A crisis of incompetence has infected the medical professions. I’m not talking about that bullshit the scientologists spew about treating your own diseased kids or that religious nonsense about not taking a life-saving blood transfusion because it will somehow steal your soul. I’m talking about the silo-fication of medical education.
Suppose you have a sore shoulder – nothing special, just a vague pain in your shoulder. If you go to a GP, you’ll probably be told to rest it for a couple of months (the ignore it and hope it goes away approach). If that doesn’t work, the doc may offer you a cortisone shot. This is a direct result of the doctor’s training: joint pain = inflammation; cortisone is a good drug for fighting inflammation.
Suppose you don’t want to get a shot, so you go to a physiotherapist. The physio ices your shoulder, puts an ultrasound on it, and then uses electrical stimulation to strengthen the muscles around it. He may give you exercises to do with bands or weights. If that doesn’t work, suppose you go to a chiropractor. The chiro will look at your spine and its relationship to your shoulders, tell you your spine isn’t straight, and adjust it. If that fails too, and you go to a massage therapist, the RMT will inspect the muscles surrounding the shoulder, find that they are too tight and compressed, and try to work out the knots.
The problem is that none of these “medical professionals” have a clue why your shoulder hurts. Instead, they look for things the kind of bodily imperfections they have been trained to treat. You may, in fact, have inflammation in the shoulder joint, weak muscles around it, tight muscles compensating for the weak muscles AND a crooked spine. However, none of these quacks knows what combination of these things, if any, is causing the pain. All they do is look for things they can fix, and assume that what they can fix must be causing the problem.
Ideally, the first person you visit should be the GP. Your GP should identify the cause of the problem and refer you to the appropriate treatment; e.g., if it’s tight muscles, go to an RMT. This, however, reveals the fundamental weakness of medical education: GPs are primarily trained to treat viral and bacterial pathology using drugs. Many of them simply cannot diagnose biomechanical ailments effectively. They don’t know who to send you to.
This problem is and will likely continue to become more pronounced in the next decade. As we continue to encourage people to become more active – to run, to lift weights, to play sports, to hike, to bike to work, to swim – people become less susceptible to heart disease, cancer and bacterial illnesses at the cost of increased minor biomechanical ailments. The occasional torn tendon, trained ligament or sore muscle is the price of protecting ourselves from the obesity and muscular atrophy that threatens our lives overall. Healing these minor biomechanical ailments is an integral part of caring for the populace and making exercise more pleasurable and sustainable.
The increasing importance of treating biomechnical injury, therefore, makes improvements in the training of GPs imperative for a healthy society.
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education essay health |
Here’s an analogy that i heard somewhere. (i forget where)
There is a small dripping of water coming from the ceiling. The house’s owner puts a cup under it to collect the water so it doesn’t cause more damage. A few days later, there are two different areas dripping water. So they put two cups. The dripping gets more and more frequent and they keep adding more and more cups. They completely ignore the cause of the problem – the leaking roof. Instead of fixing the roof, they stop the water from flooding the floor with cups. It was worded better when I originally read it but I think I got the point across.
It’s the same as treating all the little pains with drugs rather than fixing the underlying cause, which is what our health care system is based on. The cause of most health problems, from chronic fatigue, upset stomach, diabetes, and heart disease, is generally due to so many people being lazy, out of shape and eating junk food full of sugar and chemicals.
@Kavan – I have something to say on this subject, but I was wondering, how does getting medical treatment in Canada REALLY work? What I mean is, here in the US, by the time we’ve reached the chiropractor stage (in your example) we’ve had to take out a second mortgage on our home (assuming we still have it) and will probably say fuck it and not get any help at all (even some people with insurance)
@H – “The cause of most health problems, from chronic fatigue, upset stomach, diabetes, and heart disease, is generally due to so many people being lazy, out of shape and eating junk food full of sugar and chemicals.”
Ah, but the doctor can’t fix that shit for you, and there’s no money to be made in a healthy you.
Slightly off topic, doctors prescribing placebos. Is is just me, but if they’re charging money for it, isn’t that fraud (like a fucking felony)?
It’s an old article but it still pisses me off.
http://www.time.com/time/health/article/0,8599,1700079,00.html
@H- I said “there’s no money to be made in a healthy you.” , a possible exception being insurance companies.
@H, I hear what you’re saying, but I’m really focusing here on the kind of ailments that afflict active, generally healthy people, like myself, and what the treatment of those ailments indicates about the state of medical education.
@Rick, in Canada, you don’t have to pay to see a doctor or for any procedure done in a hospital. Basically, if you’re sick enough to be admitted to hospital, your stay, including treatment, drugs, bed-space, surgery, tests, etc. are all covered. Over-the-counter medicine, drugs you take at home and things like physio, massage, and chiro are not free, but most people have medical insurance that covers some or all of their cost. If you are married and both you and your spouse have insurance, often part of the cost is covered by one and the rest by the other. Long-story-short, medical care is not entirely free in Canada, but it’s affordable for most employed people. The downside is, wait times for medical procures are often quite long.
The fact that you being healthy doesn’t make anyone money is one of the many reasons that leaving healthcare to the free market is insane.
The reason I asked is because in your system there should be no financial benefit for a doctor practicing “shotgun” medicine ( or trial & error). In the US, especially smaller towns, repeat business accounts for a significant portion of the bottom line (I’m talking about GPs). If this doesn’t work come back and we’ll try this, that, and the other. Of course every time you step in his office it’s more money.
I was hoping to hear that in Canada this issue would be generally associated with the less experienced GPs. To me a GP is a lot like a IT tech ((on a much grander scale)). I mean he does front line, basic body troubleshooting; as such, I would think the more experience the better. You know, “been there, done that”.
After all, education (no matter how intense) can’t cover all possible real life scenarios. Although, IMO, this is a field were continued education is a must.
Also, I think physicians should be required to take the class (annually) “How not to be an Arrogant, Obstinate, Asshole”.
@Rick. You are right about the anual class. In my part of Louisiana, we have a US. Representtative who is a Family Practice doctor, basically a GP. He is a Republican. I find that a bit ironic.
@Rick, unfortunately, Canadian GPs are paid per client visit, so there is still a financial incentive for them to practice shotgun medicine, as you call it. Regarding education vs. experience, GPs may be unlikely to learn through experience because of their inability to identify causality. Who knows weather (correction: whether) patient X got better because of the prescribed treatment, some other action, or simply the passage of time.
But I’m with you on the required class.
@SFC Rath, ‘Republican doctor’ is indeed a scary concept, but ‘Creationist doctor’ is truly terrifying. Seriously though, in “The Shock Doctrine,” Naomi Klein describes a doctor in a private hospital in New Orleans during the Katrina disaster who was so brainwashed that he didn’t see the poor blacks as patients. It simply never occurred to him go help them. Instead, he sat in a private hospital where there were hardly any patients, twiddling his thumbs.
@Kavan – “Who knows weather patient X got better because of the prescribed treatment, some other action, or simply the passage of time. ”
That’s a good point.
In the doctor’s defense, he/she does need to know your complete history before he/she can really make a decision.
Ie, Do you play any sports? If you don’t normally do sports but you just did a few days ago, that would narrow down the problem. If you do play sports, the kind of sports you play could also narrow down the cause of your shoulder pain. However, sports is just the obvious question. Sometimes the causes are more obscure, and if you don’t give your GP the proper information, they can’t diagnose you properly.
A personal example: a few months ago, my left wrist started hurting whenever I put my hand in my pocket. I’ve never had this issue before, and after some experimentation I realized that it would hurt whenever I bent it. There was no inflammation and no discoloration. After a few weeks, I went to see the doctor. After a brief discussion, she told me that the cause of my wrist pain was the compression of one of my nerves when I was resting my elbows on a workbench. She suggested I either stop learning on my elbows when I was working for long periods of time or take frequent breaks. The pain gradually disappeared. Her diagnosis and her suggestion were both very specific, but she was only able to be so specific because of something minute but crucial that I told her that went CLICK in her mind.
My point is, when a GP mis- or is unable to – diagnose you properly, it may not be due to a lack in training, but due to a lack of proper communication. The doctor I saw was only able to diagnose me because I offhandedly mentioned that sometimes my arm would feel numb after I worked for periods of an hour or more.
The increasing number of activities we participate in on a daily or weekly basis only complicates the matter more for the poor GP.
@ PIE, I agree that a GP needs the right information to accurately diagnose problems. However, this only implies that a GP’s training should include patient communication and information gathering techniques. The patient cannot be expected to know what information is relevant, so the GP should know what questions to ask. In your example, the GP could have referred you for a nerve conductivity exam, which would have confirmed her hypothesis.