;)

 

I'm at home now waiting for the "stress" to go away.   :glare:   Weekends.  They'll do that to ya.

 

Fortunately, there's caffeine that might help.

[AnnE-girl]

So I admit that I haven't read this whole thread, but I need to rant that if my three-day-old's bilirubin doesn't go down tomorrow morning, the only option is to re-admit him for light therapy because they don't send bili lights home with patients anymore. This is the first baby I've given any formula to in attempt to get more into him since my milk hasn't come in yet.

[Meriwether]

I've been to the doctor more in the past year than in the rest of my life, excluding pregnancies. We have run many tests and ruled out a lot of nasty stuff. But something is wrong with me. It is scary to know something is wrong and have no idea what it is. The doctor is willing to keep looking into it, but he doesn't even know where to go from here.

[magnificent_baby]

I found his article full of baloney. His examples were absurd and none of them follow current guidelines. I'll be an NP in less than 6 months and in my hundreds of hours of clinicals with NP's, PA's and MD's, his "stories" are nothing I've ever seen in practice. Of course not all providers follow guidelines to a T, but nearly every example of his was so far off that I don't even believe him. Was he suggesting breast cancer should be treated as indolent?! The diabetes story? That's how you DO handle diabetes education.....it's NOT a novel concept and health coaches are mainstream now in my clinics. There are very few situations I've seen that was handled with aggression, conservative treatment is ALWAYS tried first and I've had many, many providers serve as my preceptors so far. Many times insurance won't even pay for a CT or MRI unless conservative treatment has been tried. Are tests and treatments overdone? Perhaps at times...but I think he is flat out exaggerating and doesn't even seem to know what he's blabbing about. 

[creekland]

I've been to the doctor more in the past year than in the rest of my life, excluding pregnancies. We have run many tests and ruled out a lot of nasty stuff. But something is wrong with me. It is scary to know something is wrong and have no idea what it is. The doctor is willing to keep looking into it, but he doesn't even know where to go from here.

 

Don't forget stress!   :lol:

 

Take that with the sarcasm it's sent with.  Our worlds are eerily close together.  I wouldn't say I'm scared, but frustrated is a word that comes to mind fairly often.  There have been many times I've mentally resolved to "live with it" only to have more things get added to my "ok, that was never normal before" list.  Adjusting to all of these "new normals" definitely can get frustrating, but adjusting is better than the alternative of curling up on the couch in a fetal position.

 

My co-workers were nice enough to semi-jokingly ask on one not-so-terrific day if I'd want resuscitation should things get worse.  I think I surprised them by saying no.  Not dealing with this any longer could actually be preferable... and perhaps in an autopsy we'd finally have answers that didn't conclude with stress. :glare:

 

In reality, I need to start reading up on various snake oils or other alternative options - esp since I don't care if the desired return to normal gets here via an alternative method or placebo as long as it works.  I've been waiting until I had more time to devote to it.  In another couple of weeks I'll have that time.

[TammyS]

. If you have an eighty year old who could live another year if they receive chemo, in most cases you shouldn't treat their cancer. It is a hard and cold decision to make. But, our country cannot afford to spend thousands and thousands of dollars to provide treatment that will extend a life for a year

 

No one should be making that decision, except the patient.  A year of life is a lot to give up, regardless of the age of the patient. 

[TammyS]

I agree with your first two statements, but I don't think the rest is really fair.

 

Not every parent feels confident in his or her ability to tell a serious from a not-serious illness. Some may have experienced the situation of having something become serious because they thought it was "just" something simple and didn't seek treatment sooner. Some may want reassurance that it IS "just" the flu and that their home care strategies are on the mark. Some may be concerned because their child feels so miserable and can't be comforted even if it's not pneumonia. There are lots of reasons some parents might seek a professional opinion when others don't.

 

I agree that some people won't have the experience to tell the difference.  It would probably go a long way if peds would issue a sheet to new parents with some guidelines of when to call for what. And maybe we could have some kind of national hotline to help talk parents through things when they aren't sure.

[peachskittles]

I'm always filled with unending indecision whenever something medical happens around here. Is this something worth going to the doctor for? Or not? What if I go and I've wasted all that time and money? What if I don't go and it's pneumonia?

 

This is my problem.  While my sister takes full advantage of the ER in her area for every tiny little thing, I stress about these things.  I don't want doctors to think I'm crazy.  I'm not crazy. 

 

The baby is seeing a pediatric neurologist next week.  The doctor and physical therapist both agree he probably doesn't need to go, but it's a box checker.  So I get to take my seemingly healthy baby to a neurologist who most likely will think I am absolutely nuts.  I almost canceled today, but I decided to suck it up.  I'm not looking forward to the drive, but I don't want to appear negligent either.

 

And that is the other problem, appearing negligent.  If you think that your child is completely fine, but they aren't, wow do I get the whole "Why didn't you bring them in?  Better safe than sorry" line....*sigh*

 

I had an amazing doctor, but we moved.  I miss my doctor.  I'm on the third doctor in two years for the children.  Actually only two children have been seen by a doctor, but yea, it's been pretty bad.  First doctor was making decisions before I could even think about what he was asking.  Second doctor told me that uncircumcised babies needed to be retracted daily to be cleaned (and then proceeded to retract the 2 month (at the time) old baby).  I think I have found a good match, but I haven't called in to change ALL the children.  I should probably do that since I've been with her for 4 months, and she seems competent.

[JumpyTheFrog]

His examples were absurd and none of them follow current guidelines.

I bet there are huge numbers of doctors unaware of current guidelines. The following link shows that the American Assoc of Clinical Endocrinologists recommended lowering the upper limit of TSH from 5.0 to 3.0 in 2003, yet people on this and other forums still regularly reports doctors dismissing hypothyroid symptoms and a TSH of 4.5 as "normal". (http://hypothyroidmom.com/is-your-thyroid-doctor-using-the-old-tsh-lab-standards/)

 

Furthermore, large studies were done in the mid-90s (including publishing the results of a study begun in 1975) showing that people were being undertreated with the old guidelines. So it took almost a decade of results for that association to change their recommendations.

 

I wonder if someone has done a study on what percent of doctors keep up with the latest guidelines and regularly read the journals.

[Murphy101]

Alright now wait a minute.

 

Stress really does slowly and silently kill you. It literally causes heart damage and other problems.

 

So I understand the frustration but it's a valid medical issue and concern.

 

Obviously if you aren't stressed, then that's a whole other problem.

 

But our society is not even slightly set up to facilitate healthy lifestyles and it is set up in a way that perpetuates and builds stress in huge numbers of our society. So of course, that leaves Drs peddling drugs to cover the symptoms our society doesn't care enough about to change.

 

For my part, I want to just lie to my Drs. Nope. No kids. No job. Wealthy as Midas's wife.

 

There now we've gotten that out of the way maybe they will believe me when I say I'm not depressed, anxious, or abused?

 

Maybe?

 

It's not even that I'm anti medications. Medications are frikkin awesome! Woohoo for drugs!

 

But I don't want it if I don't need it. Whether I need it is determined by me to be because we cannot correct the problem by other means or can't do it as safely without the medications.

 

But I can't count how often without ANY tests or sound reasoning I've been offering medications. Some of which could have very serious complications. And often they don't even want to discuss lifestyle changes or what could be causing the problems. It's very frustrating.

[Lolly]

I've got a good one. Dd's asthma flares up every single January. Last year, she went in to the campus doctors expecting that they would do the routine and give her a prescription of steroids which always brings her back under control in January. The doctor, who specialized in asthma, informed her that she didn't have asthma. Not only that, but her problems were most likely being caused by a blood clot in her leg...She needed to go to the hospital for testing...And, referred her to counseling for anxiety. Also tried to convince her to take an anti anxiety prescription then and there which dd declined. And, prescribed something to help her sleep (she has always had sleep issues). Dd realized that she did NOT have a blood clot and ignored the referral for testing. Dd did decide to try the sleeping pills. After a few days of constant crying, not sleeping, always being tired, and not being able to think (I mean seriously not able to keep a train of thought together), she came home for a long weekend. I pointed out that all these problems started when she started taking the sleeping pill. She stopped taking it, and a couple of days later was back to her normal self and able to do her homework...She went to her allergist here and got that round of steroids which cleared her other problems up. Dh was wishing for a sleeping pill a few months later and I mentioned that dd's were on the counter. He didn't recognize the name and looked it up. It was an anti-anxiety medication. Seems the doctor sneaked it in on dd when she refused it.Well, it didn't help her anxiety level. That blood clot in her leg was resolved with a round of oral steroids too. Amazing!

Edited November 21, 2015 by Lolly

[JumpyTheFrog]

Wow, Lolly, that's quite the story! I'm glad your daughter had enough sense to ignore most of that doctor's advice.

 

Sometimes I think that everyone needs an "anti-doctor" follow them to appointments. This person's job would be to hound the doctor with questions like, "What happens if we do nothing? What percent of patients get better without treatment? What are the side effects? What are all the lifestyle changes that we can try first? When you say it reduces the risk of a heart attack by 50%, do you mean that 1% of patients will have one in any given year instead of 2%? So in other words, 99% of the patients on this drug for one year will at best be 'just' wasting their money, or worse, be harmed by the drug?"

 

I read book about the abuse of statistics for promoting health care about eight years ago. It had amazing examples like the above where a drug is pushed because it "cuts the risk in half." While this is technically true, it's reducing the number of, say heart attacks, from 2% of people without the drug to 1% with the drug. So patients are thinking it's some miracle that saves the lives of a huge percent on it, when in reality 99% receive no benefit because most of the people weren't going to have a heart attack that year anyway! The doctors rarely say, "Sure, this drug might prevent *you* from having a heart attack if you take it long enough, but in the meantime, you'll have 20-30 years of side effects."

[magnificent_baby]

I bet there are huge numbers of doctors unaware of current guidelines. The following link shows that the American Assoc of Clinical Endocrinologists recommended lowering the upper limit of TSH from 5.0 to 3.0 in 2003, yet people on this and other forums still regularly reports doctors dismissing hypothyroid symptoms and a TSH of 4.5 as "normal". (http://hypothyroidmom.com/is-your-thyroid-doctor-using-the-old-tsh-lab-standards/)

 

Furthermore, large studies were done in the mid-90s (including publishing the results of a study begun in 1975) showing that people were being undertreated with the old guidelines. So it took almost a decade of results for that association to change their recommendations.

 

I wonder if someone has done a study on what percent of doctors keep up with the latest guidelines and regularly read the jou

 

 

The most current guideline from the association you are referring to above is here https://www.aace.com/files/final-file-hypo-guidelines.pdf

 

If you look at page 1006, it discusses that not all are in agreement of upper limits of normal (aside from minor laboratory differences, patient age and pregnancy status), but the consensus on upper limits from this group based on studies is 4.12. The authors also bring up the very important fact that if it were lowered, millions of people may end up being treated unnecessarily, which could end up being dangerous. While I'm sure there are those with symptoms and levels within normal limits, I don't see why it's worth the risk of lowering the range for what I imagine is a small amount of people. (I am just assuming it's only a very small amount just based on my own observations....the majority of my patients are adult wellness checks with TSH results on every.single.one, and not one of them have complaints of hypothyroid symptoms with normal or even upper limits of normal). And with clinical symptoms but normal levels, I hope they are being worked up for other causes and not just primary hypothyroidism. 

 

Edited to comment on doctors not following guidelines: Not sure of the statistics, but in my experience it's pretty darn risky to practice outside of guidelines unless you have a good reason to do so. They aren't the end-all-be-all of course, as every patient situation is unique and they serve as a strong recommendation to guide practice, but that's likely the FIRST thing that will be looked at in malpractice. I have not found one primary care provider (including a few specialists) thus far in my practicums that does not follow guidelines for the most part, unless in unusual circumstances. Not to say it doesn't happen, but I can't imagine it would be very many. (that's why that article was SO bizarre to me)

Edited November 21, 2015 by magnificent_baby

[snickerplum]

But the thing about that initial appointment that really made wonder about this doctor is that she seemingly refused to believe that I didn't ACTUALLY come to see her for an antidepressant. I honestly have NO idea why she kept asking me if I was okay. She kept saying I seemed so sad, was there anything I wanted to talk about, am I sure I don't want a mild antidepressant.

I was struggling with severe exhaustion so I went to see a doctor. It was horrible. He made it seem like I was only lazy. I told him I was so tired that it reminded me of when I had mono in college. He told me that I never had mono. ??

So I went to another doctor who said, "You have 4 young children, of course you're tired." Then she tried to give me a prescription for an anti-depressant. I told her I wasn't depressed, but she was quite pushy. I told her I wondered if it was my thyroid. She said it wasn't. She checked my TSH and told me I was fine. I knew I wasn't.

So my friend recommended that I see her doctor. I read her a list of my symptoms, she listened, and ran a bunch of tests. I had extremely low B vitamins, D vitamins, hypothyroid, and adrenal fatigue. She said I had the internal makeup of an 80 year old. I was so mad at those other doctors. What if I hadn't been persistent or had just thought of myself as depressed and lazy?

A doctor that is trustworthy is worth his weight in gold.

[TammyS]

 Seems the doctor sneaked it in on dd when she refused it.

 

What an asshat.  He probably thinks all women are "hysterical" and need their uterus removed after they've delivered 2.3 children.  Sigh.

 

I'm so sorry that happened to your daughter.  I doubt it will make her more likely to seek treatment in the future when she needs it.

 

[Meriwether]

Don't forget stress!   :lol:

 

Take that with the sarcasm it's sent with.  Our worlds are eerily close together.  I wouldn't say I'm scared, but frustrated is a word that comes to mind fairly often.  There have been many times I've mentally resolved to "live with it" only to have more things get added to my "ok, that was never normal before" list.  Adjusting to all of these "new normals" definitely can get frustrating, but adjusting is better than the alternative of curling up on the couch in a fetal position.

 

My co-workers were nice enough to semi-jokingly ask on one not-so-terrific day if I'd want resuscitation should things get worse.  I think I surprised them by saying no.  Not dealing with this any longer could actually be preferable... and perhaps in an autopsy we'd finally have answers that didn't conclude with stress. :glare:

 

In reality, I need to start reading up on various snake oils or other alternative options - esp since I don't care if the desired return to normal gets here via an alternative method or placebo as long as it works.  I've been waiting until I had more time to devote to it.  In another couple of weeks I'll have that time.

What scares me most is that I have a one year old to raise yet. I'd like to be healthy for the next 17 years. But it is frustrating. You do get used to the various symptoms. A month ago, my tongue started burning. It hurt to drink *water*. I cried. Kind of. I couldn't actually produce tears at that point. I couldn't imagine living a life where it hurt to drink water. But I have gotten used to it, and some days are better than others.

 

We are hoping my various symptoms are a hormonal imbalance that will eventually resolve. We don't know what would have caused the imbalance. I'd like to know if there is a root cause that we should be addressing. All of my tests have come back great, just a little off, or very off but not indicative of a problem. My doctor was aggressive when possible causes were mini-strokes, MS, lupus and other nasty stuff. Now, he would be willing to keep looking, but he has no idea where to go from here. He offered to try to get me an appointment at Mayo. I wouldn't feel right about taking a slot that should go to someone in critical condition, though.

[Meriwether]

Oh, my doctor was sure it was stress for a couple of months. My cortisol levels were fine, though.

ETA: I recently started taking acupuncture, eating vile supplements, and looking into other alternatives. I'm sure some of what I've done would fall under snake oil, but I feel compelled to try.

Edited November 21, 2015 by Meriwether

[Ravin]

So I admit that I haven't read this whole thread, but I need to rant that if my three-day-old's bilirubin doesn't go down tomorrow morning, the only option is to re-admit him for light therapy because they don't send bili lights home with patients anymore. This is the first baby I've given any formula to in attempt to get more into him since my milk hasn't come in yet.

Sunshine.

[December]

I was struggling with severe exhaustion so I went to see a doctor. It was horrible. He made it seem like I was only lazy. I told him I was so tired that it reminded me of when I had mono in college. He told me that I never had mono. ??

 

 

Just curious, had he ever given you a blood test?  I believe you can tell from a blood test if someone has ever had mono.

[Tsuga]

You did this?  My mom would just point to the bathroom and let me take care of my problems.   :lol:  She taught me how to use antibiotic cream (and washing) and various types of bandaids pretty young.

 

I did that to my little one.

 

Now she has a scar on her face. Well, you don't want them too pretty regardless. It gives her character since she's pretty cute. Still, I feel bad about the scar.

[Ravin]

I did that to my little one.

 

Now she has a scar on her face. Well, you don't want them too pretty regardless. It gives her character since she's pretty cute. Still, I feel bad about the scar.

Mederma helps, and so does time.

 

If there's a next time, liquid bandage!

[Laura Corin]

Sunshine.

My doctor's prescription for my winter-born son was to lie him on his back next to a window for as much time each day as possible.

[creekland]

What scares me most is that I have a one year old to raise yet. I'd like to be healthy for the next 17 years. 

 

:grouphug: That would definitely change the equation a bit.  Mine have all launched and know fully well what's going on.  :grouphug:

 

(And I seriously doubt I'm dying quickly from my issues.  There's no way I'd be teaching in school in front of classes if I thought that were even a remote possibility - too much trauma to the kids!  I just get frustrated with all the "outside the norm" crap that comes along with this.)

 

Now she has a scar on her face. Well, you don't want them too pretty regardless. It gives her character since she's pretty cute. Still, I feel bad about the scar.

 

I'd feel badly about that too.  Fortunately I only have one small (about an inch long) scar on my right index finger.  That doesn't affect life at all.

[creekland]

Dh was wishing for a sleeping pill a few months later and I mentioned that dd's were on the counter. He didn't recognize the name and looked it up. It was an anti-anxiety medication. Seems the doctor sneaked it in on dd when she refused it.

 

I would be absolutely livid...  The rest is an annoyance, but this really goes over the line.

 

I already check out everything prior to making a decision about it (tests as well as meds).  This gives me another reason why it's important to keep doing so (but I've never had a situation like your dd's - my reasons are just to figure out if I'm interested in what's offered).

[MedicMom]

I would be absolutely livid... The rest is an annoyance, but this really goes over the line.

 

I already check out everything prior to making a decision about it (tests as well as meds). This gives me another reason why it's important to keep doing so (but I've never had a situation like your dd's - my reasons are just to figure out if I'm interested in what's offered).

q

 

This doctor sounds fairly incompetent, but there are some medications that are prescribed both for anxiety and insomnia. Trazadone, for instance.

[Lolly]

What an asshat.  He probably thinks all women are "hysterical" and need their uterus removed after they've delivered 2.3 children.  Sigh.

 

I'm so sorry that happened to your daughter.  I doubt it will make her more likely to seek treatment in the future when she needs it.

 

 

Funny thing, this was a woman. Dd does see a good many doctors. She has asthma, allergies (including anaphylactic), and arthritis. She realizes there are good ones and bad ones out there.

 

I would be absolutely livid...  The rest is an annoyance, but this really goes over the line.

 

I already check out everything prior to making a decision about it (tests as well as meds).  This gives me another reason why it's important to keep doing so (but I've never had a situation like your dd's - my reasons are just to figure out if I'm interested in what's offered).

 

Well, the dr figured it was anxiety keeping her from sleeping, so technically....  Only dd had refused help for anxiety because it wasn't anxiety. It was asthma making her have trouble breathing. It isn't like she has had it for many, many years. No, she wasn't wheezing at the time. Why? She was taking so many hits from her rescue inhaler every single day. She has been down this road before. Dr just didn't believe her. Or look at her chart undoubtably, where she would have discovered that her regular asthma doctor is a leading pulmonologist in the state, one of the ones who goes around speaking and teaching other doctors. Surely he can diagnose asthma...

 

adding: When dh looked up this medication (tossed it/don't recall what it was), sleep was not listed as an approved use.

Edited November 21, 2015 by Lolly

[Valley Girl]

 

"I agree that some people won't have the experience to tell the difference.  It would probably go a long way if peds would issue a sheet to new parents with some guidelines of when to call for what. And maybe we could have some kind of national hotline to help talk parents through things when they aren't sure."

 

 

 

I tried a nurse hotline with our insurance company once. Never again. I called with a fairly simple question about whether or not I could give one of my kids an adult dose of an OTC painkiller for a headache. The pharmacist couldn't tell me, and the doctor's office was closed. I couldn't find a specific listing for my kid's weight online either. So it's not like I didn't try to get the information.

 

I spent about an hour on the phone answering an exhaustive list of questions. (I understand why she asked them. I'm sure she was required to ask every single one. But given the context and what I told her about the situation, it was irritating and unnecessary.) In the end, she wouldn't/couldn't tell me it was safe to go with the larger dose. What a complete waste of time.

[Word Nerd]

I've got a good one. Dd's asthma flares up every single January. Last year, she went in to the campus doctors expecting that they would do the routine and give her a prescription of steroids which always brings her back under control in January. The doctor, who specialized in asthma, informed her that she didn't have asthma. Not only that, but her problems were most likely being caused by a blood clot in her leg...She needed to go to the hospital for testing...And, referred her to counseling for anxiety. Also tried to convince her to take an anti anxiety prescription then and there which dd declined. And, prescribed something to help her sleep (she has always had sleep issues). Dd realized that she did NOT have a blood clot and ignored the referral for testing. Dd did decide to try the sleeping pills. After a few days of constant crying, not sleeping, always being tired, and not being able to think (I mean seriously not able to keep a train of thought together), she came home for a long weekend. I pointed out that all these problems started when she started taking the sleeping pill. She stopped taking it, and a couple of days later was back to her normal self and able to do her homework...She went to her allergist here and got that round of steroids which cleared her other problems up. Dh was wishing for a sleeping pill a few months later and I mentioned that dd's were on the counter. He didn't recognize the name and looked it up. It was an anti-anxiety medication. Seems the doctor sneaked it in on dd when she refused it.Well, it didn't help her anxiety level. That blood clot in her leg was resolved with a round of oral steroids too. Amazing!

My experience with campus doctors was similar. I went to the student health center after having a couple of gall bladder attacks, but at the time I didn't know that's what they were. The doctor suspected I was either pregnant or had an STD, and no amount of explaining that was impossible would convince him. I got billed for all kinds of bloodwork and tests that were completely unnecessary, and he advised me not to have sex. I was furious and never went back. I still have no idea why it never occurred to him that severe pain just below my ribs on the right side might be gallstones. I gave up on trying to find the cause and luckily I didn't have any more GB trouble until years later.

[hellen]

Sometimes I think that everyone needs an "anti-doctor" follow them to appointments. This person's job would be to hound the doctor with questions like, "What happens if we do nothing? What percent of patients get better without treatment? What are the side effects? What are all the lifestyle changes that we can try first? When you say it reduces the risk of a heart attack by 50%, do you mean that 1% of patients will have one in any given year instead of 2%? So in other words, 99% of the patients on this drug for one year will at best be 'just' wasting their money, or worse, be harmed by the drug?"

"

I went to an ENT once regarding a breathing problems in one nostril. He said it was a deviated septum. I asked how this new problem could be caused by a deviated septum I've had for years. His exact words were, "I don't know. I don't care." I was right and it wasn't a deviated septum.

 

I think most of the doctors willing to answer questions are the good ones. The bad ones deflect, lie, or sit there blankly. Actually I had one leave the room this week mid appointment and not come back so retreat is another tactic.

[Murphy101]

What scares me most is that I have a one year old to raise yet. I'd like to be healthy for the next 17 years. But it is frustrating. You do get used to the various symptoms. A month ago, my tongue started burning. It hurt to drink *water*. I cried. Kind of. I couldn't actually produce tears at that point. I couldn't imagine living a life where it hurt to drink water. But I have gotten used to it, and some days are better than others.

 

We are hoping my various symptoms are a hormonal imbalance that will eventually resolve. We don't know what would have caused the imbalance. I'd like to know if there is a root cause that we should be addressing. All of my tests have come back great, just a little off, or very off but not indicative of a problem. My doctor was aggressive when possible causes were mini-strokes, MS, lupus and other nasty stuff. Now, he would be willing to keep looking, but he has no idea where to go from here. He offered to try to get me an appointment at Mayo. I wouldn't feel right about taking a slot that should go to someone in critical condition, though.

 

OMG. GO! How do you know you are not critical? You have no idea what is causing this. For all you know this is building up to something that will be very critical and can't be fixed at that point. If he can and will get you in - GO!

[Laurie4b]

I'm always filled with unending indecision whenever something medical happens around here. Is this something worth going to the doctor for? Or not? What if I go and I've wasted all that time and money? What if I don't go and it's pneumonia?

 

I've made bad calls both ways. Took an infant to the ER with a really high fever. They gave him ibuprophen and he was fine. I should have just done that at home.

 

Didn't take a son with a persistent cough to the doctor. When I finally did, it was pneumonia.

 

I think to myself, "I'll call the office and see what they say," but they always say to come in. So, I'm left alone trying to make these calls. Sometimes I make the right choice, and sometimes like in the examples above, I make the wrong choice.

 

Did I tell you about the time the doctor gave me antibiotics for a mosquito bite that I had? True story.

 

It wears me out. I just want a clear answer. I don't want a bunch of treatment for things that aren't necessary. I want an honest opinion of whether I should come in to the office or wait it out for a few days or what signs to look for if something changes. I guess they don't have time or are scared of a lawsuit.

Yes, the doctor's office will always say to come in. However, I've found that our insurance company offers a nurse triage line. The nurse goes through a standard series of questions and then tells you if and when you need to go in. (ie within the next "24 hours" can possibly get you to Monday morning instead of a weekend call.) So I call the insurance company nurseline, see what she says, and then let that inform my judgment. (I tend to not want to go in.)

[creekland]

q

 

This doctor sounds fairly incompetent, but there are some medications that are prescribed both for anxiety and insomnia. Trazadone, for instance.

 

Good to know - thanks for posting.  I'm pretty positive I'd catch something like that if I were researching it.

 

Well, the dr figured it was anxiety keeping her from sleeping, so technically....  Only dd had refused help for anxiety because it wasn't anxiety. 

 

Technically... fun word!  Technically I won't argue that the medical stuff causes me stress.  Nothing else does though, so the solution to getting rid of the stress is to get rid of the medical stuff or learn to live with it.  I've been trying both - and it continues to slowly get progressively worse with more things.  Given time the body adjusts to more things, plus there are good days (or times within the day), so the stress level is nil (for a while) and my mind likes to think the body finally fixed itself - esp if there are a couple of good days in a row. 

 

I used to actually buy the stress story.  I don't anymore.  No one else in my family or IRL inner circle ever bought into it.

 

Such is life.

 

My experience with campus doctors was similar. I went to the student health center after having a couple of gall bladder attacks, but at the time I didn't know that's what they were. The doctor suspected I was either pregnant or had an STD, and no amount of explaining that was impossible would convince him. I got billed for all kinds of bloodwork and tests that were completely unnecessary, and he advised me not to have sex. I was furious and never went back. I still have no idea why it never occurred to him that severe pain just below my ribs on the right side might be gallstones. I gave up on trying to find the cause and luckily I didn't have any more GB trouble until years later.

 

We all knew to be very wary of our campus clinic.  Even so, my roommate went there when she had intense pain in her lower abdomen area + was vomiting.  She was told she had the flu, shouldn't party so much, and needed to go sleep it all off.  In the middle of the night I was walking out to the far parking lot where she had her car parked, finding it (not an easy task), and driving her to the local hospital.  She had multiple pretty massive kidney stones.  The partying comment was totally uncalled for.  She went to a party or two in her college career, but was absolutely never drunk.

 

I think most of the doctors willing to answer questions are the good ones. The bad ones deflect, lie, or sit there blankly. Actually I had one leave the room this week mid appointment and not come back so retreat is another tactic.

 

Ok, that's another one I would never predict...

 

If any of y'all ever have middle son in a decade or so and he were to behave this way, let me know.  My parenting instincts might still take over and I'll swat him for you!   :lol:  (Ok, so maybe not swatting him IRL, but something...  I seriously can't foresee him doing any such thing though.)

[Alice]

I started a long post but it got erased. I usually either avoid these threads or answer with some trepidation. I've been thinking about this one for the past few days. I am a big fan of Atul Gawande. I've been reading him for years, since he was a surgery resident and started writing for The New Yorker. Without defending my profession and admitting that too often our current health care system does fail patients,  I have a few thoughts to add from a blog post I wrote sort of on this topic: 

 

I think most doctors go to medical school with some idea of wanting to help people and we come out of the training process with some idea of what being a good doctor means. It means healing people, getting the right diagnosis, listening to your patients, caring for them. It means practicing excellent medicine, reading up on current therapies, practicing evidence-based medicine instead of just doing what you’ve always done.

 

I’ve been in practice for 15 years and I find that it’s so much harder than I thought to figure out how to actually do all those things in real practice. Patients often want things that I think are bad medicine. Antibiotics for colds. Unnecessary lab testing. Referrals for unproved treatments. Do I do it and keep them happy? Does a happy patient equal a good doctor even if the medicine being practiced is questionable? I’m sure doctors through history have struggled with these issues but I feel like today the added pressures of self-diagnosis by Google, doctor rating sites on the Internet, Minute Clinics in pharmacies that will almost always give the medicine the patients want, and insurance companies who are monitoring referral and testing and prescriptions makes it even more difficult to know by what standards we should measure ourselves.

I think a large source of dissatisfaction is not knowing how to know if you are doing a good job. And today it’s hard for a doctor to know by whose standards to grade themselves (and if anyone has been trained over time to care about grades and standards it’s a doctor who has been through 20+ years of schooling). Should I care that I am performing well on the insurance company’s annual report? The local hospital’s report card (yes, we get them)? My patient satisfaction level on an Internet site? How closely my practice follows the guidelines of my specialty? I don’t think any of those are good ways and it's almost impossible to do well on all of them. Keeping the insurance company happy doesn't necessarily keep my patients happy. Doing what my patients want in order to keep up my Internet ratings doesn't necessarily man I follow guidelines. I tend to measure myself by an internal barometer of sorts: Am I satisfied that I did the right thing even if the patient is unhappy? If the patient and I don’t agree on a plan, is there a way to compromise to find a solution? Do my patients respect me even if they don’t always agree with me? Have I truly listened to each person? Have I tried my best to have them walk away feeling somehow healed, even if that doesn’t mean cured?

 

One other thought, one of the most helpful things I gleaned from Gawande's Being Mortal was the idea of asking patients what would make a treatment worth it to them. This isn't something I deal with a lot in pediatrics but I think it's an important question for doctors to start asking. A simple example might be Tamiflu for the flu. I'll explain that it might decrease the symptoms and shorten the course for a day or two. So they will still have symptoms but may have less fever, less aches and be sick 4-5 days instead of 6-7. And their are side effects. Some people will say they don't wan the medicine because to them the risks aren't worth it. Others feel like getting better a day or two earlier is totally worth it. 

 

And one last thought, I do think one of the more helpful things that a doctor can do is to think of things in terms of "what would I do if this was my child (spouse, mother, etc)?" That can be a very helpful question for someone to ask to, if the doctor answers it honestly. I don't usually try to advertise my blog here but in the interest of time, here is a link to another blog post I wrote on that if you are interested. https://supratentorial.wordpress.com/2009/04/29/what-if-it-was-your-child/

Edited November 21, 2015 by Alice

[TranquilMind]

   

 

I was told the same by friends in their 50s when I was in my 40s. It's good advice, especially if you are (let's put this as politely as possible) a person who pays a smaller percentage of your income to the federal government.

 

I noticed an extremely shocking change in the way I was treated by my eye doctor and my dentist after my 50th birthday. They both needed to be fired. I'm just glad they weren't my oncologist, cardiologist, and dialysis center.

Wow.  I haven't noticed this at all BUT my dentist and my eye doctor are both in their 50's.  The dentist has to wear some microscope-looking things to do teeth but he is very good.

 

My rule of thumb is that I want a professional old enough to know what he is doing but young enough to SEE what he is doing. 

I once had a dermatologist in his 80's.  He was an awesome and sweet man, and it was an old-style office run by his wife.  I saw him until he retired. but he did need help seeing stuff!  He once said to me, "If I can't see it, I can't cut it off."  ;)

[TranquilMind]

I started a long post but it got erased. I usually either avoid these threads or answer with some trepidation. I've been thinking about this one for the past few days. I am a big fan of Atul Gawande. I've been reading him for years, since he was a surgery resident and started writing for The New Yorker. Without defending my profession and admitting that too often our current health care system does fail patients,  I have a few thoughts to add from a blog post I wrote sort of on this topic: 

 

I think most doctors go to medical school with some idea of wanting to help people and we come out of the training process with some idea of what being a good doctor means. It means healing people, getting the right diagnosis, listening to your patients, caring for them. It means practicing excellent medicine, reading up on current therapies, practicing evidence-based medicine instead of just doing what you’ve always done.

 

I’ve been in practice for 15 years and I find that it’s so much harder than I thought to figure out how to actually do all those things in real practice. Patients often want things that I think are bad medicine. Antibiotics for colds. Unnecessary lab testing. Referrals for unproved treatments. Do I do it and keep them happy? Does a happy patient equal a good doctor even if the medicine being practiced is questionable? I’m sure doctors through history have struggled with these issues but I feel like today the added pressures of self-diagnosis by Google, doctor rating sites on the Internet, Minute Clinics in pharmacies that will almost always give the medicine the patients want, and insurance companies who are monitoring referral and testing and prescriptions makes it even more difficult to know by what standards we should measure ourselves.

I think a large source of dissatisfaction is not knowing how to know if you are doing a good job. And today it’s hard for a doctor to know by whose standards to grade themselves (and if anyone has been trained over time to care about grades and standards it’s a doctor who has been through 20+ years of schooling). Should I care that I am performing well on the insurance company’s annual report? The local hospital’s report card (yes, we get them)? My patient satisfaction level on an Internet site? How closely my practice follows the guidelines of my specialty? I don’t think any of those are good ways and it's almost impossible to do well on all of them. Keeping the insurance company happy doesn't necessarily keep my patients happy. Doing what my patients want in order to keep up my Internet ratings doesn't necessarily man I follow guidelines. I tend to measure myself by an internal barometer of sorts: Am I satisfied that I did the right thing even if the patient is unhappy? If the patient and I don’t agree on a plan, is there a way to compromise to find a solution? Do my patients respect me even if they don’t always agree with me? Have I truly listened to each person? Have I tried my best to have them walk away feeling somehow healed, even if that doesn’t mean cured?

I say that "questionable" is to be decided by the person who owns the body.  Your input is certainly welcome, but if the patient has the facts and wants to try a certain treatment, let him.  It's on him. 

 

I do think that doctors who are functioning under the auspices of Big Brother (i.e. the Insurance cartel) have little time to spend with patients and are rather forced to do certain things for economic reasons.  It's unfortunate. 

 

Your guidelines are good.  Do the right thing.  Listen to the patient.  You can't do much more than that.  Do allow for patients to disagree with you, though, and sometimes, the patient will be right over time. 

[Alice]

I say that "questionable" is to be decided by the person who owns the body.  Your input is certainly welcome, but if the patient has the facts and wants to try a certain treatment, let him.  It's on him. 

 

 

But it's not always just "on him". If everyone who wants an antibiotic "just in case" it's a bacterial infection gets one, the amount of antibiotic resistance in the community goes up. That effects everyone not just the one patient. 

 

Labwork done that is unnecessary or medications ordered that are unnecssary drive up the cost of healthcare as well, effecting more people than just that one patient. 

[creekland]

I usually either avoid these threads or answer with some trepidation. 

 

FWIW, I appreciate your posting.  I've extremely little medical "anything" experience in my farther back past, a kid who has wanted to enter the field since 3rd grade (somehow he got that drive even being related biologically to me), and what seems to be a ton of figuring out how much to do (what/when/where) in my present and future both with aging itself and the lot life has thrown my way.

 

Reading different thoughts and experiences helps my brain process different aspects.

 

 

I say that "questionable" is to be decided by the person who owns the body.  Your input is certainly welcome, but if the patient has the facts and wants to try a certain treatment, let him.  It's on him. 

 

I do think that doctors who are functioning under the auspices of Big Brother (i.e. the Insurance cartel) have little time to spend with patients and are rather forced to do certain things for economic reasons.  It's unfortunate. 

 

Your guidelines are good.  Do the right thing.  Listen to the patient.  You can't do much more than that.  Do allow for patients to disagree with you, though, and sometimes, the patient will be right over time. 

 

In general I totally agree with you.  The one thing patients know better than any doctor is what they are feeling and sometimes that's incredibly difficult to convey using words - esp to someone who can't relate since they haven't BTDT.

 

But it's not always just "on him". If everyone who wants an antibiotic "just in case" it's a bacterial infection gets one, the amount of antibiotic resistance in the community goes up. That effects everyone not just the one patient. 

 

Labwork done that is unnecessary or medications ordered that are unnecssary drive up the cost of healthcare as well, effecting more people than just that one patient. 

 

But you bring up a good point.  I think it's easy for me to agree mainly because I lean the other way preferring to avoid meds unless they are undoubtedly necessary.  It's certainly not good for anyone to offer some of those without a good reason.

[Meriwether]

OMG. GO! How do you know you are not critical? You have no idea what is causing this. For all you know this is building up to something that will be very critical and can't be fixed at that point. If he can and will get you in - GO!

Well, my symptoms haven't gone away, but overall they seem a little better than they did 8 months ago. And the neurologist said the paresthesia isn't doing any permanent damage. I'm only 37, but it could be a nasty case of perimenopause. My symptoms could mostly be accounted for by low estrogen. So we are hoping it is low estrogen and my body can correct itself eventually. It could be something else, though. Many of my symptoms also indicate liver disease, but my liver enzymes were good. Not just okay. Good.

 

That is the hard thing about it. My symptoms could be accounted for by any number of things, but the tests do not seem to indicate those things. Dysuria for 9 months, diarrhea for 7, unexplained paresthesia, temporary vision changes, acid reflux, new allergies, hair loss, a resting heart rate that likes to jump around a lot, and any number of other symptoms.

 

So, according to good medicine, should we keep running tests? The tests we've had done do not indicate a serious problem. It could be something very bad. Or not. I think this is why a bunch of unnecessary tests get run. No one wants to stop looking if there happens to be something bad going on.

 

The doctor has offered several different meds for stress or other things to see if it would fix the problem. I am not comfortable with that. I think either way I go - more medical intervention or less - people would think I am doing the wrong thing.

Edited November 21, 2015 by Meriwether

[Guest]

 

 

 

ETA: I recently started taking acupuncture, eating vile supplements, and looking into other alternatives. I'm sure some of what I've done would fall under snake oil, but I feel compelled to try.

 

 

I'm ashamed to admit all the snake oil I've been taking because I couldn't handle the stress of a little girl my daughter's age rattling on and on about how she was going to

 

"educate you that you did not have to let all of your teeth rot out just because you can't remember to call your dentist every six months for a cleaning and didn't know that you needed to buy a new toothbrush if you lose the one we give you instead of just not brushing your teeth"

 

because she was too lazy and/or illiterate to look at my charts and see that I had been coming in every three months for years ever since my dentist suggested it, got my first cavity in my 30s after my $10,000+ gum surgery, and was telling the truth when I politely said, "You don't have to talk to me like that. English is my native language and also what I chose for a major in college."

 

I felt like I needed to do something besides having a panic attack and crying every time I thought about the words "tooth" and "dentist".

 

Something must have helped, though, because this has been a relatively pain free (as well as dentist free) year for the first time in recent memory and I haven't lost any teeth for the first time since before 7yods was conceived.

 

((((((Meriwether))))))))

 

37 is within the realm of normal for peri and low estrogen can have huge and unexpected effects on our health.