5 ms·

It’s because people lie for many reasons. To get out of work, get disability, make a claim, to get opioids because they’re addicted to them etc. As a doctor, yo

It’s because people lie for many reasons. To get out of work, get disability, make a claim, to get opioids because they’re addicted to them etc. As a doctor, you’re probably going to become cynical after a while. This is very different from a baby because they have little motivation to lie and you can see them reacting to simple painful situations like bumping their head.

encryptluks2 4y ago
And if doctors are worried, the first step should be doing actual tests to see if people are experiencing pain. Not making some judgement based on their cynical bias whether someone is lying or being truthful. It is amazing how much of the medical community states they believe in science, yet they seem entirely disconnected from it at times.
- vkou 4y ago
  How can you, with an objective test, determine whether or not I am experiencing chronic pain, or if I'm just pretending to be experiencing chronic pain?
  - encryptluks2 4y ago
    Brain imaging would be a good example, but there is cortisol screenings among several other tests that can help determine that someone is actually in pain.
    - vkou 4y ago
      I could be wrong, but don't people with long-term chronic pain have normal cortisol levels?
      - encryptluks2 4y ago
        I'm sure they can, but it can be a very indicator as well: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4263906/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4263906/ https://www.practicalpainmanagement.com/pain/cortisol-screening-chronic-pain-patients https://www.practicalpainmanagement.com/pain/cortisol-screen...
- tsimionescu 4y ago
  Sure, just like instead of prescribing anti-depressants, we should first do a depression test. Unfortunately, neuroscience is not at a level where we can actually perform these tests. There is no objective measure to see if someone is in pain, or depressed, or suffering many other psychological symptoms.
  - encryptluks2 4y ago
    Actually, there are tests now for depression. And yes, you can do objective tests like brain imaging to see people's responses to stimuli among other things. What should not happen is for doctors to meet someone for 20 minutes, do nothing but talk to the person and say.. oh, I don't trust them they must be lying. Except, that is what doctors do all the time and there is no scientific basis for their decisions.
    - frumper 4y ago
      Sounds expensive, wouldn't it just be easier to trust them? I think the bigger problem is if a doctor doesn't know what's wrong or how to fix it, then they disengage.
      - encryptluks2 4y ago
        Yes it is easier to trust the patient, but unfortunately many medical professionals have implicit bias and don't.
    - tsimionescu 4y ago
      Can you point to some tests for depression? A quick Google only turned out some studies, nothing approved and usable in clinical settings (and one of the studies had a test that couldnt differentiate between depression and bipolar disorder). Similarly, brain imaging for pain is at the research level, and may come with several other risks. I doubt there are such tests that could be used to conclusively prove that someone is or is not in pain.
      - 4y ago
taurath 4y ago
Wondering if it might be possible to measure the pain people are feeling somehow. It’d be interesting to compare a person with a traumatic past vs one without
Broken_Hippo 4y ago
It’s because people lie for many reasons. So? The first response should always be to take folks seriously. Always. Even if they are really searching for opioids. No doctor should assume folks are lying upfront. Even if that means that a couple people are getting off work when they don't need it. And I'd much rather have a disability system that occasionally gives the wrong people benefits than to withhold benefits from someone and make their life torturous. Much like theft an loss are costs of retail, this should be the cost of a disability system: A few folks take advantage.
- Aransentin 4y ago
  Spitballing, but maybe the problem is that no doctors wants to be the guy in town who's the most generous with opioid prescriptions, as then he'll get swamped by people seeking opioids? People who look at the statistics after that, finding our doctor prescribing a significant amount of all opioids in the community, are liable to think that he's some sort of unscrupulous stooge of a pharmaceutical company. That'd cause a race to the bottom of pain medication skepticism. To fix that you'd need some sort of liability reform (as just changing guidelines will never work if it's opposed to a self-sustaining incentive gradient), though I'm not sure what that would actually entail.
  - orangepurple 4y ago
    It's because of the chilling effect of lawsuits and the risk of losing their DEA license that doctors in the United States are skeptical of issuing pain medication. Americans with genuine pain problems that cannot be effectively treated by local doctors despite persistent good-faith efforts should instead find a doctor in a Mexican border town where pain medication is more readily available.
  - Broken_Hippo 4y ago
    Spitballing, but maybe the problem is that no doctors wants to be the guy in town who's the most generous with opioid prescriptions, as then he'll get swamped by people seeking opioids? Nope. In a well-designed system, this just be minimal. Design a better system with better access to medical records throughout the system, lesser liability (the US, mostly), and paid medical leave so that people can actually heal. The alternative is simply that we leave folks in different levels of pain. Heck, even just being able to see prescriptions nationally would be a bonus (Right now, in Norway, when I get an electronic prescription, I can go to any pharmacy to fill it and they can see my prescription history) Innocent people shouldn't have to go to the black market for pain relief because they can't get things figured out legally. Again, I firmly believe that the first response should always be to believe the patient.
rpastuszak 4y ago
> As a doctor, you’re probably going to become cynical after a while. We should probably focus more on finding ways to reduce cynicism and lack of empathy in this profession than fighting false positives in the system. > It’s because people lie for many reasons. You should err on the side of caution and default to "they're probably not lying". Most of us can agree that applying the logic you're describing to the law would be wrong. Imagine that instead of having the presumption of innocence, we'd assume that certain types of people are probably guilty, so we'll punish them pre-emptively. This already happens, of course, because of racism, xenophobia etc... but we do agree that it's morally wrong and at least we're trying to fix it.
Hellbanevil 4y ago
They don't become cynical; they just don't really give a dam about pain, unless you are a high paying client. And in this climate of all opiates are the devil, I get it. We are in a weird state in pain managment. We essentially don't have anything to cure chronic pain, except cutting nerves. Opiates make people feel better physically, and emotionally. They are addictive because they work. Unlike all those tricyclic/heterocyclic drugs. Young people should never be on opiates, except during surgery. Old people in pain should not be denied the drug. It should be a right. (There are numerous studies of older people being given opiates for pain/misery, and most studies they did not want to increase their dosages.)
rprospero 4y ago
> As a doctor, you’re probably going to become cynical after a while. As my go to story on these sorts of issues, my partner had an ER doctor tell them that they hadn't been stabbed. The fact that there was an open wound oozing blood and multiple witnesses was not sufficient evidence. That wound was obviously a diabetic sore. That my partner is not diabetic was also a lie and the fact that their medical records showed no history of diabetes was merely proof of the incompetence of the previous doctors. Stitching the wound had to wait for two blood sugar tests to be performed, because the first test was could only have been a machine glitch. After a second negative test for diabetes, the doctor finally conceded that he couldn't rule out a stabbing.
- QuantumGood 4y ago
  How do some people end up making clearly counterproductive interpretations that ignore not only evidence in general, but clear evidence of harm to others? I remember a Google employee changed a popular font for headings. It broke the layout on a very large number of websites. Several people discussed this with the employee, suggesting the font should be forked rather than force-updated. The employee engaged, but refused. Eventually they said that if enough users contacted them with complaints, that would be evidence they would consider. When it was pointed out that it was very difficult to know how to contact them (they were not required to engage on the forum, or anywhere else, no contact information for them was otherwise findable, etc) they barely shrugged. It was as if part of the logic function in this human was managed by a 4 year old child internally.
  - bergenty 4y ago
    Your use of they makes this almost incomprehensible.
    - QuantumGood 4y ago
      Writers should use the singular “they” in two main cases: (a) when referring to a generic person whose gender is unknown or irrelevant to the context and (b) when referring to a specific, known person who uses “they” as their pronoun. – apastyle.apa.org I do not know the gender of the person under discussion, nor do I know if that person has pronoun preferences. I simply followed the "generic person whose gender is unknown" standard. I've been using "they" in this manner for 50+ years. Never had anyone comment on it before. Are you attempting some kind of meta virtue signalling, considering "pronoun preferences" is a very recently added option?

encryptluks2 4y ago

And if doctors are worried, the first step should be doing actual tests to see if people are experiencing pain. Not making some judgement based on their cynical bias whether someone is lying or being truthful. It is amazing how much of the medical community states they believe in science, yet they seem entirely disconnected from it at times.

vkou 4y ago
How can you, with an objective test, determine whether or not I am experiencing chronic pain, or if I'm just pretending to be experiencing chronic pain?
- encryptluks2 4y ago
  Brain imaging would be a good example, but there is cortisol screenings among several other tests that can help determine that someone is actually in pain.
  - vkou 4y ago
    I could be wrong, but don't people with long-term chronic pain have normal cortisol levels?
    - encryptluks2 4y ago
      I'm sure they can, but it can be a very indicator as well: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4263906/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4263906/ https://www.practicalpainmanagement.com/pain/cortisol-screening-chronic-pain-patients https://www.practicalpainmanagement.com/pain/cortisol-screen...
tsimionescu 4y ago
Sure, just like instead of prescribing anti-depressants, we should first do a depression test. Unfortunately, neuroscience is not at a level where we can actually perform these tests. There is no objective measure to see if someone is in pain, or depressed, or suffering many other psychological symptoms.
- encryptluks2 4y ago
  Actually, there are tests now for depression. And yes, you can do objective tests like brain imaging to see people's responses to stimuli among other things. What should not happen is for doctors to meet someone for 20 minutes, do nothing but talk to the person and say.. oh, I don't trust them they must be lying. Except, that is what doctors do all the time and there is no scientific basis for their decisions.
  - frumper 4y ago
    Sounds expensive, wouldn't it just be easier to trust them? I think the bigger problem is if a doctor doesn't know what's wrong or how to fix it, then they disengage.
    - encryptluks2 4y ago
      Yes it is easier to trust the patient, but unfortunately many medical professionals have implicit bias and don't.
  - tsimionescu 4y ago
    Can you point to some tests for depression? A quick Google only turned out some studies, nothing approved and usable in clinical settings (and one of the studies had a test that couldnt differentiate between depression and bipolar disorder). Similarly, brain imaging for pain is at the research level, and may come with several other risks. I doubt there are such tests that could be used to conclusively prove that someone is or is not in pain.
    - 4y ago

taurath 4y ago

Wondering if it might be possible to measure the pain people are feeling somehow. It’d be interesting to compare a person with a traumatic past vs one without

Broken_Hippo 4y ago

It’s because people lie for many reasons. So? The first response should always be to take folks seriously. Always. Even if they are really searching for opioids. No doctor should assume folks are lying upfront. Even if that means that a couple people are getting off work when they don't need it. And I'd much rather have a disability system that occasionally gives the wrong people benefits than to withhold benefits from someone and make their life torturous. Much like theft an loss are costs of retail, this should be the cost of a disability system: A few folks take advantage.

Aransentin 4y ago
Spitballing, but maybe the problem is that no doctors wants to be the guy in town who's the most generous with opioid prescriptions, as then he'll get swamped by people seeking opioids? People who look at the statistics after that, finding our doctor prescribing a significant amount of all opioids in the community, are liable to think that he's some sort of unscrupulous stooge of a pharmaceutical company. That'd cause a race to the bottom of pain medication skepticism. To fix that you'd need some sort of liability reform (as just changing guidelines will never work if it's opposed to a self-sustaining incentive gradient), though I'm not sure what that would actually entail.
- orangepurple 4y ago
  It's because of the chilling effect of lawsuits and the risk of losing their DEA license that doctors in the United States are skeptical of issuing pain medication. Americans with genuine pain problems that cannot be effectively treated by local doctors despite persistent good-faith efforts should instead find a doctor in a Mexican border town where pain medication is more readily available.
- Broken_Hippo 4y ago
  Spitballing, but maybe the problem is that no doctors wants to be the guy in town who's the most generous with opioid prescriptions, as then he'll get swamped by people seeking opioids? Nope. In a well-designed system, this just be minimal. Design a better system with better access to medical records throughout the system, lesser liability (the US, mostly), and paid medical leave so that people can actually heal. The alternative is simply that we leave folks in different levels of pain. Heck, even just being able to see prescriptions nationally would be a bonus (Right now, in Norway, when I get an electronic prescription, I can go to any pharmacy to fill it and they can see my prescription history) Innocent people shouldn't have to go to the black market for pain relief because they can't get things figured out legally. Again, I firmly believe that the first response should always be to believe the patient.

rpastuszak 4y ago

> As a doctor, you’re probably going to become cynical after a while. We should probably focus more on finding ways to reduce cynicism and lack of empathy in this profession than fighting false positives in the system. > It’s because people lie for many reasons. You should err on the side of caution and default to "they're probably not lying". Most of us can agree that applying the logic you're describing to the law would be wrong. Imagine that instead of having the presumption of innocence, we'd assume that certain types of people are probably guilty, so we'll punish them pre-emptively. This already happens, of course, because of racism, xenophobia etc... but we do agree that it's morally wrong and at least we're trying to fix it.

Hellbanevil 4y ago

They don't become cynical; they just don't really give a dam about pain, unless you are a high paying client. And in this climate of all opiates are the devil, I get it. We are in a weird state in pain managment. We essentially don't have anything to cure chronic pain, except cutting nerves. Opiates make people feel better physically, and emotionally. They are addictive because they work. Unlike all those tricyclic/heterocyclic drugs. Young people should never be on opiates, except during surgery. Old people in pain should not be denied the drug. It should be a right. (There are numerous studies of older people being given opiates for pain/misery, and most studies they did not want to increase their dosages.)

rprospero 4y ago

> As a doctor, you’re probably going to become cynical after a while. As my go to story on these sorts of issues, my partner had an ER doctor tell them that they hadn't been stabbed. The fact that there was an open wound oozing blood and multiple witnesses was not sufficient evidence. That wound was obviously a diabetic sore. That my partner is not diabetic was also a lie and the fact that their medical records showed no history of diabetes was merely proof of the incompetence of the previous doctors. Stitching the wound had to wait for two blood sugar tests to be performed, because the first test was could only have been a machine glitch. After a second negative test for diabetes, the doctor finally conceded that he couldn't rule out a stabbing.

QuantumGood 4y ago
How do some people end up making clearly counterproductive interpretations that ignore not only evidence in general, but clear evidence of harm to others? I remember a Google employee changed a popular font for headings. It broke the layout on a very large number of websites. Several people discussed this with the employee, suggesting the font should be forked rather than force-updated. The employee engaged, but refused. Eventually they said that if enough users contacted them with complaints, that would be evidence they would consider. When it was pointed out that it was very difficult to know how to contact them (they were not required to engage on the forum, or anywhere else, no contact information for them was otherwise findable, etc) they barely shrugged. It was as if part of the logic function in this human was managed by a 4 year old child internally.
- bergenty 4y ago
  Your use of they makes this almost incomprehensible.
  - QuantumGood 4y ago
    Writers should use the singular “they” in two main cases: (a) when referring to a generic person whose gender is unknown or irrelevant to the context and (b) when referring to a specific, known person who uses “they” as their pronoun. – apastyle.apa.org I do not know the gender of the person under discussion, nor do I know if that person has pronoun preferences. I simply followed the "generic person whose gender is unknown" standard. I've been using "they" in this manner for 50+ years. Never had anyone comment on it before. Are you attempting some kind of meta virtue signalling, considering "pronoun preferences" is a very recently added option?