Comments on: The Crisis of Competence in the Medical Professions

By: Kavan Wolfe

Kavan Wolfe — Fri, 20 Feb 2009 18:10:59 +0000

@ 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.

By: PIE

PIE — Fri, 20 Feb 2009 10:16:39 +0000

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.

By: Rick

Rick — Fri, 20 Feb 2009 01:48:23 +0000

@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.

By: Kavan Wolfe

Kavan Wolfe — Thu, 19 Feb 2009 23:57:28 +0000

@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.

By: SFC Rath

SFC Rath — Thu, 19 Feb 2009 21:48:28 +0000

@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.

By: Rick

Rick — Wed, 18 Feb 2009 22:58:51 +0000

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”.

By: Kavan Wolfe

Kavan Wolfe — Wed, 18 Feb 2009 21:01:55 +0000

@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.

By: Rick

Rick — Wed, 18 Feb 2009 17:28:55 +0000

@H- I said “there’s no money to be made in a healthy you.” , a possible exception being insurance companies.

By: Rick

Rick — Wed, 18 Feb 2009 17:08:50 +0000

@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

By: H

Wed, 18 Feb 2009 01:47:13 +0000

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.