Latest Diablo 3 News
DiabloWiki Updates
Support the site! Become a Diablo: IncGamers PAL - Remove ads and more!

How much do doctors truly know?

Discussion in 'Off-Topic' started by Dutchman, Mar 21, 2005.

  1. Dutchman

    Dutchman IncGamers Member

    Joined:
    Jun 22, 2003
    Messages:
    1,726
    Likes Received:
    2
    Trophy Points:
    347
    How much do doctors truly know?

    I spent a wonderful weekend in the hospital with my son and the myriad of doctors we encountered has left me wondering what doctors truly know, what value they truly possess?

    I reserve this question for those who diagnos, not surgeons. Surgeons do something, surgeons take a responsibility in their hands, a great responsibility, their value remains clear to me. I don't mean to disparage, I remain simply curious as this is something I have never thought about before.

    My son was having trouble breathing, so we took him to a walk in clinic on saturday morning where we saw a young doctor who I presume was in his late 20's, and looked about 14. Not sure if his looks are relevant, but I mention them as perhaps they contributed this this new line of questioning thinking. He noted the breathing, the lack of a temperature, the seal like barking cough, and suggested croup was the likely cause, a very bad case of croup. Take him to the ER he said, they will give him a mask and he should feel better instantly. I got the thinking, what has this man done? He recognized some systems he had read about, and inferred an illness from there. He has read something I have not. It was an interesting thought.

    Off to the ER, of a hospital slightly farther away than the closest, as the closest one is insanely busy and pretty run-down.

    They take a look at him, and give him a mask of some stuff or another. His breathing fails to improve. Another mask of something else, no result. Chest x-ray (The contraption used to give children a chest x-ray is something to behold, looks like something you would find in a dungeon. Lungs look reasonable, though perhaps a tiny bit cloudy on one side. Cloudy lungs, books says possibly pnemonia. As not overly cloudy he gets 2 more masks, little, if any, improvement. No pediatrician at this hospital, transferred by ambulance back to the closest hospital (Love the irony).

    New doctor looks at him, sees the same things, more masks, and what the hell, some antibiotics. We stay overnight for some more masks periodically and regular doses of anti-inflamatories and antibiotics.

    Doctor tells me that they really aren't sure what he has, could be a really really bad case of croup, or a slight case of pnemonia. Since they don't know they'll treat him for both, plus the anti-inflamatories and anti-biotics could cure a host of other things anyway so what the heck.

    He's improved quite a bit, and was never in any real danger, he wasn't even slowed down, kept on playing, kept eating normally, just wheezed like a bellows.

    This whole experience got me thinking about what these types of doctors really do, what they really know. They bascially have in their heads a host of information about symptons and diseases, particularly common ones, and look for telltale signs. They then prescribe standard treatments also documented in many books. When they don't know, they have hosts of info available to reference, and hosts of drugs handy which treat a myraid of things whether they know what they are or not. Per the last doctor, they know these treatments won't cause harm, so they'll do them anyway.

    There is certainly a value, my son was sick, now he is less sick, but what about a doctor makes them more than a person who has read a lot of stuff, who had access to a vast medical library? How are these people of any more value than someone with a good memory? They do not take a knife to someone, they do not research new material for those vast databases of info, they simply regurgitate what others have already discovered. They apply knowledge, and not necessarily overly technical knowledge. A complicated brain problem goes to the neuro guys, a complicated heart problem goes to the cardiolgist. They are the setters of simple breaks, the specialist handles the shatters.

    Is the generalist physician any more valuable than the tax accountant? They both know a lot of info, they both can reference what they do not know, neither one handles life and death. The generalist has the specialists for life and death, for the accountant it is simply outside their purview.

    I'm not passing judgement, I'm genuinely curious.

    Dutch
     
  2. Necrolestes

    Necrolestes IncGamers Member

    Joined:
    Jul 23, 2003
    Messages:
    1,904
    Likes Received:
    0
    Trophy Points:
    165
    The doctor is in

    There's no substitute for experience. Medical texts only present the most common presentation and may list atypical presentations of diseases, disorders, and syndromes, but not all presentations of every condition. Some diseases present like other diseases yet sometime the treatment is different (case in point: ulcerative colitis can resemble Crohn's disease; both can be treated with mesalamine or 5-ASA but there's one modality that can be used for ulcerative colitis that is contraindicated in Crohn's disease and this treatment is nicotine; also, some cases of Crohn's disease won't respond to mesalamine, particularly in patients who are missing the terminal portion of their small intestine which is where the mesalamine is broken down to the active drug sulfasalazine, but as ulcerative colitis never involves the ileum, mesalamine can ALWAYS be used). If you didn't ask a doctor who had seen this before, and relied solely on a textbook, you might well kill the patient.

    The whole reason behind medical texts is to assist the doctor, to point them in the right direction, and to standardize treatment. A well-read person might know more facts than a practicing physician, but how many patients has the well-read person seen? How many different presentations of flu have they observed? Do they know how to relate to the patient? Can they sympathize with the patient? It is questions like these that separate the consultant from the physician.

    Someone who is well-read would assume that the seal-bark cough indicated croup and as that is the textbook sign of croup, that would probably be their diagnosis (the odds ARE in their favor). Croup would certainly be in my differential diagnosis, but without a chest X-ray, I wouldn't definitively say that the patient had croup. The patient could have pneumonia or an acute asthma attack (my mother has asthma and at times, she vocalizes a seal-bark cough...an atypical presentation but one that I recognize from experience and not a textbook) instead of croup and the treatment for those conditions differs from that of croup. But if you don't do more than take a textbook symptom of a disease, you are not making a diagnosis: you are making an educated guess.

    There is no substitute for experience.
     
  3. Dutchman

    Dutchman IncGamers Member

    Joined:
    Jun 22, 2003
    Messages:
    1,726
    Likes Received:
    2
    Trophy Points:
    347
    Quick question Necro, would any of the items you mention, where similar symptoms indicate the same disease, with potentially negative consequences from various treatments, ever get treated without first seeing a specialist. Does the generalist ever make those calls?

    I'm reminded of the early days of my career, working in a branch. People would ask for the manager, and my job was to try and handle their issue rather than just passing them on to the manager. Am I akin to the generalist doctor, first contact who handles the stuff I think I know, doing nothing outside my experience where a screw up might cause harm, and passing the client on if I don't know what to do next and don't want to risk damage?

    If these folks are really a first line of defense, are they as valuable as the experts?

    Again, I'm curious, not passing judgement.

    Dutch
     
  4. Necrolestes

    Necrolestes IncGamers Member

    Joined:
    Jul 23, 2003
    Messages:
    1,904
    Likes Received:
    0
    Trophy Points:
    165
    General specialization

    In some cases, generalists dictate the course of treatment. In other cases, it is better to let the specialists handle it. For UC and CD, you let the gastroenterologists handle it. For croup or pneumonia, you can let specialists help you but it is up to the generalist to treat those conditions.

    A generalist has to determine whether or not a specialist is needed. Just like a carpenter has to decide which nail to use for a certain project, a generalist must come up with a provisional diagnosis (to either determine treatment by the generalist or which specialist to send them to).

    Here's one instance of when you absolutely need a generalist before you need a specialist: pseudoappendicitis. This is a condition that appears to be simple appendicitis (it is a near perfect mimic for that condition) and therefore would be a candidate for surgery. However, with pseudoappendicitis, the appendix is perfectly normal and the problem lies with an infection of the gut by a bacterium called Yersinia enterocolitica. By taking a careful history, the generalist may be able to determine that the appendix is not the cause of the pain and that something else is at play here. If you sent the patient on to the surgeon without a history, they may have a perfectly healthy appendix removed. With the generalist's help, you've not only saved an appendix but a patient's life as well.
     
  5. Dutchman

    Dutchman IncGamers Member

    Joined:
    Jun 22, 2003
    Messages:
    1,726
    Likes Received:
    2
    Trophy Points:
    347
    So in general (if you'll pardon the pun) do you consider the generalist to have as much value as the specialist. Do you place equal importance on the family doctor, the ER doc, the ER pseudo specialist (Ie. Pediatrician) on call, all the way through to the neurosurgeon or any specialist?

    It would seem you do, just want to be sure.

    Even with the funky appendix case, is it not in the textbooks that you check for this strange thing when appendicitis presents? Would not someone who had simply read about it know to do this?

    Not sure why I find this so interesting, but I do.

    Dutch
     
  6. Necrolestes

    Necrolestes IncGamers Member

    Joined:
    Jul 23, 2003
    Messages:
    1,904
    Likes Received:
    0
    Trophy Points:
    165
    We are all one

    All doctors are equally important. A general family practitioner may be the first to see a psychiatric case in a patient. An ER doc may recognize an apparent drug overdose is actually a diabetic crisis. A pediatrician may recognize a retinoblastoma (a deadly eye tumor) before the child has eye problems and goes to see the specialist (which would be an ophthamologist).

    As to your other question, the case would be in the text but you have to know which text to use. No one can possibly study every medical text on psychiatry, cardiology, rheumatology, virology, or even general internal medicine. You may have read only one text and it might not be a very good one. A doctor gets more knowledge than what he/she can gleam from a textbook.
     
  7. MixedVariety

    MixedVariety Banned

    Joined:
    Jul 8, 2003
    Messages:
    2,498
    Likes Received:
    0
    Trophy Points:
    0
    I basically agree with Necrolestes; when it comes to general practice, in doctors there is no substitute for experience. Whenever possible, I'll have my child seen by an older doctor as long as said doctor isn't drooling.

    A few years back I brought my daughter in to see the doctors at our local pediatrician's office. They could only spare the youngest doctor in the group at the time. My daughter had been experiencing headaches, general malaise, some cold-like symptoms. The doctor tested her for Lyme Disease, flu, a few other things, and basically pronounced her saddled with a virulent cold or flu, pending the results of the tests.
    Before I left, I asked to see the doctor we normally see, a woman in her fifties who is familiar with our family. The first thing she said to the other doctor was, "Have you taken samples for mononucleosis? That's what it sounds like to me." The young fellow blustered a bit, protesting that there were no cases of mono around as far as he knew, bla bla...to which the older doctor replied "Not yet, maybe. Run the test."
    It was mono, of course.

    I'll go with experience every time. Yes, I realize it takes time to gain experience, but perhaps young, fresh doctors should be overseen by older ones until they are at least 35 or 40 years old. Of course then we would have to pay for two doctors, wouldn't we? Sigh...

    I feel for ya, Dutch.
     
  8. Necrolestes

    Necrolestes IncGamers Member

    Joined:
    Jul 23, 2003
    Messages:
    1,904
    Likes Received:
    0
    Trophy Points:
    165
    What DO I know anyway?

    The problem with young doctors is that they are either trying to become the next Dr. House (a character who can diagnose just about everything regardless of circumstance) or just are eager to prove themselves (in doing so, they often skip necessary steps in the process of discovering disease). That's the #1 reason why I am so reluctant to make a definitive diagnosis when someone asks for one here: I am not a full-fledged doctor and even if I were, I'd ask for a second opinion first. I'd try to prove myself as the best doctor out there but that would make me cocky and cockiness leads to carelessness. Careless doctors care more about being right than they do about the health of their patient. I sure as hell don't want to be one of them.
     
  9. dantose

    dantose IncGamers Member

    Joined:
    Aug 8, 2003
    Messages:
    2,935
    Likes Received:
    0
    Trophy Points:
    255
    experiance is the difference. As a doctor I worked under so astutely put it, " until you feel a bunch of healthy prostates, you wont beable to catch the unhealthy one." If everyone had to go out and try to gather that kind of experiance, it would be a pain in the butt. (pun intended)
     
  10. Echod16

    Echod16 IncGamers Member

    Joined:
    Jun 24, 2003
    Messages:
    752
    Likes Received:
    2
    Trophy Points:
    166
    may i ask what your occupation is, Necro?
     
  11. Steel_Avatar

    Steel_Avatar IncGamers Member

    Joined:
    Jun 22, 2003
    Messages:
    3,087
    Likes Received:
    0
    Trophy Points:
    255
    I've always felt that specialists are masters of one thing, at the expense of the others. So while specialists have their place, having a vanilla isn't always a bad thing either.
     

Share This Page