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> But now imagine for a second that the abdominal pain actually was a manifestation of a back disc issue. Few gastrointestinal specialists would find that and s

> But now imagine for a second that the abdominal pain actually was a manifestation of a back disc issue. Few gastrointestinal specialists would find that and say “I think your back is the real problem and the gut pain is just a secondary symptom”. What are you talking about? Referred pain is well known and any doctor and especially any specialist will have studied and be familiar with common and likely referred pain pathways in the same way that they're familiar with other common interactions between systems. If you're struck with left arm pain while seeing an orthapedic surgeon, they'll make sure that you're not having a heart attack rather than trying to rule out orthapedic causes first. In your example, assuming an uncommon referred pain that your gastroenterologist is not familiar with, what more do you want from them than ruling out a gastrological cause? It's incredibly useful information that you and your primary care physician will be able to use to help track down the real cause. And if, after consulting multiple specialists, your primary care physician has no more ideas for pursuing the root cause of the issue, they'll help manage your chronic condition in consultation with a pain specialist and psychologist if required. Bottom line, doctors think more holistically thank you realise. To the extent that isn't sufficient, the medical system as a whole should be treating the patient as a whole. If that's not happening because of a variety of perverse incentives that's the fault of how we structure and pay for our healthcare systems and not the fault of western medicine.

alkonaut 7y ago
> what more do you want from them than ruling out a gastrological cause? I just want to get rid of the abdominal pain - I really don’t care about whether the cause is actually gastrointestinal. I want to rule out illness, that they are good at. If the referred pain isn’t a known condition such as a herniated disc or anything else that shows up on a test o image - then they are usually not concerned at all (no illness - job done). And even if it is a known/visible cause outside their specialization, they are extremely bad in my experience at both recognizing and “referring sideways” to another specialist. I live under a single payer system so the economics probably don’t factor into it, but I think the siloed thinking at specialists requires that the generalists take a holistic perspective, but in reality they cure tonsillitis and point to specialists. Somewhere I feel there is a gap.
TheOtherHobbes 7y ago
I'm not sure there's a huge distinction between "how we structure and pay for our healthcare systems" and "western medicine." As for the holistic view - there's a difference between check-list diagnosis (left arm pain -> possible heart attack) and what is effectively personal medical research, which may require knowledge of everything from diet to sleeping habits to emotional stressors to historical infections and illnesses. (That's a very short list, and not in any way exhaustive.) There are limited professional incentives for doctors to dig into patient history with that level of detail. It's not a matter of specialist referrals, because some problems can be caused by multiple minor factors interacting with each other. Or they may have very generic symptoms, like fatigue, with a ridiculously huge number of possible causes. Or the causes still aren't understood. Medicine is an example of a huge market failure. Not only is it the single biggest cause of personal bankruptcy in the US, but most people have had personal experience of obvious delayed diagnosis or outright misdiagnosis. An effective market - rather than a "rational" one - could easily support a much larger number of doctors and supporting medical professionals, including non-corporate researchers. The effect on "western medicine" would be a dramatic increase in effectiveness.
- crispinb 7y ago
  > I'm not sure there's a huge distinction between "how we structure and pay for our healthcare systems" and "western medicine." Given that different 'western' nations structure and pay for their health care systems entirely differently, there must be, mustn't there? Or are you conflating "Western medicine" with "US medicine"? Indeed you are: > Medicine is an example of a huge market failure.

alkonaut 7y ago

> what more do you want from them than ruling out a gastrological cause? I just want to get rid of the abdominal pain - I really don’t care about whether the cause is actually gastrointestinal. I want to rule out illness, that they are good at. If the referred pain isn’t a known condition such as a herniated disc or anything else that shows up on a test o image - then they are usually not concerned at all (no illness - job done). And even if it is a known/visible cause outside their specialization, they are extremely bad in my experience at both recognizing and “referring sideways” to another specialist. I live under a single payer system so the economics probably don’t factor into it, but I think the siloed thinking at specialists requires that the generalists take a holistic perspective, but in reality they cure tonsillitis and point to specialists. Somewhere I feel there is a gap.

TheOtherHobbes 7y ago

I'm not sure there's a huge distinction between "how we structure and pay for our healthcare systems" and "western medicine." As for the holistic view - there's a difference between check-list diagnosis (left arm pain -> possible heart attack) and what is effectively personal medical research, which may require knowledge of everything from diet to sleeping habits to emotional stressors to historical infections and illnesses. (That's a very short list, and not in any way exhaustive.) There are limited professional incentives for doctors to dig into patient history with that level of detail. It's not a matter of specialist referrals, because some problems can be caused by multiple minor factors interacting with each other. Or they may have very generic symptoms, like fatigue, with a ridiculously huge number of possible causes. Or the causes still aren't understood. Medicine is an example of a huge market failure. Not only is it the single biggest cause of personal bankruptcy in the US, but most people have had personal experience of obvious delayed diagnosis or outright misdiagnosis. An effective market - rather than a "rational" one - could easily support a much larger number of doctors and supporting medical professionals, including non-corporate researchers. The effect on "western medicine" would be a dramatic increase in effectiveness.

crispinb 7y ago
> I'm not sure there's a huge distinction between "how we structure and pay for our healthcare systems" and "western medicine." Given that different 'western' nations structure and pay for their health care systems entirely differently, there must be, mustn't there? Or are you conflating "Western medicine" with "US medicine"? Indeed you are: > Medicine is an example of a huge market failure.