5 ms·

It's fascinating, isn't it? It's also frustrating. You see a doctor because something hurts, they look at the something -- often in isolation -- and if they can

by elric 5y ago

It's fascinating, isn't it? It's also frustrating. You see a doctor because something hurts, they look at the something -- often in isolation -- and if they can't figure it out, you're pretty much on your own. I had constant foot pain in one foot for nearly a year. Doctors told me to rest. I walk a lot, and walking less wasn't really an option. Saw an osteopath, with more than a healthy dose of skepticism. They gave me exercises which were both baffling and ridiculous, which basically taught me how to use my big toes, then graduated to strengthening those muscles. At some point during this process, the pain went away, and it hasn't come back. Why couldn't my doctor identify this apparent muscle weakness in my foot? I don't know. But I'm glad the osteopath did.

bishoprook2 5y ago
>You see a doctor because something hurts, they look at the something -- often in isolation -- and if they can't figure it out, you're pretty much on your own. A quick Old Man(tm) rant. Concerning healthcare, you have to be your own project manager. They're a lot better at curing things they can see (ie. surgery), GPs have crude tools for analysis and mostly serve as gatekeepers to specialists and pharmacists. Also, GPs work mostly from flow charts and you are just one of 1000 patients they see that year. Communications between hospital departments, independent contractors like specialists or ER personnel, GPs, etc. are poor. Continuously audit procedures and drug regimes. Sci-Hub is your friend but don't overestimate the value of studies.
- foepys 5y ago
  I was told recently that there is already change happening. Medical students are being told that they need to work with the patient, not on them. Nobody knows their symptoms and illness better than the patient themselves. A doctor looks at them for 5 minutes, the patient lives with them so not including the patient in the diagnostic process is like working with a blindfold on.
  - arpa 5y ago
    there are also ideas about patient empowerment (since last century). Medical community is not the most flexible, but we'll get there.
  - ziml77 5y ago
    That's how good doctors have done it as far back as I can remember. If the person you're seeing isn't involving you in the process and trying to get the whole picture, you should try a different doctor. You don't have to stick with a doctor just because they're the closest or the one you happened to choose first.
- BoxOfRain 5y ago
  As someone with a rare neurological disorder that hadn’t even been clinically recognised when I contracted it (it was seen as a weird subset of migraine in the few places it’d been studied systematically) this is fantastic advice. I also had the joy of being put on SSRIs only to find out they interact horribly with my condition and there’s many reports of this that doctors for the most part seem totally unaware of. I won’t touch anything of the sort ever again as a result, I can only describe my experience as a bad trip that lasted around nine months.
  - elric 5y ago
    As someone who gets weird migraines, I can empathize. Can you elaborate on the nature of journey? Much appreciated!
    - BoxOfRain 5y ago
      No worries! It started when I was about fifteen or so, I noticed the sky looked "wrong" during a PE lesson. I'd developed what looked like TV static over my whole vision along with seeing trippy patterns in things like repeating tiles, things which came and went but were always there in some respect. I also started having weird dissociative episodes where everything felt like a dream and seemed to lack tangibility. Realising that something was wrong I asked my doctor who told me to go to an optician, who found no sign of eye disease. I went back to my doctor and I saw an opthalmologist who also found no eye disease, and then a neurologist who didn't really know what to make of me. He did a few tests including getting me to stare at some trippy patterns with electrodes glued to my head, then said words to the effect of "we don't really know what this is, but it's unlikely to be anything bad so just try and imagine it away". I could have had a brain scan at this point but I had braces on my teeth at the time which would have made it an enormous faff, so it wasn't seen as a good risk/reward ratio. Years later when I was a university student it got suddenly worse. I remember the exact day, I had an awful fever from some bug I picked up but still took some painkillers and went out drinking with my housemates as I wasn't sleeping anyway and figured the good old "miracle of the sesh" might make me feel less grotty. The next day I went to lectures and couldn't read the board with the slides on it. My visual symptoms had got much worse, I've never really been able to account for why (whether it was the booze, the fever, or just chance) and new ones had developed too, including a permanent, painful pressure on one side at the back of my head. These acute episodes got increasingly worse until my final exams which I bombed spectacularly because while I could just about read the letters and words, they wouldn't really form meaning properly*. This was terrifying, and I quickly sought medical help. The problem was the NHS waiting lists for non-urgent things would have meant I'd have drop out of uni indefinitely rather than simply re-sitting my third year so I had to go private, which I was very fortunately to be able to do. I saw another barrage of opthalmologists, neurologists, and other professionals who didn't really recognise what was going on until I finally saw a neuro-opthalmologist who diagnosed me with visual snow syndrome, a recently recognised disorder that's believed to happen when the brain fails to filter out its own noise which then "leaks" into your conscious perception. It turns out I'm not actually hallucinating, what I'm seeing is the inherent noise of the brain's visual system which is actually kind of cool in a sense, it's a bit of a draught through the doors of perception! The cause of this isn't actually known but visual snow produces characteristic markers visible on an fMRI scan and it's theorised to be caused by a localised problem with metabolism in certain areas of the brain. The problem after that was that anxiety disorders are often comorbid with visual snow (perhaps unsurprisingly, given the nature of the disorder) and I'd spent the last two years or so convinced I had some deleterious brain disease - given the rapid decline and painful pressure in my head I don't think this was an unreasonable fear. I was put on SSRIs because of this, which rather like a Faustian pact made everything infinitely worse very quickly. I'm not sure of the scientific nature of the interaction between jacked up serotonin levels and visual snow syndrome but the subjective nature is almost literally Hellish. Not the Calvinist fire and brimstone Hell, but the kind of Hell that's a total seperation between oneself and everything that is joyful and light in the world. I don't have the literary skills to do the description justice, but the "Life in Death" of the Rime of the Ancient Mariner or J.K. Rowling's "Dementor's Kiss" are both pretty close in different ways! I cannot stress how unpleasant this was enough, I honestly struggle to express how bad it was without coming across as melodramatic. Other visual snow patients prescribed SSRIs have anecdotally reported similarly unpleasant worsening of their disassociative symptoms, but as far as I know this isn't currently acknowledged in medical literature on the subject. I managed to pass my degree with second class honours, and I went cold turkey on the SSRIs. I also managed to have an appointment with the UK's leading researcher on the disorder, which was very helpful! Quitting SSRIs was a very punishing process, but over the course of about six to nine months (!) I slowly began to regain everything the drugs had robbed me of. I sought out therapy because of my experience which has been extremely useful, and I've made adaptations to my life which allow me to live fairly normally. The chronic pain is effectively managed with CBD (luckily it's legal in my country which is otherwise utterly backwards on the subject of cannabis!) and the other chronic aspects are effectively managed using adaptations like close control of colour temperature and certain fonts to make programming easier (monofur is my current choice). The acute episodes still happen and they're still grim, but they've cost me little enough in sick days I can still be gainfully employed as a programmer. While the acute episodes are grim while they're happening, the only disability I face 100% of the time now is my lack of night vision (so I'll never be able to drive in the dark), the photophobia (I'm always in sunglasses even on cloudy days), and general sensory overload issues. *this is consistent with the fact the lingual gyrus is implicated in visual snow, a part of the brain known to be involved in processing vision, especially written language.*
- chewz 5y ago
  > Concerning healthcare, you have to be your own project manager. +1 for that. 10 years ago I had misdiagnosed cancer for 3 years despite seeing lots of doctors. The symptoms were there but none of the doctors connected the dots. Since that experience I am coming to the doctors prepared and with defined expectations. And I engage them in well defined Q&As which have defined goals. I am taking care of my 90 years old Mom now and I do the same - I read the medial literature and suggest to the doctors what results I am expecting. To my surprise most doctors are quite keen to co-operate. I have improved my Moms quality of life suggesting replacing sleeping pills for mild ant-anxiety pills, and getting anti-depressants that work well for osteoarthritis pain.
nradov 5y ago
If something hurts then why should the default reaction be to see a doctor? It makes more sense to start with a trainer or physical therapist first. Then if you're not seeing improvement after a few weeks move up the continuum of care to a physician and investigate medical treatments. We can't fairly criticize doctors for not knowing absolutely everything about the human body.
- Noumenon72 5y ago
  That's a good question. I had to learn this lesson through experience -- that doctors rarely solved anything, while self-study and exercise worked miracles. But I was 35 before I really got beyond "Well, I went to the doctor, nothing else I can do."
- cmiles74 5y ago
  My personal experience has been that I need a referral from my primary physician before I can get physical therapy covered under my insurance. So far, when I express to my physician my interest in PT they are happy to provide the referral. That said, the idea that PT may be more effective than medication or surgery is kind of new to me. People may need to be informed that PT is a possible solution for a some pain, especially those a physician may find difficult to diagnose.
- newbamboo 5y ago
  Physical therapists are more helpful than doctors for many maybe most problems, in my experience, though the variation in quality may be greater. Part of this could be economics; pt’s have more time. In the future I think having pt rather than doctors as primary point of contact for most patients will be shown to result in better outcomes. I susspect the reason this isn’t already the way it works is mostly because of organized labor (the ama wouldn’t have it) and liability.
- void_mint 5y ago
  > If something hurts then why should the default reaction be to see a doctor? If something hurts the default is, and should be, consulting a primary care physician, who should then forward your issue to a specialist. PTs are less trained and less useful than MDs, so their scope should be more limited (and should only be consulted for appropriate ailments).
dade_ 5y ago
Ha! Exactly that, he has named all of his exercise with humorous names. Worst result is the referral to a podiatrist for expensive insoles that IMHO are snake oil. Huge waste of time and money. It turned out that the primary problem they were trying to fix was an issue with glute activation, nothing to do with the foot itself.
xyzzy21 5y ago
Doctors tend to be shockingly "analytic" and siloed in how they approach things. Easily 99% in my experience. Problem: the human body is a system rather than a "bag of parts"! If they know bones, everything is caused by bones. It's a variant of "if your only tool is a hammer, every problem looks like a nail". Each specialization has only one tool: a hammer or screwdriver, etc. and that's the only lens most have. None know how to holistically look at things or, for example, consider that bones are connected to tendons to muscles so all three are likely to be involved in certain common pathologies. The other issue I have with most: they are both shallow and gullible AF. It's far too easy to "suggest" an ailment and get them to only focus on that. Objectivity is not part of their methods in my experience. That does not build trust either. So both of these combined to create a lot of "cookbook medicine" - like the old pizza commercial: "I go to the fridge and get the box!" which is everything they do. At least in America. I've had better experiences with doctors overseas sometimes. Not always but sometimes concierge/resort medicine does better. More time. More focus.

by elric 5y ago

bishoprook2 5y ago

>You see a doctor because something hurts, they look at the something -- often in isolation -- and if they can't figure it out, you're pretty much on your own. A quick Old Man(tm) rant. Concerning healthcare, you have to be your own project manager. They're a lot better at curing things they can see (ie. surgery), GPs have crude tools for analysis and mostly serve as gatekeepers to specialists and pharmacists. Also, GPs work mostly from flow charts and you are just one of 1000 patients they see that year. Communications between hospital departments, independent contractors like specialists or ER personnel, GPs, etc. are poor. Continuously audit procedures and drug regimes. Sci-Hub is your friend but don't overestimate the value of studies.

foepys 5y ago
I was told recently that there is already change happening. Medical students are being told that they need to work with the patient, not on them. Nobody knows their symptoms and illness better than the patient themselves. A doctor looks at them for 5 minutes, the patient lives with them so not including the patient in the diagnostic process is like working with a blindfold on.
- arpa 5y ago
  there are also ideas about patient empowerment (since last century). Medical community is not the most flexible, but we'll get there.
- ziml77 5y ago
  That's how good doctors have done it as far back as I can remember. If the person you're seeing isn't involving you in the process and trying to get the whole picture, you should try a different doctor. You don't have to stick with a doctor just because they're the closest or the one you happened to choose first.
BoxOfRain 5y ago
As someone with a rare neurological disorder that hadn’t even been clinically recognised when I contracted it (it was seen as a weird subset of migraine in the few places it’d been studied systematically) this is fantastic advice. I also had the joy of being put on SSRIs only to find out they interact horribly with my condition and there’s many reports of this that doctors for the most part seem totally unaware of. I won’t touch anything of the sort ever again as a result, I can only describe my experience as a bad trip that lasted around nine months.
- elric 5y ago
  As someone who gets weird migraines, I can empathize. Can you elaborate on the nature of journey? Much appreciated!
  - BoxOfRain 5y ago
    No worries! It started when I was about fifteen or so, I noticed the sky looked "wrong" during a PE lesson. I'd developed what looked like TV static over my whole vision along with seeing trippy patterns in things like repeating tiles, things which came and went but were always there in some respect. I also started having weird dissociative episodes where everything felt like a dream and seemed to lack tangibility. Realising that something was wrong I asked my doctor who told me to go to an optician, who found no sign of eye disease. I went back to my doctor and I saw an opthalmologist who also found no eye disease, and then a neurologist who didn't really know what to make of me. He did a few tests including getting me to stare at some trippy patterns with electrodes glued to my head, then said words to the effect of "we don't really know what this is, but it's unlikely to be anything bad so just try and imagine it away". I could have had a brain scan at this point but I had braces on my teeth at the time which would have made it an enormous faff, so it wasn't seen as a good risk/reward ratio. Years later when I was a university student it got suddenly worse. I remember the exact day, I had an awful fever from some bug I picked up but still took some painkillers and went out drinking with my housemates as I wasn't sleeping anyway and figured the good old "miracle of the sesh" might make me feel less grotty. The next day I went to lectures and couldn't read the board with the slides on it. My visual symptoms had got much worse, I've never really been able to account for why (whether it was the booze, the fever, or just chance) and new ones had developed too, including a permanent, painful pressure on one side at the back of my head. These acute episodes got increasingly worse until my final exams which I bombed spectacularly because while I could just about read the letters and words, they wouldn't really form meaning properly*. This was terrifying, and I quickly sought medical help. The problem was the NHS waiting lists for non-urgent things would have meant I'd have drop out of uni indefinitely rather than simply re-sitting my third year so I had to go private, which I was very fortunately to be able to do. I saw another barrage of opthalmologists, neurologists, and other professionals who didn't really recognise what was going on until I finally saw a neuro-opthalmologist who diagnosed me with visual snow syndrome, a recently recognised disorder that's believed to happen when the brain fails to filter out its own noise which then "leaks" into your conscious perception. It turns out I'm not actually hallucinating, what I'm seeing is the inherent noise of the brain's visual system which is actually kind of cool in a sense, it's a bit of a draught through the doors of perception! The cause of this isn't actually known but visual snow produces characteristic markers visible on an fMRI scan and it's theorised to be caused by a localised problem with metabolism in certain areas of the brain. The problem after that was that anxiety disorders are often comorbid with visual snow (perhaps unsurprisingly, given the nature of the disorder) and I'd spent the last two years or so convinced I had some deleterious brain disease - given the rapid decline and painful pressure in my head I don't think this was an unreasonable fear. I was put on SSRIs because of this, which rather like a Faustian pact made everything infinitely worse very quickly. I'm not sure of the scientific nature of the interaction between jacked up serotonin levels and visual snow syndrome but the subjective nature is almost literally Hellish. Not the Calvinist fire and brimstone Hell, but the kind of Hell that's a total seperation between oneself and everything that is joyful and light in the world. I don't have the literary skills to do the description justice, but the "Life in Death" of the Rime of the Ancient Mariner or J.K. Rowling's "Dementor's Kiss" are both pretty close in different ways! I cannot stress how unpleasant this was enough, I honestly struggle to express how bad it was without coming across as melodramatic. Other visual snow patients prescribed SSRIs have anecdotally reported similarly unpleasant worsening of their disassociative symptoms, but as far as I know this isn't currently acknowledged in medical literature on the subject. I managed to pass my degree with second class honours, and I went cold turkey on the SSRIs. I also managed to have an appointment with the UK's leading researcher on the disorder, which was very helpful! Quitting SSRIs was a very punishing process, but over the course of about six to nine months (!) I slowly began to regain everything the drugs had robbed me of. I sought out therapy because of my experience which has been extremely useful, and I've made adaptations to my life which allow me to live fairly normally. The chronic pain is effectively managed with CBD (luckily it's legal in my country which is otherwise utterly backwards on the subject of cannabis!) and the other chronic aspects are effectively managed using adaptations like close control of colour temperature and certain fonts to make programming easier (monofur is my current choice). The acute episodes still happen and they're still grim, but they've cost me little enough in sick days I can still be gainfully employed as a programmer. While the acute episodes are grim while they're happening, the only disability I face 100% of the time now is my lack of night vision (so I'll never be able to drive in the dark), the photophobia (I'm always in sunglasses even on cloudy days), and general sensory overload issues. *this is consistent with the fact the lingual gyrus is implicated in visual snow, a part of the brain known to be involved in processing vision, especially written language.*
chewz 5y ago
> Concerning healthcare, you have to be your own project manager. +1 for that. 10 years ago I had misdiagnosed cancer for 3 years despite seeing lots of doctors. The symptoms were there but none of the doctors connected the dots. Since that experience I am coming to the doctors prepared and with defined expectations. And I engage them in well defined Q&As which have defined goals. I am taking care of my 90 years old Mom now and I do the same - I read the medial literature and suggest to the doctors what results I am expecting. To my surprise most doctors are quite keen to co-operate. I have improved my Moms quality of life suggesting replacing sleeping pills for mild ant-anxiety pills, and getting anti-depressants that work well for osteoarthritis pain.

nradov 5y ago

If something hurts then why should the default reaction be to see a doctor? It makes more sense to start with a trainer or physical therapist first. Then if you're not seeing improvement after a few weeks move up the continuum of care to a physician and investigate medical treatments. We can't fairly criticize doctors for not knowing absolutely everything about the human body.

Noumenon72 5y ago
That's a good question. I had to learn this lesson through experience -- that doctors rarely solved anything, while self-study and exercise worked miracles. But I was 35 before I really got beyond "Well, I went to the doctor, nothing else I can do."
cmiles74 5y ago
My personal experience has been that I need a referral from my primary physician before I can get physical therapy covered under my insurance. So far, when I express to my physician my interest in PT they are happy to provide the referral. That said, the idea that PT may be more effective than medication or surgery is kind of new to me. People may need to be informed that PT is a possible solution for a some pain, especially those a physician may find difficult to diagnose.
newbamboo 5y ago
Physical therapists are more helpful than doctors for many maybe most problems, in my experience, though the variation in quality may be greater. Part of this could be economics; pt’s have more time. In the future I think having pt rather than doctors as primary point of contact for most patients will be shown to result in better outcomes. I susspect the reason this isn’t already the way it works is mostly because of organized labor (the ama wouldn’t have it) and liability.
void_mint 5y ago
> If something hurts then why should the default reaction be to see a doctor? If something hurts the default is, and should be, consulting a primary care physician, who should then forward your issue to a specialist. PTs are less trained and less useful than MDs, so their scope should be more limited (and should only be consulted for appropriate ailments).

dade_ 5y ago

Ha! Exactly that, he has named all of his exercise with humorous names. Worst result is the referral to a podiatrist for expensive insoles that IMHO are snake oil. Huge waste of time and money. It turned out that the primary problem they were trying to fix was an issue with glute activation, nothing to do with the foot itself.

xyzzy21 5y ago

Doctors tend to be shockingly "analytic" and siloed in how they approach things. Easily 99% in my experience. Problem: the human body is a system rather than a "bag of parts"! If they know bones, everything is caused by bones. It's a variant of "if your only tool is a hammer, every problem looks like a nail". Each specialization has only one tool: a hammer or screwdriver, etc. and that's the only lens most have. None know how to holistically look at things or, for example, consider that bones are connected to tendons to muscles so all three are likely to be involved in certain common pathologies. The other issue I have with most: they are both shallow and gullible AF. It's far too easy to "suggest" an ailment and get them to only focus on that. Objectivity is not part of their methods in my experience. That does not build trust either. So both of these combined to create a lot of "cookbook medicine" - like the old pizza commercial: "I go to the fridge and get the box!" which is everything they do. At least in America. I've had better experiences with doctors overseas sometimes. Not always but sometimes concierge/resort medicine does better. More time. More focus.