Does your doctor remember who you are ?

I think it is a generational thing - they got all this magic data and are taught how they should understand it rather than the clinical skills to interpet it relating to THIS patient themselves. My GP is very good about that - she won't jump on the bandwagon of "Oh, that's out of range, panic panic, panic". If it is something that can vary she repeats it to see what trend there is. I find that a lot of men are fixated on the numbers, women often are less so. Maybe it depends on the speciality though. Claudia (GP) knows that patients with arthritis and rheumatism vary a lot, blood tests are really not that useful for monitoring the course of the disease once you have a diagnosis. Unlike kidney disease or BP and stuff. 

Funnily enough, I have found the (real) cardio people I have seen very laid back - while the physicians who happen to cover cardiology when their patient turns up with it in hospital are less so. That happens a fair bit because there is a shortgage of specialist cardiologists locally and you can't always go to Bozen, it isn't practical for a minor thing. But on the whole it works - and I haven't yet had the sort of poor diagnositics I met in the UK. I'm also fortunate in having a good paramedical background so I can work things out for myself a lot of the time. Emergencies are different though.

my real cardio is really laid back!

I suspect also that acute stuff doesn't have a long time frame and shows up well with spot data - its pretty obvious from one data point that something is wrong. With chronic stuff its long time frame with slow trends or instability which makes plotting charts more worthwhile and useful. Industrial style quality control charts, with control limits, work for me. Last night's fish and chips didn't show up as anything unusual on my daily weight chart.

The medical system seems to work on "specifications" and individual samples. So the blood report from the path lab has min and max alongside each result. Height/weight has a min max. After years of industry I think in terms of variation and standard deviations and run charts and trends. Bah humbug.

In my limited view the increasing incidence of chronic in the population and a required shift from "breakdown" to "preventive" medicine requires a change in the approach to individual statistics. A change in the tools.

Probably what is needed is that medics learn something about the proper use of statistics! It is obvious from some publications that they got the department consultant statistician in and he told them how to prove what they wanted to prove! My husband has sent back papers because what they have is loads of figures - p's and confidence intervals and whatever - but what they are showing isn't particularly relevant in the great scheme of things. It's the publish, publish, publish climate which is bringing out more and more rubbish as they desperately try to up their numbers to get that next grant.

Hi Lee,

After almost 2 years I am tapered down to 4mg of prednisone. I also take methotrexate that does seemed to have helped.

it's good to hear from another spreadsheet person - I think that once the relevant data has been shown to a medical professional, they do become more concerned that they have been doing the correct scope of treatment, not only because it is of interest but they realize that the patient is closely watching them and may actually understand the disease that they are being treated for. As I mentioned before, three of my doctors (internist, urologist and rheumatologist) all sit and review the charts after I give them at the begining of an appointment and then they go into significant discussion and ask many questions. As you reference above, your data lines appear to refer to all the relevant info necessary for the particular doctor you are seeing - this is what I do and have a chart or two for each doctor.

I think that I now get the best response from doctors since using charts etc. than I have had all my life.

Have a fun holiday season and make lots of charts !

Dave

It definitely helps to make sure the doctor sees you as an intelligent human being, not just a bundle of symptoms.  I had the misfortune to be under the care of a young doctor for about fourteen months.  She did not give me test results or describe implications of x-rays because, in her own words, she thought I "would not understand them". 

Hi Tony - I disagree with you - I think that someone who is responsible for trying to identify the cause and cure for a disease that can have life imposing misery or even more serious issues should be fully cognisant of the history, current conditions and potential future activuity necessary to cure the patient.

All doctors are responsible for following the Hippocratic oath - no excuses.

Dave

I'm with you.....how can you expect your GP to remember all

the relevant info about you?  One thing though.....my mouth

works well and I can tell him what he needs to know.   I do have

a wonderful GP...he's been my Primary for about l7 years.

He's wonderful!!

No - that means they should be able to find the notes and listen to you and have a pretty good idea what to do about the current problem. As a patient with a chronic illness, so a frequent flyer, I do expect them to know who I am and what the primary problem is but NOT necessarily all the details without looking at them on the computer screen. My single-handed GP has up to 1500 patients, in the UK a practice may have 10,000 or more shared between several doctors and you do not necessarily see the same person every time. If you are there for a chest infection or the usual sort of guff one goes to the GP for, most of your history is uninteresting. I don't think you would expect a manager in a factory to know the work history of all their staff - and doctors are only human beings who know a bit more about certain things than we do.

Like Faye, my mouth works pretty well and I am an "expert patient" when it comes to me and my PMR/GCA. The atrial fibrillation is something else - I don't expect Claudia to have a handle on that, she was a rheumatologist in another life. But I do expect her to know when to send me to the hospital to the cardiologist or anyone else as appropriate. And if I have been attending at very frequent intervals (weekly say) for a time for a specific problem then yes, I do expect them to at least be orientated on why I'm there today. 

There are, however, no  doctors you will see in office-based practice who can determine the cause or cure of autoimmune disorders in general - they base their actions on what they were taught and it isn't at that level. The people who do that are in research orientated departments - usually grazing on elevated pastures!

My doctor retired literally one week before I became a (probably) more interesting patient. Took over a year to be placed with a doctor who paid attention to my symptoms as his replacement I'm sure thought I was a whining hypochondriac - one look at my chart would have shown her how seldom I had previously darkened their doors.

I guess the reason that I am 'pushing' on this issue of medical professional competency is because my wife had to have very severe surgery for an unusual cancer that was the result of incompetent review of yearly physical records and eventually pathetic excuses when another doctor made comments and made the doctor pursue the problem. The result had to be resolved by a 'super' cancer surgery specialist at UCLA medical center and now still requires yearly reviews. Action taken years before the surgery should have happened when records show the potential would have been very simple and would have only required a minor nodlue removal and bioptsy.

As you can imagine, it is hard for me NOT to review records and show doctors what I find and require them to study me and my wife in medical detail.

The interesting thing about this is that the doctors who subsequently hear about this all become very critical of the doctors who have 'errored' and their statements are "I wonder why did he/she not regularly review the patients history before or during the appointment that would have identified this issue as this is their job".

Anyway - enough - Have a fun holiday season 

Dave

We had a similar experience except - mercifully - it was weeks not years! David had a "chest infection", signified by a cough that wouldn't go away. Three lots of abx later and no change the GP handed over a peak flow meter. It was down - must be asthma, here take this inhaler. Two days later (at the weekend of course) he coughed up some blood. And again the next morning. Phoned for an appointment with the GP, nothing until the afternoon so he went to work. He happened to pass a colleague who knew he hadn't been well and on ebeing asked how he was his first response was "OK" but something sent him back to her and he told the full story. She put her hand in her pocket and wrote out a referral for a chest x-ray and told him to get over there so he'd have the x-ray for the GP in the afternoon. They did the x-ray and it was checked immediately to be sure the picture was good. They made an excuse, it was OK but they couldn't hand him the film there and then, they'd send it over later. And called the colleague. There was a massive shadow - which turned out to be a mediastinal teratoma, a rare presentation of testicular cancer. He had a bronchoscopy that afternoon, a CT next day and a biopsy 3 days later, By the following Monday it was known what they were dealing with. but there was a long weekend ahead, chemo was delayed until the Monday. Over that weekend he deteriorated markedly - I saw the expression on the oncologist's face, It was "Oh s%*&, why did I wait?". However, 21 years on he's here, deaf and daft but alive. It was an interesting year and one I never want to repeat.

All because they handed out abx indiscriminately and didn't send him for a chest x-ray before deciding it was asthma. It was appalling and they didn't even apologise. Nor for the way I and the children were ignored "David was the patient". No, the whole family is the patient in cancer and not one of them could even ask me how I was. I wanted to leave the practice - David didn't, but the following summer my daughter was the subject of their arrogance and incompetence and I left. The guy in the next village was fantastic - you'd have approved Dave, he would call in to ask how we all were when he passed through the village, and that was before David transferred to him. Hamish was the perfect family doctor - but there are not many like him. I do measure them all against him, I haven't found his equal yet but there have been a few who aren't bad. But I won't say they are not good, I will do my best to educate. 

Over on another forum I got slated a few weeks ago, by a former GP with PMR. In the 2 years they have been a member over there, there has not been a useful chunk of information and they also refused to help with one of the charities where a lot could have been achieved if they had said yes. I post - as you all know - saying what benefit may be had from Bowen therapy and I was told very nastily it was hokum, we might as well dance naked under the moon [sic]! And I got the "I'm a GP, the other posters aren't" line. The thread reached over 50 posts - at least 40 from people telling their stories about less than sympathetic/helpful doctors of all colours. Which I suppose says it all really.

its a long time ago now, about 1980. I'd not long arrived in the town at the southern tip of New Zealand. A magic place after preceding years in mining towns. Last appointment of day with Doctor at about half past four.

His wife phoned about seven to find out where he was. We'd been talking about how to protect lobster pots from corrosion. It didn't seem to matter that there wasn't a cure for whatever ailed me.

Eh, it were grand in them days. Before anyone could spell economics and we all had time for people.