(01-10-2013, 11:31 AM)Shastzi Wrote: Sounds like you need a 2X4 to get their attention first.
...oh my, did I type that out loud?
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Why don't medical professionals listen?
05-20-2013, 07:53 AM
(01-10-2013, 11:31 AM)Shastzi Wrote: Sounds like you need a 2X4 to get their attention first.
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05-20-2013, 05:09 PM
Should I start a thread with why don't patients listen? And why they often think they know more about medicine than we do? And no matter what you do for them, they still don't take an active hand in their health management so that when something goes wrong that was preventable, they blame the medical professionals? And no matter what we do to help them to get better, they don't follow the instructions and never finish the course of treatment (one of the biggest reasons you Americans have so highly anti-biotic resistant bugs isn't the over prescription of antibiotics but the patients never finishing the course of treatment, just to give an example - it is less of a problem here (although growing) because we don't' prescribe as many antibiotics on the whole).
So WHY DON'T PATIENTS EVER LISTEN?
(05-20-2013, 05:09 PM)DocWils Wrote: (one of the biggest reasons you Americans have so highly anti-biotic resistant bugs isn't the over prescription of antibiotics but the patients never finishing the course of treatmentSuperbug fears in antibiotic overuse
AUSTRALIANS spooked by the swine flu pandemic have driven a rise in the use of antibiotics in the past two years, undoing the work of health campaigns and prompting concerns about the rise of so-called superbugs.
Doctors dispense 22 million prescriptions each year, and Australians are estimated to be among the highest users of antibiotics in OECD countries.
NPS Medicinewise, a federally funded body promoting health education, says about 3 million of those prescriptions are wasted on viral infections.
Antibiotic prescriptions dropped during an NPS awareness campaign about treating common colds which ran in 2006-08, but they rose again in 2009 after the outbreak of swine flu.
The NPS is planning to renew its campaign early next year and the World Health Organisation has put antibiotic resistance on the agenda for World Health Day next month.
One of the reasons world health experts believe antibiotic-resistant bugs are increasing is because of the misuse of antibiotics by doctors and patients.
The Australian Institute of Health and Welfare identified over-prescribing of antibiotics for upper respiratory tract infections as one of its key challenges in its report last year into Australia's health.
Peter Collignon, professor of infectious diseases and microbiology at the Australian National University, said part of the problem was patients expecting a quick fix.
''People expect to get a drug to fix their problem. In fact, they probably just need to accept the fact that they have a virus and they just need to rest.''
Ronald McCoy, spokesman for the Royal Australian College of General Practitioners, said that although the use of antibiotics had dropped proportionally over the past 15 years, doctors still needed to be wary of prescribing unnecessarily.
''We have to get even smarter and stricter,'' Dr McCoy said.
Andreas Heddini, the executive director of the Swedish group Action on Antibiotic Resistance, believes antibiotics could be put in the same class as narcotics to reduce unnecessary prescribing. He compared the global increase in antibiotic resistance with climate change, requiring a similar international strategy.
''It's a global problem with no easy solutions,'' Dr Heddini said.
The use of antibiotics as a growth promoter in agriculture was also contributing to growing resistance.
Read more: http://www.smh.com.au/lifestyle/diet-and...z2TsVXUfBz
*sigh* I do wish that actual medical people would write these and not journalists, who are so good at reporting half the story and twisting it to fit their needs. And then influencing people like friend Zonk here. What is reported above is what we in the science world call Lies to Children - it is not really true, but it gives a good general idea while thoroughly avoiding an understanding of the real intricacies of the subject. Remember once I said basic sleep medicine isn't rocket science?* Well, immunology is.
Overprescrition is in itself not the problem, which has been demonstrated time and again in the literature. Because of overprescrition, the normal problem of patients NOT finishing their course of anti-biotics, the result of which is the bug it was meant to combat is not eradicated, it develops a resistance to the antibiotc, and if enough people do that, such bugs spread and the problem of resistant bugs become acute (and for those evolution deniers, well, there is evolution in action, real fast). But the point about the quick fix is true, and the Aussies are catching up with the Amis in resistant strains. Because of air travel, the resistant strains get spread around the world, and that creates pandemics. And prescribing antibiotics for virus is just dumb, and often easily avoided by simple blood tests before prescribing. However, using antibiotics on a virus infection won't normally aid in developing a strain of antibiotic resistant bacteria. I will waste a dose of the stuff, though, and compromise the immune system of a patient, opening them potentially to other opportunistic infections.
*not in any way denigrating those in the medical profession that have chosen to follow sleep medicine as a career path. Sleep medicine can be incredibly interesting and intricate, but the basic medical understanding of how apnoea works is relatively simple in comparison with immunology or certain other branches of medicine. That said, my first speciality, surgery, is even simpler - basically it is plumbing and carpentry with some metal shop and tailoring thrown in for good measure. You gotta like cutting things and hammering them and then sewing them back up. Jocks with a prissy streak, basically. Compared to that, sleep medicine is rocket science. Sort of.
05-20-2013, 11:34 PM
(05-20-2013, 05:09 PM)DocWils Wrote: Should I start a thread with why don't patients listen? And why they often think they know more about medicine than we do? And no matter what you do for them, they still don't take an active hand in their health management so that when something goes wrong that was preventable, they blame the medical professionals? And no matter what we do to help them to get better, they don't follow the instructions and never finish the course of treatment (one of the biggest reasons you Americans have so highly anti-biotic resistant bugs isn't the over prescription of antibiotics but the patients never finishing the course of treatment, just to give an example - it is less of a problem here (although growing) because we don't' prescribe as many antibiotics on the whole).
Wow! Do you realize how many times you stated or implied that every patient exhibits those negative characteristics that are exhibited by some patients? If I had that attitude towards the customers I serve I'd be a very depressed person and would likely seek some other way of making my living.
I'm a patient. I can tell you for sure that I've listened, have finished courses of treatment, taken an active role in my treatment, and haven't blamed doctors for things that can be prevented by my actions.
I know I'm not the the only one.
And I know when I've found a doctor who doesn't put me in the category that you seem to be putting your patients in.
You should post a copy of your message on your office door so patients will know ahead of time just what you think of them.
Apnea Board Moderator
05-21-2013, 05:29 AM
(05-20-2013, 11:34 PM)Sleepster Wrote: Wow! Do you realize how many times you stated or implied that every patient exhibits those negative characteristics that are exhibited by some patients? If I had that attitude towards the customers I serve I'd be a very depressed person and would likely seek some other way of making my living.
And do you realise how many times throughout this thread that it was implied the same of all medical professionals. Event the title says it! We're all bloodsucking, arrogant buggers who don't ever listen or do what the patient wants, which is what I have heard throughout this thread! Nice you can dish it out but can't take it. We're here to help, so give us a break.
And by the way, a lot DO seek other professions because of depression from this problem. Suicide is also extremely high in our profession. Medicine isn't for everybody and quite a few who think they would like it are severely disappointed. Medical professionals work under tremendous pressure to help people, usually with longer working hours than most outside the profession (100 hours or more a week is hardly unknown for us) and yet we try our best to help, given tremendous time pressure and the difficulties in fathoming what is really wrong with the patient, often not at all what they say is wrong. No, not every patient is like that, I have a lot of good patients, and fantastic relationships with some of them, but I get tired of the constant diatribes against us when there are only a few who don't provide the service as the patient desires it, and often enough, it is because the patient expects something that cannot be delivered. So stop tarring us all with the same brush!
We ask the questions again from the questionnaire because a patient history is not the same thing as what goes on the form, and "House's Rule Number One" is patently true - every body lies, even if they don't know it themselves - they see the problem from their own filter, and we need to cut through the filter to get to the meat of the problem. That is why we always do a thorough history no matter what is filled out on the form. We need it, and we need time to consider what is being said, which nine times out of ten is not the same thing as has been filled out on a form by the patient - that is just the guide into the problem and it is the difference between what is written down by the patient and what they say during the history that gives us the clue. The form, BTW, is only given for the initial visit - we don't repeat the form each time you come to us, at least not here in Switzerland. If they do in the US, it is either due to insurance purposes or due to another methodology, maybe a better one.
We sometimes make quick decisions, sometimes under time pressure and sometimes because of over familiarity with some aspects of a symptom. We don't always get it right. But we do more often than not. For all the science behind medicine, it is still mostly intuition and repetitive pattern matching. We are detectives who have to process an average of fifty mysteries a day (if you are a GP in a normal practice, up to twice that if you are a hospital specialist or internist). Sometimes we overlook something the patient is telling us because we are so focused on the problem solving that we miss an added detail. It happens. But more often it is the patient not providing us with sufficient information or not communicating it in the right way for us to grasp the significance of it.
In medical jargon we have a scale for pain, for instance, and around thirty different types of pain. This helps us to cut through the nebulosity of the symptom and get to a core. But patients aren't medical professionals, so they don't know these terms or the scale - they don't say "I have crepitus in my right leg near the tibial tuberosity, scale 5" - they say it hurts around the knee. So we have to ask questions and probe around until we can get it more precise. Now that one is easy, but daily I get far more complicated and shrouded complaints, and if I can't immediately see what they mean (and how can I? I can't feel what they feel) I am accused of not listening or padding the bill by ordering unnecessary tests, but I can only go on what the patient gives me. And often they are giving me a miasma of feelings that I may cut through in the wrong direction because they put emphasis on the wrong symptom. So we have a pretty tough job.
We DO listen. But not all patients are telling us what we need to know in a way that we can process. And the next ten patients are waiting. We're hardly perfect, and very few are saints (I do know one or two that are, but most - meh...), but we aren't in this for the money, believe me. There are way easier methods to earn a big buck than medicine, at least over here. We are in it because we want to help people, and I suspect, most of us are mystery buffs underneath it all. We like to solve puzzles (except for surgeons - they like to cut and bang things, and work with their hands - and they have deadened senses of smell - if they didn't, they couldn't be surgeons, given the intense and amazingly awful smells the insides of a human body gives off). So give us a break, we're trying. I hope you are trying too. Before you say we don't listen, check to see that you have carefully and correctly communicated to us the problem. We do try to listen.
I like most of my patients. I even usually can have a good laugh with them, and some are absolute delights. I enjoy meeting people and sharing in their lives. But some, more than you would suspect, simply don't listen back, or only half hear it. I learned long ago to avoid jargon with patients and try to communicate a carefully as possible, often with Lies to Children when necessary, as the only way to explain immensely complex concepts in a way a layman could understand, but it doesn't always succeed, and sometimes the patient takes in less than half the important information (one reason, BTW, why pharmacists here not only write the instructions on the label but careful explain the treatment course again to the patients), they get the instructions three times, but still statistically only 63% finish the course of treatment because they "feel better" halfway through it or don't like the side effects (I have a better average amongst my patients, but those are the stats in the literature. My stats are around 72% and I have had people come and sit in on my patient sessions to observe what I am doing right). For some treatments, that is fine, for antibiotics, it ain't. I prefer to avid prescribing drugs unless absolutely necessary. Often there are simpler ways to fix a problem, and herbal and alternative remedies work in many cases (Switzerland is a bit different that way - we do prescribe herbal cures and the like; I will prescribe baldrian (valarian) long before I will suggest a sleeping pill like Ambien (or the equivalent - Ambien isn't sold here)).
Please note I am only speaking of the the diagnostic and therapeutic medical profession here - DMEs and the like I cannot guess at. Different world, I suspect.
06-08-2013, 05:18 PM
(05-20-2013, 05:09 PM)DocWils Wrote: (one of the biggest reasons you Americans have so highly anti-biotic resistant bugs isn't the over prescription of antibiotics but the patients never finishing the course of treatment, just to give an example - it is less of a problem here (although growing) because we don't' prescribe as many antibiotics on the whole).
I think our beloved corrupt agricultural system has a lot to do with it as well.
Many farmers in the US feed large quantities of antibiotics to well animals because it makes them gain weight faster. The government knows it causes the growth of superbugs, but the farm lobby and the agricultural pharmaceutical lobby pay large bribes to congressmen and regulators.
Every so often some honest bureaucrat tries to do something about it and they suddenly find themselves transferred to an unimportant new post in the backwoods of Alaska.
Welcome to the USA, where we have the best government money can buy.
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