6 ms·

Regarding (a) - do you know that I've never been told why I need to finish my antibiotics? For some reason (arrogance?) doctors don't explain their reasoning in

by iLoch 10y ago

Regarding (a) - do you know that I've never been told why I need to finish my antibiotics? For some reason (arrogance?) doctors don't explain their reasoning in many cases (I live in Canada FWIW.) If I was told "hey, you need to finish your antibiotics or you'll risk becoming immune to them, potentially putting yourself or your family, colleagues, or friends at risk" I don't think even the dumbest person would ignore that warning. Then they could even explain WHY that is, if the patient was curious. Instead, here in Canada, you say you're sick, the doctor will likely immediately perscribe antibiotics, then shuffle you out the door in less than 5 minutes.

atmosx 10y ago
> Regarding (a) - do you know that I've never been told why I need to finish my antibiotics? Drug therapies have specific regimens that need to be respected in order to ensure the highest degree of success. An average regimen for penicillins (penicillin-derivatives) is 7 days because that's how many days it takes for the ATB to kill the bacterial infection. Now all the above is the N-th level of abstraction. If you really want to know what's on you need to start doing evaluations. You need data like from the patient like: - Age - Kg - Health state (liver, nephrons, stomach, allergies, etc.) - History the specific class of ATBs (how did your body and the infection react to this class of ATB in the past?) - Other medication (are there interactions with other drugs a patient might be taking?) - Food (e.g. you shouldn't eat St. John's Wort while on drugs, because it's a CYP3A4 inducer and so on and so forth...) - etc. And it goes further down the rabbit hole depending on the case. So, I of course prefer doctors who are big on explaining what's happening, but I understand those who don't. The thing is that once the doctor starts talking ,you will probably start asking why, especially if you're an engineer who wants to put everything into context. At some point you'll just won't be able to understand - which means he'll have to make silly analogies, even more explanation, etc. Add to that you might have been his 20th patient that day and you get the point. On the other hand, if you pay for it, you should be able to get a doctor which gives you the appropriate amount of care/explanations.
aggie 10y ago
I had also never heard an explanation before. I'd like to think I would inquire if it came up (haven't needed antibiotics since I was a kid), but many people aren't inquisitive. I had a similar lightbulb moment when I heard why you shouldn't slouch, even though it can be comfortable: the intervertebral discs in your spine are poorly innervated[1], so you don't feel the damage you are causing until it is severe. 1 - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2913007/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2913007/
loopbit 10y ago
Not only in Canada, it's like that in every country I've seen a doctor. As for the 'why'... You'd be surprised on how difficult is to get an answer like that from any doctor. My suspicion[0] is that they simply don't know anymore: It's something they learnt in college, but after a few years of dealing with symptoms and prescribing treatments, they forget about the why. Don't get me wrong, I kind of understand it. On one hand I've found that most people don't care about the 'what's or 'why's of medicine. They go to the doctor and either take the treatment they prescribe or not. I think the people that want to know the 'why' are a minority and doctor's time is valuable, so they end up processing people as fast as they can. On the other, medicine is a vast field and they need to keep up to date with the latest developments, so I can see how they can start to forget seemingly superfluous pieces of information when faced with all the new info they have to absorb. [0] From personal observation, so I can (I hope) to be mistaken.
- chimeracoder 10y ago
  > My suspicion [from personal observation] is that they simply don't know anymore: It's something they learnt in college, but after a few years of dealing with symptoms and prescribing treatments, they forget about the why. If your doctor actually doesn't know why it's necessary to take the full course of antibiotics (antibiotic resistance), please get a new doctor. Seriously. (And report the old one, since he/she should not be practicing). Of course, if the problem is simply that you can't get a layperson-intelligible answer from them, or get enough time with them for them to explain it to you, or if they're willing to explain it to you, but only if you ask... that's another story, and much more commonplace. The sad truth is, even for the most compassionate, attentive, dedicated doctor - the one who would always go the extra mile to provide you with the best care imaginable - over the years, it's become increasingly difficult (read: next-to-impossible) to dedicate that extra time to the patient unless they really press for it. Insurance reimbursements have been cut to the point where the only way most physicians can stay afloat is to make their practice a volume game[0]. As the patient, you're not actually the paying customer (the insurer is), and the insurer doesn't care if the doctor takes an extra five minutes to talk about bacterial resistance and evolution. They'll reimburse him/her the same amount either way[1]. The exception to this is high-end, self-paying practices (think 'concierge medicine'). Unsurprisingly, those tend to have the best service (of course, you pay heavily for this). [0] Or to go bankrupt, and sell to a hospital/practice group. Which is subject to the same pressure to generate volume, except the hospital cares a lot less about you, the patient, on an emotional level than a private practitioner does. [1] In fact, in the worst case, the provider is getting reimbursed exactly $0 for providing you this care, because you're on a capitated plan. Under captitation, the provider (usually a hospital) gets a fixed, annual amount per patient that they are responsible for, and that's all the payment they ever get. The idea there is that it discourages unnecessary care - which is true, but it also disincentivizes necessary care as well. And spending an extra 5 minutes to educate the patient in a way that may have an impact on broader public health, but is unlikely to affect their own actual care in any measurable way? They don't have time for that, and they're certainly not getting paid for it.
Dove 10y ago
This is a more general problem. Warning labels on toothpaste and such generally include the phrase "SERIOUS INJURY OR DEATH MAY RESULT" if they really mean something's dangerous. Medications don't seem to do the same thing, so you can't tell if they're worried about you irritating your stomach or ending the human race. In fact, I have a medication right in front of me that has a little label on it that says "Take or use exactly as directed. Do not discontinue or skip doses unless directed by your doctor." That's all it says about it on the bottle. Doesn't explain why. Doesn't say how serious it is. Doesn't even use an exclamation point. My first thought is, well, I've had lots of medications before that came with labels like that, and what they meant was, "You might get a little dizzy for a day or so if you stop too fast." Not this one, it turns out. Three paragraphs into the fine print on the literature that came with it, it says, "Some people who have suddenly stopped taking similar drugs have had . . . heart attacks." Oh. That really seems like it ought to be worth a "SERIOUS INJURY OR DEATH MAY RESULT".
CamperBob2 10y ago
For some reason (arrogance?) doctors don't explain their reasoning in many cases In this case it might be as simple as "I don't have time to argue with the patient about evolutionary biology." But that's probably a bigger issue in the US than in Canada.

by iLoch 10y ago

atmosx 10y ago

> Regarding (a) - do you know that I've never been told why I need to finish my antibiotics? Drug therapies have specific regimens that need to be respected in order to ensure the highest degree of success. An average regimen for penicillins (penicillin-derivatives) is 7 days because that's how many days it takes for the ATB to kill the bacterial infection. Now all the above is the N-th level of abstraction. If you really want to know what's on you need to start doing evaluations. You need data like from the patient like: - Age - Kg - Health state (liver, nephrons, stomach, allergies, etc.) - History the specific class of ATBs (how did your body and the infection react to this class of ATB in the past?) - Other medication (are there interactions with other drugs a patient might be taking?) - Food (e.g. you shouldn't eat St. John's Wort while on drugs, because it's a CYP3A4 inducer and so on and so forth...) - etc. And it goes further down the rabbit hole depending on the case. So, I of course prefer doctors who are big on explaining what's happening, but I understand those who don't. The thing is that once the doctor starts talking ,you will probably start asking why, especially if you're an engineer who wants to put everything into context. At some point you'll just won't be able to understand - which means he'll have to make silly analogies, even more explanation, etc. Add to that you might have been his 20th patient that day and you get the point. On the other hand, if you pay for it, you should be able to get a doctor which gives you the appropriate amount of care/explanations.

aggie 10y ago

I had also never heard an explanation before. I'd like to think I would inquire if it came up (haven't needed antibiotics since I was a kid), but many people aren't inquisitive. I had a similar lightbulb moment when I heard why you shouldn't slouch, even though it can be comfortable: the intervertebral discs in your spine are poorly innervated[1], so you don't feel the damage you are causing until it is severe. 1 - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2913007/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2913007/

loopbit 10y ago

Not only in Canada, it's like that in every country I've seen a doctor. As for the 'why'... You'd be surprised on how difficult is to get an answer like that from any doctor. My suspicion[0] is that they simply don't know anymore: It's something they learnt in college, but after a few years of dealing with symptoms and prescribing treatments, they forget about the why. Don't get me wrong, I kind of understand it. On one hand I've found that most people don't care about the 'what's or 'why's of medicine. They go to the doctor and either take the treatment they prescribe or not. I think the people that want to know the 'why' are a minority and doctor's time is valuable, so they end up processing people as fast as they can. On the other, medicine is a vast field and they need to keep up to date with the latest developments, so I can see how they can start to forget seemingly superfluous pieces of information when faced with all the new info they have to absorb. [0] From personal observation, so I can (I hope) to be mistaken.

chimeracoder 10y ago
> My suspicion [from personal observation] is that they simply don't know anymore: It's something they learnt in college, but after a few years of dealing with symptoms and prescribing treatments, they forget about the why. If your doctor actually doesn't know why it's necessary to take the full course of antibiotics (antibiotic resistance), please get a new doctor. Seriously. (And report the old one, since he/she should not be practicing). Of course, if the problem is simply that you can't get a layperson-intelligible answer from them, or get enough time with them for them to explain it to you, or if they're willing to explain it to you, but only if you ask... that's another story, and much more commonplace. The sad truth is, even for the most compassionate, attentive, dedicated doctor - the one who would always go the extra mile to provide you with the best care imaginable - over the years, it's become increasingly difficult (read: next-to-impossible) to dedicate that extra time to the patient unless they really press for it. Insurance reimbursements have been cut to the point where the only way most physicians can stay afloat is to make their practice a volume game[0]. As the patient, you're not actually the paying customer (the insurer is), and the insurer doesn't care if the doctor takes an extra five minutes to talk about bacterial resistance and evolution. They'll reimburse him/her the same amount either way[1]. The exception to this is high-end, self-paying practices (think 'concierge medicine'). Unsurprisingly, those tend to have the best service (of course, you pay heavily for this). [0] Or to go bankrupt, and sell to a hospital/practice group. Which is subject to the same pressure to generate volume, except the hospital cares a lot less about you, the patient, on an emotional level than a private practitioner does. [1] In fact, in the worst case, the provider is getting reimbursed exactly $0 for providing you this care, because you're on a capitated plan. Under captitation, the provider (usually a hospital) gets a fixed, annual amount per patient that they are responsible for, and that's all the payment they ever get. The idea there is that it discourages unnecessary care - which is true, but it also disincentivizes necessary care as well. And spending an extra 5 minutes to educate the patient in a way that may have an impact on broader public health, but is unlikely to affect their own actual care in any measurable way? They don't have time for that, and they're certainly not getting paid for it.

Dove 10y ago

This is a more general problem. Warning labels on toothpaste and such generally include the phrase "SERIOUS INJURY OR DEATH MAY RESULT" if they really mean something's dangerous. Medications don't seem to do the same thing, so you can't tell if they're worried about you irritating your stomach or ending the human race. In fact, I have a medication right in front of me that has a little label on it that says "Take or use exactly as directed. Do not discontinue or skip doses unless directed by your doctor." That's all it says about it on the bottle. Doesn't explain why. Doesn't say how serious it is. Doesn't even use an exclamation point. My first thought is, well, I've had lots of medications before that came with labels like that, and what they meant was, "You might get a little dizzy for a day or so if you stop too fast." Not this one, it turns out. Three paragraphs into the fine print on the literature that came with it, it says, "Some people who have suddenly stopped taking similar drugs have had . . . heart attacks." Oh. That really seems like it ought to be worth a "SERIOUS INJURY OR DEATH MAY RESULT".

CamperBob2 10y ago

For some reason (arrogance?) doctors don't explain their reasoning in many cases In this case it might be as simple as "I don't have time to argue with the patient about evolutionary biology." But that's probably a bigger issue in the US than in Canada.