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When Patients Read What Their Doctors Write

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Re: When Patients Read What Their Doctors Write

#91
post #10
post #8

My doctor types at a computer whose screen is explicitly set up to point at both of us. I was surprised and appreciative when he first did so.

I too have seen this at a chain of clinics where I live: the doctor's laptop is hooked up to a wall-mounted screen, where I can actively watch what is being typed into my reports. It surprised me too, and makes me feel much better about the whole experience.

Do you have any implementation details I could take to my doctor?

(My doc currently uses a laptop that only she can see.)

Re: When Patients Read What Their Doctors Write

#92

I would imagine a lot of the concern over this is more of the existential fear resulting from the balance of power between patient and doctor than anything else. The Internet started that, with patients able to become much more knowledgable about their own conditions (with the unfortunate side effect of every symptom being cancer). Once patients become knowledgable, the doctor moves from a pillar of all knowledge to…

Physician here. I personally believe patients should do their own research, up to a certain point. There is a reason physicians have tens of thousands of hours of training. We quickly learn medicine is rarely black and white and straight from the textbooks. The art of medicine is a skill that takes a lifetime to develop, and is still not perfect.

Sure, you can search pubmed for the best therapies, but patients often don't know how to fully interpret a study. Was there enough power? Does the patient fit the studied population? Are the primary endpoints significant in this scenario? The knowledge is out there, but dangerous in the wrong hands.

Its generally a subpopulation of patients that give a reasonably self informed patient a bad reputation. Many patients (especially in the low income brackets) treat their physician like a McDonald's drive through. I want this, this, and this and I don't care about your extensive training and clinical judgement.

Re: When Patients Read What Their Doctors Write

#93

Earlier quoted context omitted.

Doctors absolutely hate knowledgable patients, from what I can tell, however. I've just spent two years begging for an ultrasound because I've strongly suspected I have gall stones - and my GP has consistently rebutted me, and has written stuff like "hypochondriac" in my notes - he left the room, didn't lock his computer. Tut tut. I initially tried playing totally stupid and letting them reach their own conclusions,…

Maybe you should file a complaint with the medical standards board, sounds like you'd have a valid case if this story is true. Although I'm assuming you're in a country where you'd have a medical standards board or some kind of complaints procedure, which not all have...

I absolutely agree. There are bad doctors out there. The medical community, like every other professional community, will stand together to protect each other from what they feel are unfair attacks, but they---like every other professional community---don't particularly care for the bad doctors either. The situation can be improved, but it won't unless someone complains.

Re: When Patients Read What Their Doctors Write

#94
post #81

I would imagine a lot of the concern over this is more of the existential fear resulting from the balance of power between patient and doctor than anything else. The Internet started that, with patients able to become much more knowledgable about their own conditions (with the unfortunate side effect of every symptom being cancer). Once patients become knowledgable, the doctor moves from a pillar of all knowledge to…

I 100% agree with [1]. I used to work with a group of MDs and the paternalism was shocking. While not universal, many of them relished the role of oracle on high and were uneasy with any change which would take them off of the top of that pillar. On the actual topic at hand, my last doctors office had a system where I could see everything they wrote on a web portal and it was eye opening. The number of times I'd say…

Weirdly, I've found the same thing but primarily with general practitioners. I started going to internal medicine specialists (Asthma, don'tyaknow) and have had much better treatment.

Re: When Patients Read What Their Doctors Write

#95
post #92

I would imagine a lot of the concern over this is more of the existential fear resulting from the balance of power between patient and doctor than anything else. The Internet started that, with patients able to become much more knowledgable about their own conditions (with the unfortunate side effect of every symptom being cancer). Once patients become knowledgable, the doctor moves from a pillar of all knowledge to…

Physician here. I personally believe patients should do their own research, up to a certain point. There is a reason physicians have tens of thousands of hours of training. We quickly learn medicine is rarely black and white and straight from the textbooks. The art of medicine is a skill that takes a lifetime to develop, and is still not perfect. Sure, you can search pubmed for the best therapies, but patients often…

Which sets us up for the anecdotes posted elsewhere on this thread. Doctors become cynical, discount every patient's questions and ideas; patients with real problems get ignored; HN fills up with horror stories.

Do you have a solution in mind?

Re: When Patients Read What Their Doctors Write

#96

Earlier quoted context omitted.

Maybe you should file a complaint with the medical standards board, sounds like you'd have a valid case if this story is true. Although I'm assuming you're in a country where you'd have a medical standards board or some kind of complaints procedure, which not all have...

I'm in the UK - it's straightforward to complain, but nothing comes of it, apart from even shittier treatment the next time around, because they know you've complained about them!

Sounds like your GP sucks, have you tried a different one?

Re: When Patients Read What Their Doctors Write

#97

I would imagine a lot of the concern over this is more of the existential fear resulting from the balance of power between patient and doctor than anything else. The Internet started that, with patients able to become much more knowledgable about their own conditions (with the unfortunate side effect of every symptom being cancer). Once patients become knowledgable, the doctor moves from a pillar of all knowledge to…

Doctors absolutely hate knowledgable patients, from what I can tell, however. I've just spent two years begging for an ultrasound because I've strongly suspected I have gall stones - and my GP has consistently rebutted me, and has written stuff like "hypochondriac" in my notes - he left the room, didn't lock his computer. Tut tut. I initially tried playing totally stupid and letting them reach their own conclusions,…

I have Hashimoto's thyreoiditis

The symptoms started when I was 14 years old, and my mother took me to a endocrinologist, back then as wild attempt to see what was going on (we had no idea what the issue was, my mom choose the medic specialty in a sorta random manner).

The result was: medic refused to do any exams, told my mom that all my symptoms was because I was fat, and I was absolutely mad at my mother (because I told her that endocrinologists are medics for fat people, and I did not needed one, and then the medic tell me all my issues, including random pains are because I am fat, just made me offended)

Fast forward some years, my health was getting slowly worse, with other medical specialties trying to stave off the effects (For example research shows that seemly one of the first symptoms, if not the first symptom that shows up, is cholesterol imbalance... I spent years going to cardiologists that tried their best to fix my cholesterol, until one of them suggested some heavy-weight drug, and I decided to give up on that and let it run unchecked).

Until one day, a marketing director that was friend of my mother, saw me from afar, and told me mother I had a thyroid problem.

My mother puzzled, told me that... And I asked her more about it, and she then remembered (and then told me) that my grandma had it, my great grandma had it too, and my aunt had thyroid cancer because of the same disease (hashimoto disease can lead to cancer if left unchecked)

I was kinda baffled, I mean, lots of people had the disease, she never wondered about it? In fact, she had symptoms too (much weaker than mine, to the point I don't realized), and never ocurred to her too... and indeed, she went to a doctor and promptly got diagnosed herself (she also had the disease).

Now the important part: after that, I spent 6 years going to medics, and as my information grew, the more they went into "shut down" mode and refused to cooperate, I had to threaten one to get the exams I needed (she was a elderly woman, I stood up, and I am very big for my country standards, and stared her down, and told her to sign the godamn request for the exam I wanted), and this was the only way to get results (the exam I wanted DID confirmed I had hashimoto), but still no doctor wanted to treat me...

It was funny, I showed up, gave them ultrasonography showing my destroyed thyroid, and gave them my symptoms, and then they would ask for a blood test, that would give normal TSH, and then they would promptly tell me I was hypocondriac or something and my health was fine.

As this went on I got more and more convinced that medics are just people with a crazy power trip, seemly saving (or not) people lives makes them think they are some sort of god or demi-god, with power of life and death...

Several went to tell me that I was wrong because they were right and I would never understand medical research and whatnot and that is not what the association said.

I went for some time to hate the association, they are involved in scummy stuff, and they were all the time cited as the reason why my normal TSH meant no treatment for me...

Until I decided to read the association documents, and whoa, my own arguments, the same ones that I use to argue with the doctors, citing the exact same papers, are written down in the section that explain how to achieve diagnosis... in the end the association actually agrees with me, and is the medics that in their hubris don't even read it, or read it and ignore it, and lie to their patients.

The only reason why I still go to a doctor, is to get the permission to get the blood tests (privately ordered blood tests cost like 2 month wages, and I need blood test every 4 months so...), because I am mostly treating myself with my own knowledge (and so far it is mostly working).

EDIT: "normal" TSH as in below 5.0 (it was 4.0), and my argument was that they are using the wrong baseline, the association use 5.0 for general case, but the association cite studies related to my specific symptoms and situation that suggest that TSH should be below 2.5 instead... thus my TSH is "normal" only for the "generic" most conservative case

EDIT2: I started treatment just some months ago, I am 26 now (meaning it took me 12 years to start the treatment)

Re: When Patients Read What Their Doctors Write

#98

Earlier quoted context omitted.

Doctors absolutely hate knowledgable patients, from what I can tell, however. I've just spent two years begging for an ultrasound because I've strongly suspected I have gall stones - and my GP has consistently rebutted me, and has written stuff like "hypochondriac" in my notes - he left the room, didn't lock his computer. Tut tut. I initially tried playing totally stupid and letting them reach their own conclusions,…

Maybe you should file a complaint with the medical standards board, sounds like you'd have a valid case if this story is true. Although I'm assuming you're in a country where you'd have a medical standards board or some kind of complaints procedure, which not all have...

The problem for most patients is that filing a complaint, making sure it gets into the system, staying on top of it to make sure it isn't buried, responding to criticisms and building justification for the claim, and then maybe losing in the end because you have an unsympathetic judge / board / whatever is too much of a pain in the ass. This being compounded by boards of reviewers in many places that are friends with the reviewed, so you get an effect like the police, with a wall of white, rather than a wall of blue.

Just switch doctors, tell folks you know not to use that doctor, and tell the doctor why you're leaving. Network effects and market forces can make an impact on this kind of thing if you're diligent.

Re: When Patients Read What Their Doctors Write

#99

I would imagine a lot of the concern over this is more of the existential fear resulting from the balance of power between patient and doctor than anything else. The Internet started that, with patients able to become much more knowledgable about their own conditions (with the unfortunate side effect of every symptom being cancer). Once patients become knowledgable, the doctor moves from a pillar of all knowledge to…

Doctors absolutely hate knowledgable patients, from what I can tell, however. I've just spent two years begging for an ultrasound because I've strongly suspected I have gall stones - and my GP has consistently rebutted me, and has written stuff like "hypochondriac" in my notes - he left the room, didn't lock his computer. Tut tut. I initially tried playing totally stupid and letting them reach their own conclusions,…

[deleted]

Re: When Patients Read What Their Doctors Write

#100
post #98

Earlier quoted context omitted.

Maybe you should file a complaint with the medical standards board, sounds like you'd have a valid case if this story is true. Although I'm assuming you're in a country where you'd have a medical standards board or some kind of complaints procedure, which not all have...

The problem for most patients is that filing a complaint, making sure it gets into the system, staying on top of it to make sure it isn't buried, responding to criticisms and building justification for the claim, and then maybe losing in the end because you have an unsympathetic judge / board / whatever is too much of a pain in the ass. This being compounded by boards of reviewers in many places that are friends with…

I'm not sure what kind of insane complaints procedure you've had to deal with, but here you just file it, they sometimes come back for more information/questions, and then that's the end of it. You sometimes get a letter with a result, but there's none of that other stuff you listed ("making sure it gets into the system," "staying on top of it," "making sure it doesn't get buried," etc).

Plus you don't really "lose." You make a complaint, they investigate, and then take action if they feel it is justified. There isn't any "prize" for "winning" so therefore you don't lose.

Ultimately I'm not sure what you're getting at. Sounds like FUD to me, essentially "don't complain because it might be a hassle and the free market will magically solve the issue anyway."

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