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Why Did My Patient Leave Me?

cancer.nautil.us

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Re: Why Did My Patient Leave Me?

#201

Post by magnetic »

maxxxxx wrote: post #188
kbutler wrote: post #121

Earlier quoted context omitted.

This is definitely more at the specialist, chronic care level. Like anything else, if you have a weekly contact with them, you are much more significant than a once or twice a year visit.

Probably correct. My girlfriend just had a few surgeries. I was shocked how little time these specialists gave their patients. I bet most of them spent less than an hour thinking about the whole case. There are exceptions but we had several surgeons who stopped by a few minutes before the surgery and didn't remember anything about the case or confused cases. Then they took 3 minutes to get up to speed. They also ofte…

I was following you until... > I can't imagine how bad software development would be if we acted like the medical system.

...which made me laugh. Until I realized you weren't sarcastic (I think).

Re: Why Did My Patient Leave Me?

#202

Post by maxerickson »

ThomPete wrote: post #198
maxerickson wrote: post #193

Earlier quoted context omitted.

For me, to be "market driven", you have to have easy entry on the supply side and not have huge amounts of mandated care on the demand side. The US has all sorts of constraints on the supply side and a lot of the demand side is treated under various mandates. Without easy entry on the supply side, there can't really be a market response to changes in demand, hence not really market driven. When care is provided to co…

We were talking relative to ex. europe. Not some ideological defintion. Then the US isn't a market driven economy. Thats not a useful way to look at things.

Creation of new supply seems more in the "words mean things" bucket than the ideological bucket.

Re: Why Did My Patient Leave Me?

#203

Post by giardini »

madengr wrote: post #130
giardini wrote: post #81

In my case, - reluctance to diagnose and treat the ailment instead of the symptoms and - simply refusing to hear what the patient says. I had an oozing rash break out behind my knees. The dermatologist said "That'll go away easily if you put some OTC corticosteroid cream on it." Wrong! The rash flared up within hours and nearly ate the flesh off the back of my knees. I happen to know that this indicates a fungal infe…

Dermatologists have a cream for everything. Once in a while I have a horrible itch breakout on the top of my feat; so bad I'll scratch it bloody. In this case, the one pound tub he prescribed does work. Works well for chiggers too.

I asked two friends about my itching woes. Both are gardeners so have dealt with maddening itches. Their response: "I ask my doctor and he gives me a prednisone pill. The itching disappears; 3 days later I'm OK."

In the case of the fungus, prednisone would have been a mistake, but I nonetheless sometimes feel I am a target for a form of alternative medicine. Why didn't _I_ get a prednisone pill instead of a tub of corticosteroid lard?

As for chiggers: in college I got a serious case of chiggers from a romantic blanket evening in the Texas desert. We two were apparently the only mammals within miles as every chigger available mobilized to fulfill its Darwinian destiny. Next morning I awoke up with a maddening itch everywhere (and I do mean _everywhere_) that lasted until the chiggers died (~3 days IIRC). Best treatment was to take as hot a shower as possible [The only thing better than sex is steaming hot water on chigger bites - it's like the Scratch of God]. Rest 30 minutes and repeat. I've heard a hair dryer works too. Thanks to your recommendation I'll keep the tub of steroid cream around just in case.

Re: Why Did My Patient Leave Me?

#204

Post by bayouborne »

The author of this article is living in the some 'It's a Wonderful Life' twilight zone. Medical professionals now, generally speaking, don't care about you. Actually they care about you moderately for the time you are positioned directly in front of them, so if you've got an easily treatable malady there's hope for you. But if you are frightened and have an abdominal issue you know is not normal, then you're cast out into the Wilderness of Specialists who put you through a series of diagnostics and if these tests don't flash positive for something, you are on your own. Doctors don't care and are not your friend; a majority are goobs with no troubleshooting skills at all. They know to prescribe the blue powder for this condition, and the red powder for the other thing. They do not understand, nor do they care to. The Chinese physician of 600 years ago may well have served you better. Marcus Welby is dead; actually he's a fiction, he never was.

Re: Why Did My Patient Leave Me?

#205

Post by comicjk »

giardini wrote: post #203
madengr wrote: post #130

Earlier quoted context omitted.

Dermatologists have a cream for everything. Once in a while I have a horrible itch breakout on the top of my feat; so bad I'll scratch it bloody. In this case, the one pound tub he prescribed does work. Works well for chiggers too.

I asked two friends about my itching woes. Both are gardeners so have dealt with maddening itches. Their response: "I ask my doctor and he gives me a prednisone pill. The itching disappears; 3 days later I'm OK." In the case of the fungus, prednisone would have been a mistake, but I nonetheless sometimes feel I am a target for a form of alternative medicine. Why didn't _I_ get a prednisone pill instead of a tub of co…

Prednisone pills are substantially more dangerous than cortisone cream, no? The one time I've taken prednisone, I had pretty severe mood swings, which is just one of a dozen notable side effects.

Re: Why Did My Patient Leave Me?

#206

Post by sxg »

jacquesm wrote: post #146
sxg wrote: post #115

Earlier quoted context omitted.

I'm not totally convinced your story with the cup of water was an ego related issue. The workflow of doctors in the hospital is complicated, and different doctors and nurses have different privileges for different patients, which can make things appear to be ego related. In your scenario, you're a post-operative patient. Your primary doctor is likely the surgeon that performed surgery on you. I'm thinking the doctor…

> I'm not totally convinced your story with the cup of water was an ego related issue. Ok. > The workflow of doctors in the hospital is complicated, and different doctors and nurses have different privileges for different patients, which can make things appear to be ego related. In your scenario, you're a post-operative patient. Your primary doctor is likely the surgeon that performed surgery on you. I'm thinking the…

Obviously I don't know all the details of your story, but I'm still a little skeptical. Yes, there are likely doctors out there that do believe they're too good to get water for patients, but I haven't worked with any like that yet. I have rounded with doctors who have delegated simple tasks like getting water to someone else, but it's always been to either save time or avoid giving water to someone who isn't allowed to get it.

You mentioned you had a tube down your throat—that's probably an NG or OG tube, which is often used for feeding solids and liquids. If you had one of those tubes, then there's very likely a reason you couldn't take solids/liquids by mouth. Again, I don't know all the details, but I'd imagine what happened is that your consulting doctor saw you had an NG or OG tube and wasn't sure why. He probably deferred the decision on whether you could have water to your nurse who would know for sure what you were and weren't allowed to have. The nurse probably isn't aware of what the different doctors know and don't know about their patients and interpreted the request to get water as an ego thing. If my interpretation is correct, the doctor is still wrong in not giving you or the nurse an explanation of what's going on, but the issue is more communication related than it is ego related. I don't believe what happened to you is ideal or how medicine should work, but it's how medicine often ends up working with so many different people having tangential and partial responsibilities for patients.

Based on my experiences working in the hospital so far, communication issues are massive and frequent causes of problems and conflicts between health care providers and patients as well as between different health care providers. Again, the workflow in the hospital is complicated, and I don't believe any one person really knows what any other person should be doing. Each provider knows the extent and limitations of their own role, but others' roles are a mystery. All of this leads to miscommunication, misunderstandings, and massive/frequent problems like your experience.

Re: Why Did My Patient Leave Me?

#207

Post by bayouborne »

magnetic wrote: post #201
maxxxxx wrote: post #188

Earlier quoted context omitted.

Probably correct. My girlfriend just had a few surgeries. I was shocked how little time these specialists gave their patients. I bet most of them spent less than an hour thinking about the whole case. There are exceptions but we had several surgeons who stopped by a few minutes before the surgery and didn't remember anything about the case or confused cases. Then they took 3 minutes to get up to speed. They also ofte…

I was following you until... > I can't imagine how bad software development would be if we acted like the medical system. ...which made me laugh. Until I realized you weren't sarcastic (I think).

..but I understand his broader point - these are not deeply introspective, gifted individuals. A front line GP (and probably many 'specialists') is an auto mechanic who replaces an awful lot of ECM modules unnecessarily along to way to actually fixing the problem. In an aggressively supervised service field many of these people wouldn't make it. Doctors may get flagged when they kill enough people over a local threshold, but qualitatively dismal performance (empathy, followup, even a solid fundamental knowledge of the subject matter) is tolerated quite nicely in the system.

Re: Why Did My Patient Leave Me?

#208

Post by waqf »

dleslie wrote: post #104
ziikutv wrote: post #97

It ain't perfect in Canada either. I remember losing my hairs and getting patches of super smooth bald spots. Super embarrassing for a kid in a bad neighbourhood and bad school. Went to the doctor she looked at my charts and said I was super low on iron so low that I might even die if it continues to lower. I was given iron pills. Two months after I went to the doctor again and said my hair patches are not fixed. She…

Bureaucratic mishaps and mediocre care providers are bound to occur in any sufficiently complex system.

Have you looked at the work in the 2000s on preventing medical errors, e.g. http://www.nytimes.com/2006/10/31/health/31safe.html?

Re: Why Did My Patient Leave Me?

#209

Post by m-j-fox »

mhneu wrote: post #149
falcolas wrote: post #84

Earlier quoted context omitted.

My parents actually had a doctor's office say "why do you care, insurance is covering it", and the insurance company say "we'll get it fixed, but you realize you won't get anything in return". Yeah, the system is deeply busted.

Lack of price transparency is a huge, huge problem. Without price transparency you can't have a market system -- America already has a socialist health care system because no one can price shop.

http://www.pamf.org/forpatients/pamf-health-care-costs-and-c...

Your Better Health Care organizations do publish prices. The outfit across the street from PAMF does not publish prices and as you could guess, they end up being at least 10 times higher. For everything.

Re: Why Did My Patient Leave Me?

#210

Post by waqf »

losteverything wrote: post #125

I'd say in a bar to this author dr 1. Kittens die 2. You have a unique position to help people. 1. If you have ever cared for 4-7 week kittens then you know sometimes they just die. Don't be surprised when they do. They simply do. One moment they seem healthy and the next-they are gone. Your patients will not come back. They just won't. Don't be surprised when they don't come back. It happens. You will not know why.…

You are correct to forget this kitten, but that doesn't in any way mean you shouldn't research ways to stop kittens dying.
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