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healthy vs not sick and symptom suppression
#51
(05-04-2015, 10:32 AM)player Wrote: Is upping the pressure pretty much all you can do?

Not at all, but in my case, it was enough - there are many possible ways to tweak your treatment, but you do have to first be cognisant of why you are having whatever results you have. What I was more trying to get at is that it is not enough to look at a number as a gestalt, when it is made up of a number of pieces and complex interactions. AHI is just part of a larger picture, and although we do use it as the measure of success or failure of the treatment, it remains within the treatment scheme, insufficient to fine tune treatments based on that number alone.
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#52
(05-04-2015, 03:50 PM)PaytonA Wrote: Many people seem to view the word argument as meaning a heated disagreement.

Many people also seem to think of arguing as a negative thing. Lawyers argue cases before the Supreme Court. Sometimes those arguments can get heated. They usually involve a disagreement.

In the context of this discussion, it's the disagreement that's key. Doctors will disagree over the implications of new evidence. What does it mean? Arguments will ensue, including disagreements, and even sometimes heated disagreements. When it's followed by consensus it leads to advances that save lives and improve the quality of life for a lot of people. Usually new evidence must come forth to settle these arguments, and it's these arguments that lead to new research that gives us new evidence that leads to consensus. It's part of a process.

Many people think that doctors and other scientists simply accept what they learn from others and follow it dogmatically. Like a cult where no one is allowed to argue.
Sleepster
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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#53
(05-04-2015, 08:13 PM)Sleepster Wrote: Many people think that doctors and other scientists simply accept what they learn from others and follow it dogmatically. Like a cult where no one is allowed to argue.

Definitely not true, but we are taught to be dispassionate when superior data is presented, but of course we do demand that all aspects of the data be superior, not just the numbers, but how it was gathered, the sampling size, etc.

In the context of medicine, these days it is very much evidence driven and because of that, we tend to look at the evidence very closely but happily put aside our old beliefs when the evidence is overwhelming - one small example is my GP (bless him and may he live many more years) - he is very old school (as he should be at his age, which is well past second retirement for most people) - he and I had an ongoing discussion as to the benefits of daily aspirin - for years he did not advocate it for most of his patients, because of the risk of internal bleeding and the fact that there was at the time a good theory but not enough evidence to support the idea - last year the numbers came through in a real big way - the final nail in the coffin, so to speak. He did not so much as shrug - he turned to me, said I was of a certain age, and wrote out a script. End of story. So, arguments aside, when the evidence is there, we accept the findings.

And now, I'd like an argument please - just the 15 minute version.....

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#54
(05-05-2015, 06:21 AM)DocWils Wrote: And now, I'd like an argument please ....

I'm sorry - you've already had it. Smile
Disclaimer: The 'Advisory Member' title is a Forum thing that I cannot change. I am not a doctor and my comments are purely my opinion or quote my personal experience. Regardless of my experience other readers mileage may vary.
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#55
(05-05-2015, 06:21 AM)DocWils Wrote:
(05-04-2015, 08:13 PM)Sleepster Wrote: Many people think that doctors and other scientists simply accept what they learn from others and follow it dogmatically. Like a cult where no one is allowed to argue.

Definitely not true, but we are taught to be dispassionate when superior data is presented, but of course we do demand that all aspects of the data be superior, not just the numbers, but how it was gathered, the sampling size, etc.

We come at this from different perspectives. You're a practicing physician, I'm an educator. Many people have a fundamental misunderstanding of science in general and medicine in particular. The knowledge that we have is not stuff we memorize from books written by know-it-alls. It's hard-won through a process of evidence-gathering, experiment-design, and debate. People who dismiss medical advice, for example, because they know of cases where the accepted wisdom turned out to be wrong, could be in grave danger of harm. And it would be one thing if they kept their stupidity to themselves, but unfortunately they spread it around like a disease. Some go so far as to create schools so that other people's children don't have to be exposed that kind of "learning".

Quote: - he and I had an ongoing discussion as to the benefits of daily aspirin - for years he did not advocate it for most of his patients, because of the risk of internal bleeding and the fact that there was at the time a good theory but not enough evidence to support the idea - last year the numbers came through in a real big way - the final nail in the coffin, so to speak. He did not so much as shrug - he turned to me, said I was of a certain age, and wrote out a script. End of story. So, arguments aside, when the evidence is there, we accept the findings.

You had a series of arguments that eventually led to consensus! Both of you, and your patients, are the better for it.

Quote:And now, I'd like an argument please - just the 15 minute version.....

I'm sorry, your 15 minutes is up. If you want to continue to argue you'll have to pay for another 15 minutes.
Sleepster
Apnea Board Moderator
www.ApneaBoard.com


INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#56
(05-06-2015, 08:41 AM)Sleepster Wrote:
(05-05-2015, 06:21 AM)DocWils Wrote:
(05-04-2015, 08:13 PM)Sleepster Wrote: Many people think that doctors and other scientists simply accept what they learn from others and follow it dogmatically. Like a cult where no one is allowed to argue.

Definitely not true, but we are taught to be dispassionate when superior data is presented, but of course we do demand that all aspects of the data be superior, not just the numbers, but how it was gathered, the sampling size, etc.

We come at this from different perspectives. You're a practicing physician, I'm an educator. Many people have a fundamental misunderstanding of science in general and medicine in particular. The knowledge that we have is not stuff we memorize from books written by know-it-alls. It's hard-won through a process of evidence-gathering, experiment-design, and debate. People who dismiss medical advice, for example, because they know of cases where the accepted wisdom turned out to be wrong, could be in grave danger of harm. And it would be one thing if they kept their stupidity to themselves, but unfortunately they spread it around like a disease. Some go so far as to create schools so that other people's children don't have to be exposed that kind of "learning".

Yes. I have encountered that more than once, alas, even here. Also religions that deny science to the point that they endanger the lives of their practitioners.

BTW, not to be grim, but as I teach my students, we come to our knowledge through people snuffing it through our errors. Our trial and error (evidence gathering and experimentation) process is deadly. That's why I remind them that they will all kill at least one person within their careers. Not comforting for patients to hear, I know, but even with all the science, it happens - one reason why second opinions are so important, and why I prefer a hospital environment, since their is almost always at least one other person looking over your shoulder. What you may miss, they will catch, and even though Chiefs of Medicine and department heads can be martinets and you dare not cross them, I tell my students to dare, nonetheless, because they might save a life.

(05-04-2015, 08:13 PM)Sleepster Wrote:
Quote: - he and I had an ongoing discussion as to the benefits of daily aspirin - for years he did not advocate it for most of his patients, because of the risk of internal bleeding and the fact that there was at the time a good theory but not enough evidence to support the idea - last year the numbers came through in a real big way - the final nail in the coffin, so to speak. He did not so much as shrug - he turned to me, said I was of a certain age, and wrote out a script. End of story. So, arguments aside, when the evidence is there, we accept the findings.

You had a series of arguments that eventually led to consensus! Both of you, and your patients, are the better for it.

In German and French, we had discussions, not arguments, so I can see where the misunderstanding lies in this. Language differences and subtleties. In his and my case, the discussions were jovial and laced with laughter, even when we are serious with each other - we like each other, and I can count him as a friend, even though we don't socialise much outside of his office or at the retirement home where we both look in on patients (he for GP stuff, me for ortho).

(05-04-2015, 08:13 PM)Sleepster Wrote:
Quote:And now, I'd like an argument please - just the 15 minute version.....

I'm sorry, your 15 minutes is up. If you want to continue to argue you'll have to pay for another 15 minutes.

But I just paid!
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#57
(05-06-2015, 10:02 AM)DocWils Wrote: In German and French, we had discussions, not arguments, so I can see where the misunderstanding lies in this. Language differences and subtleties. In his and my case, the discussions were jovial and laced with laughter, even when we are serious with each other - we like each other, and I can count him as a friend, even though we don't socialise much outside of his office or at the retirement home where we both look in on patients (he for GP stuff, me for ortho).

The arguments I refer to are often jovial, and usually respectful. But I have seen them escalate to shouting matches. Usually the shouting itself is not mean spirited, but sometimes it is.

Quote:But I just paid!

No, you didn't.
Sleepster
Apnea Board Moderator
www.ApneaBoard.com


INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#58
(05-06-2015, 09:07 PM)Sleepster Wrote:
Quote:But I just paid!

No, you didn't.


Yes I did! Look, if I didn't pay you wouldn't be arguing with me now, would you? Aha! I've just run rings around logically!
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#59
No you didn't!
Sleepster
Apnea Board Moderator
www.ApneaBoard.com


INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#60
Yes I have! If you're arguing, I must have paid.
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