(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.