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anniedeighnaugh

Dr./patient relationships...

Annie Deighnaugh
3 years ago

So as not to hijack the other thread from its original intent, I thought it better to bring our discussion here.

--------------

Elmer, just to clarify, I disagree with your assumptions about how I view the medical profession. It is not how I view it at all. Rather, I think Drs are generally wonderful people and the world is immeasurably better off having them in the world than not. I think science is incredible and has brought innumerable advances to the world. They know a lot about the human body, its illnesses and treatments and cures. However, they are largely limited to two treatments for patients: cut it out, or prescribe toxic chemicals. When I mentioned this to my dear doc, he thought for a minute and then said, "Well I can encourage them to live a healthier lifestyle." Great.


Moreover, while doc's may know a lot about the human body, they don't know me and my experiences. They only know what I tell them or what they can test for. They don't live with me to see how I eat, sleep or move. They can't feel what I'm feeling. And because I'm with my body 24/7 for my entire life, I understand it, what it does, how it reacts and what works best for me and what doesn't far better than they ever could.


So, IMO, for best outcome, and the way I've worked with all my doctors is to partner with them. I know my body, they know medicine. We meet in the middle. They have to explain to me what they want to do and why in such a way that I understand it. They have to help me understand the risks and the benefits as it is *I* who will have to live with the consequences of that choice, not them. I need them to listen to what I have to say, and take me seriously. I need them to tell me when I'm wrong and answer my questions to my satisfaction. If I'm wrong, I need to understand why. If they don't have any good answers then they need to let me know that and then together we can try to find a solution by trial and error and research. And if they have no answers, but I'm still suffering, I will go elsewhere to find solutions even if that takes me somewhere outside their ken such as nutrition, chiropractic care, naturopathy or chinese medicine as examples.


It's my body, my suffering, my life and I have to do what makes the most sense for me...not some medical protocol that will be revised over the next few years.


Comments (163)

  • olychick
    3 years ago

    "You missed my question, I'm sure intentionally so and I'm sure because your answer is No."

    Lol!

    Just because you ask a question doesn't mean anyone is under any obligation to answer you.

    I listed all my medical survey experience, as a doctor or hospital administrator which is what our discussion is about. Not everyone needs to expound on their non-relevant (to the discussion) experience.

  • jmm1837
    3 years ago

    Elmer - I daresay I could come up with plenty of counter-examples of failures in the American system as well. Neither your examples nor my anecdotes constitute data. But the data is there.

    Since you seem to have entirely missed the point of both my comments I'll lay it out in simple English: the health systems of Australia, Canada, France, Germany, etc have better outcomes and kill fewer people than the American system.

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  • Elmer J Fudd
    3 years ago
    last modified: 3 years ago

    I'm happy to ignore those who find any possible excuse to be snippy. Sorry you're always so unhappy. Bye!

  • Elmer J Fudd
    3 years ago

    Jmm, I already responded. No need to continue the redirect effort. You said your peace, none of the countries you mentioned have systems without problems or lacking areas to criticize.

  • jmm1837
    3 years ago

    Actually, Elmer, you did not respond. You attempted to argue that universal public health systems produce poorer outcomes because of cost controls. And you repeated that point, but substantiated it with nothing but a few anecdotes. You failed entirely to respond to data which establishes the contrary.

    By the way, I never suggested the other systems are without fault. What I said is that your assessment of the impact of tighter cost control on health provision is uninformed. All those other countries deliver a better standard of health care at a lower cost than the US, possibly because the resources available are directed where they will make the greatest impact. Not a flawless standard, but a better one. The commercialisation of health care in the US has created worse, not better, results.

    And btw, I find your casual dismissal of the 43% of Americans who rely on Medicare or Medicaid, or who have no insurance at all, quite disturbing.

  • lucillle
    3 years ago

    I don't care for sites that review individuals.

    I have a different perspective completely. In the news (NYT) today yet another story about Dr. Nassar who allegedly sexually abused young Olympic gymnasts.

    Our local Next-door site constantly has requests and reviews for doctors/clinics. An outlier bad opinion is met with those who have had good experiences, but a flood of bad reviews by actual neighbors using their actual real names is something to consider, imho.

  • Elmer J Fudd
    3 years ago
    last modified: 3 years ago

    I attempted to argue? Don't flatter yourself so.

    You won't find the word outcomes in any of my comments. You'll find comments about delayed services and tight cost controls that ration services. These complaints (among locals in the respective jurisdictions) are not new, are not outliers, and are not limited in number.

    Last I saw, the number of Americans wholly without medical coverage is something under 15 percent. For I think the fourth time, I'm not defending that. As for the percentage of Americans covered by Medicare or Medicaid, so what? What is the percentage of Aussies covered by Medicare? Right, it hardly matters. For the record, Medicare for seniors in the US does not require referals for specialists, does not involve queues or delays for treatment beyond what other patients experience. And, for the poorest of seniors, is furnished without cost. Supplemental coverage is usually required for types of services not covered by basic Medicare but can be obtained at relatively modest cost.

    And, unlike universal coverage in Canada, as a for instance, the coverage most have fully or inexpensively covers prescription drugs for patients not hospitalized.

  • Zalco/bring back Sophie!
    3 years ago
    last modified: 3 years ago

    Jmm, I fail to see what the problem with Americans having Medicare or Medicaid insurance. Medicare is a retirement benefit, which American workers pay into all of their lives. Medicaid is a safety net medical insurance for those who are having financial difficulties.

  • Zalco/bring back Sophie!
    3 years ago

    For all of those who have suffered due to sub optimal-doctors, I am so sorry. I can only imagine how frustrating it must be to be unwell, and not be able to depend on the people who are there to care for you.

  • jmm1837
    3 years ago

    zalco - you might want to go back and review Elmer's comments about low income and uninsured Americans and the quality of care they receive.

  • jmm1837
    3 years ago

    "You won't find the word outcomes in any of my comments. You'll find comments about delayed services and tight cost controls that ration services. These complaints (among locals in the respective jurisdictions) are not new, are not outliers, and are not limited in number."

    Quite right. I don't find "outcomes" mentioned in any of your comments. Outcomes are a significant measure of the effectiveness or not of health care systems. Why are you making such an effort to avoid that measurement?

    What data do you have to suggest that the links I've provided about lack of access and mediocre result from your system are incorrect? What data do you have to suggest that, for Americans reliant on Medicare, Medicaid, or no coverage at all, the delays they encounter aren't as bad or worse? Do you actually have anything beyond anecdotes?

    And by the way, 100% of Australian citizens and permanent residents are covered by Medicare. Some have supplemental private insurance. I'm not even sure what your point is. I suspect you don't know either.

  • althea_gw
    3 years ago

    Lucille,, I agree with you about neighborhood list serves. Ours has questions about clinics and doctors quite often. The responses are from people we know or can get to know, not anonymous contributors. It is like the pre-internet where word about a clinic or doctor was done by talking to others.

  • Springroz
    3 years ago

    (I had to skip quite a few comments, so forgive me if this seems off-topic. I believe it relates to Annie’s OP)

    Last year, just as Covid was ramping up in early March my DH was stricken by abdominal pain. It was totally intermittent, and he attempted to go to the clinic here, twice, and both times left due to staff who seemed ill, and being told that HIS doctor was gone for the day, and the new doctor was on the way.

    He was in a smaller town on business in late March, and he stopped at a clinic where a friend of ours is a PA. She looked at him, listened to his symptoms, and ordered an ultrasound. Ultrasound showed nothing(they US the wrong body part....not where the pain was. She recommended him to a urologist, who is also an acquaintance. She ordered a CT scan.

    After about 2 weeks, the CT scan was scheduled. He had it done, and the results took several days to come back, and when the PA reviewed them, she told him that he had a fatty liver, diverticulitis, and a prostate the size of a goose egg!! When he relayed that to me, I said, “No way. Not your scan”.

    By now, we are well into May, and getting quite weary of Covid, and pain, and DH has decided he has a hernia, and the urologist’s office calls, and says,” Be here on June 1. “ He drops his pants, and the doctor says, “You have a hernia.” Checks his prostate. “Feels fine, we will check PSA to be sure. Call your surgeon” (He had the other hernia fixed on the other side 5 years prior.)

    Early July, he had the hernia fixed.

    The CT Scan? Who KNOWS whose that was. His PSA was practically non-existent. He may have a touch of an inflammatory bowel, but fatty liver? No.

    Question everything. Do NOT let them put you on the “specialist merry-go-round” , and taking drugs that are unnecessary, and dangerous. Those drugs just get you a trip tho yet another specialist.

    Our risk of dying is 100% and unavoidable. Why spend precious hours in multiple doctors offices and drug store lines??

    Real food, water and sleep. Get out of the building. That is the way to health. Apologies for the novel...

  • nickel_kg
    3 years ago

    Most of what I enjoy about the KT is people sharing their anecdotes. Between everyone who posts here, ya'll have such a wide variety of life experience, much more than any one individual of us could possibly have. If an anecdote seems relevant to me, that's a starting point to find out more information on the subject.

    Elmer, finally I understand your use of the term "partnership", how you reserve it for relations of two entities with similar backgrounds. So now it makes sense to me how calling the doctor-patient relationship a "partnership" would grate on your nerves. Never the less, it seems to be a popular term right now.

  • lucillle
    3 years ago
    last modified: 3 years ago

    Our risk of dying is 100% and unavoidable. Why spend precious hours in multiple doctors offices and drug store lines??

    Real food, water and sleep. Get out of the building. That is the way to health.


    I have to disagree with the above. Because there are misdiagnoses does not mean there is no value in seeing some specialists. There are some complex areas of health that take many years of study. But be informed, be a partner.


    Question everything. Do NOT let them put you on the “specialist merry-go-round” , and taking drugs that are unnecessary, and dangerous.

    I do agree with the above, question everything, ask why certain medications are being prescribed. And a targeted appointment with a relevant specialist can be helpful and lifesaving, but sometimes multiple referrals are made for the economic health of the doctors involved. Ask why the referral is being made. If you suspect it is not for your benefit, go somewhere else.

  • Annie Deighnaugh
    Original Author
    3 years ago
    last modified: 3 years ago

    Elmer, finally I understand your use of the term "partnership", how you reserve it for relations of two entities with similar backgrounds.

    That's certainly not how I define a partnership. A partnership is two people, who each bring assets to the party, working to achieve a common goal. IMO, a partnership is better if the two entities have *different* backgrounds.

    If I can use our home building as an example. DH is an engineer and was much more concerned with the "plant" of the house in terms of HVAC, plumbing, electrical, etc. I was more concerned with the looks and the design of the house, the symmetry, window placement, built-ins, etc. So together, by bringing our assets from different backgrounds, we covered more bases and I think our finished product was better as a result.

    Same in business where, say, both are partners bringing assets to the firm, but one is better at sales and marketing while the other is better at finance and accounting.

  • Elmer J Fudd
    3 years ago
    last modified: 3 years ago

    Annie, as before, I spent a career as a partner of a partnership, working with other partnerships, setting up partnerships, etc. You can have whatever definition you want, I have experience with them in what I think to be a typical manifestation.

    An interesting experience I'll try to relate without it being too long that should be an example of a collaboration for all except those who like to argue. Not that long ago, I had a day long "adventure" in Paris that was called "One Day French Cooking School". It really was a cooking experience. Met a guy dressed as a chef at 8:00am on a specified street corner, which was in a neighborhood of nearly exclusively food shops and an open market in the street. 6 "students", one chef. We had a brief orientation - we were there to purchase the food of our choice for a meal we would prepare and eat. Not everyone something different, at least 3 had to agree for anything and the remaining 3 if necessary could make a different choice. Starter, a main course with accompaniments and items to also prepare a dessert. All normal kitchen items would be supplied and needn't be purchased, same too for a wide selection of wine already in place to go with any choices. Open budget short of guidance "don't buy anything like lobster, saffron or caviar". The chef paid for the purchases and would consult on possible choices and preparations since there wasn't time for something that might take too many hours. Toting our purchases, we walked 10 minutes to the commercial location where there was a larger than normal kitchen with restaurant-level equipment, expansive prep areas, knives, implements, etc., Sitting on stools around a prep table, the chef reiterated preparation alternatives, which were discussed and agreed on, and we set to work preparing the meal. The chef divided us into teams for the required tasks. He'd explain, demonstrate, leave us to do the thing, and then rotate stations every 15 minutes so that everyone got to try every experience. For steps where our amateur technique was deficient, the chef would step in quickly to make things right. Preparation took several hours, cooking about another hour in total.

    We prepared and ate a phenomenal meal and couldn't possibly have had a better time. It was expensive but worth the cost.

    The shopping and the preparation of the meal was NOT a partnership. It was a limited collaboration, very limited. We neophytes expressed some preferences, added some information, and were completely in the hands of a knowledgeable and experienced professional who, through our hands and his own at times, was the sole person who produced the result.

    The term "partnership" may be a popular slogan for medical care but even in the best of circumstances, the patient-physician relationship is not a partnership as I understand the definition of the term.

    Edit to add - but the distinction is of no consequence in reality but arose in a conversation where so many expressed a need (and even with a lot of imagination, the ability) to almost direct and supervise the work of a physician. Anyone who thinks that's either necessary or helpful needs to find new physicians.

  • nickel_kg
    3 years ago

    Annie, I'm understanding how Elmer uses the term, not saying I agree with it. I appreciate how English has so many terms for just about the same thing, because it can give us extra precision when communicating. Most of us make no difference between "partnership" and "collaboration" etc. Maybe the legal field does, when drawing up contracts and terms have a precise meaning -- but in common everyday use, not so much. Peanut Butter and Chocolate -- partners or collaborators? (remember that old commercial? lol)

  • isabellagracepan
    3 years ago

    Elmer, I think it is possible to find negative anecdotes about poor medical outcomes in all countries. I am glad that as an American you are happy with your U.S. medical system, and as a Canadian, I can tell you that the vast majority of Canadians are very grateful for our medical system too. It is very rare to hear about Canadians who wish we had an American system (there seems to be only one big public agitator at the moment, who wants to open private clinics, so he is hardly impartial).

    And yes, new Canadian graduates of medical school are instructed to collaborate with their patients and view it as a working relationship. The doctor needs clear information from their patients as well as patient compliance for treatment protocols, and the patients need good listening, accurate knowledge and empathy from their health professionals. This is the current goal in medicine, but it of course does not mean that all professionals are working to that standard, or that all patients are doing their best either. Human beings are not exactly famous for always doing the right thing!

  • Annie Deighnaugh
    Original Author
    3 years ago

    Elmer your example is a false equivalency.

    The relationship between a student and educator is not one I'd ever call a "partnership" or a "collaboration", regardless of whether it's a hands-on class or a lecture. Other than tuition, a student rarely has any assets to bring to that relationship.

  • Zalco/bring back Sophie!
    3 years ago
    last modified: 3 years ago

    Same in business where, say, both are partners bringing assets to the firm, but one is better at sales and marketing while the other is better at finance and accounting.


    This example, along with the house building example, don't hold up to me. Doctors do not bring one set of skills to the table while patients bring another set. Doctors bring medicine, patients bring their health, either it's maintenance or it's remediation to the table. Even when a doctor is a patient outside of her specialty, the set up is similar.

  • Elmer J Fudd
    3 years ago
    last modified: 3 years ago

    Zalco understands, nickel too. For the rest of you, I'm outta here. ,



  • Zalco/bring back Sophie!
    3 years ago

    I think this conversation reflects an attempt to bring doctors down a peg or two- a corrective to a time when doctors may have been intimidating to some people. If you can acknowledge a student doesn't bring anything to the table vis-à-vis a teacher, I fail to see how the doctor patient relationship is different.

  • Elmer J Fudd
    3 years ago

    Exactly.

  • lucillle
    3 years ago

    I think this conversation is an exploration, despite attempts to make it adversarial, saying that only certain people 'understand'. I applaud those who continue to have a dialogue about this important issue of both being informed and being active, not passive, in the doctor patient relationship.

  • nickel_kg
    3 years ago

    I should have stopped reading this thread when "h-e-double-hockeysticks" froze over (that is, when Elmer paid me the compliment of saying I understood something!)

    Because I don't agree that this thread was attempting to bring [all] doctors down a peg -- hasn't everyone who posted acknowledged that some individual doctors are better/worse than others? And also I don't agree with the premise that [all] students bring [absolutely] nothing to the table. I'm an equal opportunity disagree-er!

  • Annie Deighnaugh
    Original Author
    3 years ago

    It's not about bringing doctors down a peg. It's about both the doctor and the patient have a common goal of getting the patient well...or at least they should. The doctor brings the knowledge of medicine and treatments, the patient brings the information and knowledge about her body, what she's feeling, how she's feeling, what she's doing or not doing, and the final say so when there are choices to be made about treatment options with varying risks and benefits.

    As we have seen from my examples and others', the role of patient is at greater risk of error, misdiagnosis and mistreatment if a passive recipient of medical information rather than proactively involved in her diagnoses and treatments. If this is all about getting the patient well, then a doctor should not be afraid of a proactive and informed patient. Rather I'd think they'd welcome one as it can be a tremendous time saver for the doctor and more likely to result in compliance by the patient who understands and accepts the treatment as prescribed.

  • maifleur03
    3 years ago

    I wondered at the comment that students do not bring anything to to the table. While not a teacher and I only dabbled in art until the amber haze in my eyes got in the way several times I showed a couple of teachers a different method of doing something with paint brushes or a different type that they did not know existed. I also doubt that there is any teacher that has not learned something from their students. Some times a better way other times something they are doing that they needed to stop. No one knows everything in depth and should be continually learning and changing based on new information.

  • Annie Deighnaugh
    Original Author
    3 years ago

    maifleur, I agree and didn't mean to imply that teachers learn nothing from their students and certainly the wise teacher is always open to learning from whatever source. Only that, in terms of the relationship, it largely is a one-way street in terms of transfer of knowledge from teacher to student. Certainly not one that I would describe as a partnership as the power balance is very unequal in that relationshp. One may argue that the relationship may change, particularly at the graduate and post-grad level where research is breaking new ground upon which both student and teacher may learn. But the vast majority of students especially in el-hi, are more often recipients of instruction and are graded accordingly. I don't expect to receive a grade from my doctor. So I don't see it as an apt comparison.

  • Sandplum1
    3 years ago
    last modified: 3 years ago

    Maifleur, as a teacher, I agree 100%. ETA, communication and a bond between a student must exist to ensure the best means of teaching and learning to facilitate the best possible education possible. If I can form some type of partnership and collaborate with a student, that is an essential element to successful teaching.

    Carol

  • lucillle
    3 years ago
    last modified: 3 years ago

    It's not about bringing doctors down a peg.

    Of course it isn't. The 'peg' is a straw man argument designed to make you work hard to disprove something that was never an issue. It's a debate trick.

    Annie Deighnaugh thanked lucillle
  • Annie Deighnaugh
    Original Author
    3 years ago
    last modified: 3 years ago

    Sandplum, you are highlighting an important difference for me between collaboration and partnership. A teacher can collaborate with a student, a boss can collaborate with an employee, but there is an inherent inequality in the relationship. The teacher grades the student; the boss can fire the employee. One is clearly in charge and one clearly follows the others' lead. In a partnership, the relationship is on a more equal footing.

  • maifleur03
    3 years ago

    Irony is when looking for where a noise is coming from I found a Alzheimer's Association packet that is labeled as "Patients as Teachers". First thing is a form letter to be given/shown to your doctor. After stating they are in a partnership it goes on to "be honest with me". "Listen to me". "Evaluate me completely do not fall prey to shortcuts because I may be older". "Suggest treatment paths to me; don't tell me what I have to do" "We ask that you hear me". If these are needed to be said to a physician it is not the 'one of' that does not listen. Everything coming out of this office is reviewed by the Kansas University Neurology area.

  • Annie Deighnaugh
    Original Author
    3 years ago

    jmm, precisely.

    Another example from way back when our neighbor who had serious and complicated health issues, was in the hospital for awhile. His lung doctor came in, listened and said, I don't like the sound of your lungs. I'm putting you on oxygen. A few hours later, his heart doctor came in and said, "What are you doing on oxygen! Your heart can't take it!"

    Yeah, a team approach would've been much better.

  • Elmer J Fudd
    3 years ago
    last modified: 3 years ago

    -If the public Medicare system in Australia is so fantastic, why do people pay extra to have private insurance?

    -Why do private patients in Australia receive more prompt treatment and have access to more immediate appointments than Medicare patients, from the same doctors?

    -Why are so many doctors in Britain leaving the NHS system each year and choosing to practice in the private medicine sector instead? It's thousands every year, from what I've read.

    - Similarly, why do many white collar employers provide private insurance as a benefit and more affluent Britons pay extra for private insurance and choose to be seen by providers outside the NHS system?

    One of several Americans I know who lives in Australia and who has first-hand insights to how the system works (for a reason I won't say) has said to me that they are impressed with the availability of GP access for most of the population but they believe that both GPs and specialists are less well trained than in the US. And that private insurance (which apparently is relatively affordable) is important for getting better and more timely care. So, maybe there's a need for you to think you're preparing yourself for your own medical matters. Or, as with the others, you're fooling yourself or protecting yourself from doctors with less than stellar competence? As the preceding example highlights.

  • Zalco/bring back Sophie!
    3 years ago
    last modified: 3 years ago

    Yikes, doctors not working in teams, where does that happen? That seems pretty backwards. Everyone here is very specialized and works together easily thanks to great IT infrastructure.

  • maifleur03
    3 years ago

    Better to ask why do people in the US with original Medicare need an additional policy. Why is there a need for Part D of Medicare. Address what the US does before trying to address what other countries do.

  • Elmer J Fudd
    3 years ago
    last modified: 3 years ago

    Exactly. Especially with what seemed to be a hospitalized patient. Not checking what was in place for the patient already, nor hopefully existing notes or cautions in the chart, is inexcusable. Or maybe the fault is with the cardiologist for not noting what others needed to understand. Or maybe the cardiologist was wrong?

    Incompetence and sloppiness seems to be explaining more of this than these individuals realize. Pulmonology and cardiology are complimentary specialties, both branches of internal medicine, whose practitioners often work together on patients needing the skills of both- each knows a lot about what the others do and common matters to be alert to. There's more to know by these people making serious judgements with superficial facts.

  • Elmer J Fudd
    3 years ago
    last modified: 3 years ago

    "Better to ask why do people in the US with original Medicare need an additional policy."

    Why? It's not relevant. This isn't a "my dog is better than your dog" discussion. For me, it's a matter of having a discussion with relevant (not just cherry-picked) facts and varying perspectives.

    US Medicare exists because of enacted laws and changes periodically to those laws. Like any and every law, it does what it does and doesn't do what it doesn't do because of what was put into and left out of the law. If you think it should be different, contact your elected officials. There's no theory or philosophy involved.

    Why in many states do blue laws still exist? Why are there still dry counties right next to counties with normal retail alcohol laws throughout some parts of the US? Why do some states ban alcohol sales in grocery stores and some don't? It's an easy answer for all of these - it's because that's what the laws in those places allow or don't allow. In the case of national health plans anywhere, which mostly are much better as a concept than they tend to be in fact, same thing plus cost containment.

  • maifleur03
    3 years ago

    Some times you are so funny Elmer. Did you forget you asked this? "If the public Medicare system in Australia is so fantastic, why do people pay extra to have private insurance?"

  • jmm1837
    3 years ago

    "If the public Medicare system in Australia is so fantastic, why do people pay extra to have private insurance?"


    Another straw man logical fallacy, attacking an argument that was never made. When did I say the Australian system was "fantastic?" That's right. I didn't.


    What I said was that the data provided in those two studies shows that the US health system provides poorer access to medical services and poorer outcomes from them than the health services of comparable countries. The US ranks well behind both Canada and Australia, as well as all other comparable countries, on the "Healthcare Access and Quality Index." That is why the US has higher rates of avoidable deaths.


    As for private insurance, the advantages, and the reason I carry it, include shorter waiting times for elective surgery, coverage of some dental care, physio, eyeglasses, etc, and a partial rebate on the Medicare Tax Levy surcharge I pay. I see it as an affordable luxury.


    I won't comment on your anecdotes (an excellent example of another logical fallacy, cherry-picking) about comparable levels of training in Australia vs the US, except to say that those same sources I've already referred to include reference to the US having a significantly higher rate of medical, medication and lab errors than comparable countries, including Australia.


    I don't think I'm the one who's fooling myself.

  • amicus
    3 years ago

    Zalco, (re your feeling that the definition of 'partnership' would not hold up for a patient/doctor relationship) you said "Doctors do not bring one set of skills to the table while patients bring another set. Doctors bring medicine, patients bring their health, either it's maintenance or it's remediation to the table. Even when a doctor is a patient outside of her specialty, the set up is similar."

    I'm in agreement that patients do not bring to the table the skills that their doctors have, with their numerous years of rigorous medical training. But it is now being taught that patients bring valuable knowledge to the table, by having specific information the physician lacks. This is everything pertaining to their symptoms. It is vital information to add to the physician's trained skills, in order to bring about an accurate and expedient diagnosis. I assume that's why they named their objective 'Patients as Partners.'

    This in no way implies that the patient has equal medical expertise as their physician. It simply means that physicians are now being taught to engage in more communication with their patients. The old adage 'Children should be seen and not heard' was often applied to patients as well. But now this is recognized as detrimental to optimal health care. For those who don't already have a good communicative relationship with their physicians, at least their children probably will, thanks to how the next generation of med students are being trained.

    Elmer, if you're still reading this thread, thanks for informing me that 'Ivy League' universities are only in the U.S. I was under the (wrong) impression that the few universities ranking highest in the U.S. U.K. and Canada were somehow also referred to that way (maybe because they are all very old, lol) so I'm happy to be corrected on that. Yes, my specialist did pursue the same line of investigation (believing it to be an autoimmune problem) as my GP, so no 'superfluous steps and tests were wasted.' But my most telling symptom did not appear until after I'd been referred to the specialist, who was able to pinpoint the precise condition, because of that specific information.







  • olychick
    3 years ago
    last modified: 3 years ago

    Apparantly, the horse wasn't really dead and keeps being resurrected. Poor thing. As an American, I apologize to other countries for the insults posted here about your countries and institutions/systems. Ugly Americanism in full view.

  • Elmer J Fudd
    3 years ago
    last modified: 3 years ago

    Yes amicus, I'm more than done with the medical discussion but happy to explain the Ivies.

    They're all old, all in the Northeast, all hard bordering on impossible to get into, and their group name "Ivy League" does come from the sports federation their teams compete against one another in. Think like NHL or CFL. Some have a few departments that receive some funding from their states but they are all private just the same. The moniker is misunderstood on this side of the border too. The 8 Ivies are outnumbered, of course (and some outranked) by other prestigious and excellent universities that are named in the various competing Top 20 rankings (which from one to the next aren't always in agreement as to members or rankings). The US has many outstanding public universities, many of which are not cheaper to attend (and because of family income based scholarships and aid, some more expensive to attend) than private institutions but I don't think any usually wind up in anyone's the Top 20.

  • Zalco/bring back Sophie!
    3 years ago

    Amicus, Even in the times of leeches and humors, patients brought the same knowledge to the table- The knowledge of how they feel, where it hurts, how, and when they feel unwell, etc. Doctors have never claimed to be mind readers. I am pretty sure I could come up with plenty of old writing about the importance of listening to the patient in making a diagnosis. I am guessing Hippocrates himself had something to say on the subject. Patients need to participate in their care, no doubt. For example, February 28 is Rare Diseases Day. About one quarter of all diagnoses, in the aggregate, fall into the category of a rare disease. These patients often have to persist and persist in getting the appropriate diagnosis. But the persistence they bring to the table is not a partnership, to my thinking, it is advocacy.

  • Annie Deighnaugh
    Original Author
    3 years ago

    We used to talk about six sigma in quality control. (Sigma has to do with standard deviations and such from statistics.) It came out of Toyota and was a goal to get manufacturing processes that perfect. The problem is humans operate at about 3.8 sigma.

    3.8 Sigma 98.93% accuracy or 10,724 defects per million
    6 Sigma 99.99966% accuracy or 3.4 defects per million

    The difference?

    20,000 lost mails every hour vs. 7 mails lost every hour

    Unsafe drinking water for almost 15 minutes each day vs. one unsafe minute every seven months

    200,000 wrong drug prescriptions every year vs. 68 wrong drug prescriptions every year

    So whether the mistakes are through incompetence, sloppiness, or just being human, if you want to avoid them in medicine, you need to be proactive in your care as medicine is largely a human process.

  • Annie Deighnaugh
    Original Author
    3 years ago

    This conversation has reminded me of an old movie called "The Doctor".

    https://www.rogerebert.com/reviews/the-doctor-1991

    "Anyone who has ever been through the medical system - even with the very best of treatment - will identify with this film. “The Doctor” tells the story of an aloof, self-centered heart surgeon who treats his patients like names on a list. Then he gets sick himself, and doesn't like it one bit when he's treated like a mere patient."

  • amicus
    3 years ago

    Elmer, I appreciate your additional info about 'Ivy League' schools. I actually knew which universities in the U.S. were in that category, but hadn't realized that referring to Oxford and Cambridge in the U.K. and U. of T. and McGill University (in Montreal) as 'Ivy League' was a definite misnomer, on my part. Somehow I attached 'Ivy League' schools with the country's highest ranking/hardest to get into, I don't know why.

    I'll have to share my misperception with my son, (who has 4 of your Ivy Leagues, as well as universities in Europe and Asia, as clients.) I know he'll tease me with "Mom, so you honesty didn't know that Ivy League schools are only in the U.S.?" Maybe I'll just keep my ignorance between us for now Elmer, until I'm able to visit my son, so we can enjoy a laugh over this in person. He knows I'd always prefer that someone bother to correct me about a factual mistake, than let me carry on in ignorance. So thanks again!


  • Elmer J Fudd
    3 years ago

    I won't say a word to him, I promise.

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