6 ms·

> The core issue is that the system is just not good at catching outliers, and the only conceivable way to do so would be incredibly wasteful and expensive. Bu

by tivert 2y ago

> The core issue is that the system is just not good at catching outliers, and the only conceivable way to do so would be incredibly wasteful and expensive. But in this case, I don't think it would be "incredibly wasteful and expensive." The case study stated, "On her ED visits, she was discharged with the diagnosis of alcohol intoxication, despite her reports of no alcohol intake, corroborated by her family." She didn't need some expensive diagnostic test for a diagnosis, she needed a doctor to pay attention to what she and her family were saying.

shermantanktop 2y ago
And to disregard their previous experience with high-functioning alcoholics who deny everything when they mess up. I’d bet there’s a lot more hidden day-drinkers out there than patients like this. As someone with a relatively obscure condition, I’ve gotten used to being the pachinko ball that falls straight down the diagnostic chart to the wrong conclusion. But I understand the numbers are against me.
- encoderer 2y ago
  Yes. High functioning alcoholics are not checking themselves into the emergency room 9 times over a year.
- monkeyfun 2y ago
  Should doctors never trust their patients? What's the threshold for where doctors should begin to believe their patients' claims, as opposed to simply assuming they're merely some drug addict seeking another hit or someone lazy seeking time off work? I'm someone who's specifically had GI doctors ignore what I say so intensely as for this conversation to have seriously taken place: Me: "The [medication] might have worked, I feel slightly better, but it was way too strong. I had nearly all the major side effects that the instructions said to contact you if I get them. Is there any smaller dose, or could I try out something else?" GI Specialist: "Ok, so would you like me to increase the dose? I can prescribe [double]." Edit: meant to conclude that I think it's not just excessive distrust, and that it'd be absurd and cruel to just always distrust patients completely -- that doctors definitely seem to ignore patients heavily, especially if they're in any way abnormal.
  - s1artibartfast 2y ago
    Doctors are human. how did the rest of conversation go? did you explain that they misunderstood what you said? Also, Did you consider just taking half the dose?
    - hooverd 2y ago
      They can't be human too and make oopsie whoopsies with no repercussions while demanding unlimited deference from society.
      - s1artibartfast 2y ago
        What is this "unlimited deference" you speak of? I dont think doctors should be elevated to some super-human status. They are human. Many of them do a tricky and socially useful job, but there is nothing magic about it or them.
    - monkeyfun 2y ago
      The rest of the conversation was mostly uneventful, I did explain it but got told that it was the smallest dosage available. As for the doctor personally he mostly just acted like it was a misunderstanding and not actively not paying attention to what I was clearly saying, but I'd have to say that's a pretty incredible lack of listening/language comprehension for a native english speaker with a college degree. I sure didn't trust that doctor ever again to be paying attention or properly respond to my symptoms if he could hear the exact opposite of what I said. And as for dose, it was a medication measured in micrograms -- I'd have to be able to carefully measure microgram amounts and put them back into new capsules, it wasn't very realistic. I wound up finding alternatives on my own. As an aside, I actually have FAR worse stories of GI doctors being incompetent and careless, that one just seemed the most relevant to the topic there. One other funny one seriously went like: GI Specialist Dr., "No, you can't really be feeling pain there, the intestines don't have any nerves" Me, "So why did you say I needed to be sedated for my colonoscopy because it would be too painful otherwise?" Dr, [angry response about if I want to just argue or let him do his job] If you can't tell, I soon switched doctors after. But overall that sort of encounter, or things like even violating their own medical association's recommendations such as with prescribing PPIs and Antibiotics simultaneously to a patient already at higher risk of c. Difficile or more than one doctor not being aware of which painkillers are NSAIDs (Yes, really! One GI and one Urologist) has really reduced my trust in specialists, at least in Texas. They so, so, so often seem to just ignore or disbelieve patients.
- tivert 2y ago
  > And to disregard their previous experience with high-functioning alcoholics who deny everything when they mess up. I’d bet there’s a lot more hidden day-drinkers out there than patients like this. I'd rather them disregard their bias than disregard their patients. If someone insists they don't drink when challenged with the BAC data (especially with corroboration like in this case), do a test to determine if they're lying or not. Don't just assume they're lying. But doctors often are arrogant and unwilling to admit error, even to other doctors. The best you can sometimes do in those situations is to get bossy and try to take control of the situation (e.g. I know you're assuming I'm a lying alcoholic, but I don't drink, so explain to me how I could be intoxicated without drinking...what tests would you need to prove that...), but not everyone has the confidence to do that or to do it only when it's needed.
  - DoreenMichele 2y ago
    When I was extremely sick, I was super frustrated with the 15 Minute Appointment. It was more infuriating than the things that inspired me to bitterly joke "They majored in medicine and minored in hubris and contempt." Some of my big breakthroughs came in ER visits where they are a little more focused on problem solving and less on getting you out the door in time to keep to schedule. It doesn't live up to the fiction of House but sometimes if I had good rapport with an ER doctor, they took a few minutes to think about how best to keep me out of their ER in the future. This sometimes got me what a relative called "real drugs instead of tea and sympathy." We have a broken system. I don't know how to fix it but some of the criticisms of specific people in the broken system implicitly assume "These people are the problem!" And that doesn't really fit my firsthand experience.
    - nerdponx 2y ago
      > little more focused on problem solving I actually had a great ER experience along these lines. I felt bad being there after it became clear that I was going to be fine while there was a lady wailing in pain about 10 feet away, but at least I left with a lot of things to discuss with my regular doctor and I at least knew when I should/shouldn't worry in future situations.
  - 2y ago
DoreenMichele 2y ago
Women get dismissed a lot by doctors. (This is common enough knowledge I'm not going to provide citations in spite of being a woman posting on an overwhelmingly male forum. If you downvote this without doing a quick google: There's your problem.) When I was a homemaker and having serious health issues, I sometimes wore a suit to see a medical professional to try to get them to take me more seriously. I used to bitch to friends that I felt like pinning a list of my academic achievements to my lapel. "Oh, it's a homemaker. Must be stupid! Couldn't possibly have been a good student in school! Smart women all have serious careers." Yeah, sure. That's reality./s
- wing-_-nuts 2y ago
  If 200 people presented with alcohol intoxication and no history of use, 199 would be secret alcoholics sneaking booze, and maybe 1 would be someone with this condition. The previous case I read about, they forced the poor guy to inpatient for weeks to rule out alcohol use. It's not just 'doctors don't believe women' it's 'doctors don't believe (probable) addicts'.
  - roxya 2y ago
    Yeah, as a man nobody would believe me either. I was in hospital with acute pancreatitis and they found at the same time I had a fatty liver. Both are often explained by heavy alcohol intake. The truth is I hardly drank at all (I had perhaps had a single bottle of beer in the whole previous 12 months) but nobody would believe me. I ended up being told to never drink alcohol again.
    - rvnx 2y ago
      Did you find a solution eventually ?
      - roxya 2y ago
        Not really. Since then I've been unable to eat bananas due to a severe bloated feeling (even a tiny bite causes it), and I found a Japanese research paper about a banana allergy inducing acute pancreatitis. But I don't know for sure if it's linked. I've continued to drink alcohol in moderation for another 15 years+ without issue.
s1artibartfast 2y ago
And that is the tradeoff. 99.999% of the time the person is lying, confused, or crazy. I doubt it was lack of attention, but lack of trust instead.
- op00to 2y ago
  You get much further with crazy people by not directly challenging them.

by tivert 2y ago

shermantanktop 2y ago

And to disregard their previous experience with high-functioning alcoholics who deny everything when they mess up. I’d bet there’s a lot more hidden day-drinkers out there than patients like this. As someone with a relatively obscure condition, I’ve gotten used to being the pachinko ball that falls straight down the diagnostic chart to the wrong conclusion. But I understand the numbers are against me.

encoderer 2y ago
Yes. High functioning alcoholics are not checking themselves into the emergency room 9 times over a year.
monkeyfun 2y ago
Should doctors never trust their patients? What's the threshold for where doctors should begin to believe their patients' claims, as opposed to simply assuming they're merely some drug addict seeking another hit or someone lazy seeking time off work? I'm someone who's specifically had GI doctors ignore what I say so intensely as for this conversation to have seriously taken place: Me: "The [medication] might have worked, I feel slightly better, but it was way too strong. I had nearly all the major side effects that the instructions said to contact you if I get them. Is there any smaller dose, or could I try out something else?" GI Specialist: "Ok, so would you like me to increase the dose? I can prescribe [double]." Edit: meant to conclude that I think it's not just excessive distrust, and that it'd be absurd and cruel to just always distrust patients completely -- that doctors definitely seem to ignore patients heavily, especially if they're in any way abnormal.
- s1artibartfast 2y ago
  Doctors are human. how did the rest of conversation go? did you explain that they misunderstood what you said? Also, Did you consider just taking half the dose?
  - hooverd 2y ago
    They can't be human too and make oopsie whoopsies with no repercussions while demanding unlimited deference from society.
    - s1artibartfast 2y ago
      What is this "unlimited deference" you speak of? I dont think doctors should be elevated to some super-human status. They are human. Many of them do a tricky and socially useful job, but there is nothing magic about it or them.
  - monkeyfun 2y ago
    The rest of the conversation was mostly uneventful, I did explain it but got told that it was the smallest dosage available. As for the doctor personally he mostly just acted like it was a misunderstanding and not actively not paying attention to what I was clearly saying, but I'd have to say that's a pretty incredible lack of listening/language comprehension for a native english speaker with a college degree. I sure didn't trust that doctor ever again to be paying attention or properly respond to my symptoms if he could hear the exact opposite of what I said. And as for dose, it was a medication measured in micrograms -- I'd have to be able to carefully measure microgram amounts and put them back into new capsules, it wasn't very realistic. I wound up finding alternatives on my own. As an aside, I actually have FAR worse stories of GI doctors being incompetent and careless, that one just seemed the most relevant to the topic there. One other funny one seriously went like: GI Specialist Dr., "No, you can't really be feeling pain there, the intestines don't have any nerves" Me, "So why did you say I needed to be sedated for my colonoscopy because it would be too painful otherwise?" Dr, [angry response about if I want to just argue or let him do his job] If you can't tell, I soon switched doctors after. But overall that sort of encounter, or things like even violating their own medical association's recommendations such as with prescribing PPIs and Antibiotics simultaneously to a patient already at higher risk of c. Difficile or more than one doctor not being aware of which painkillers are NSAIDs (Yes, really! One GI and one Urologist) has really reduced my trust in specialists, at least in Texas. They so, so, so often seem to just ignore or disbelieve patients.
tivert 2y ago
> And to disregard their previous experience with high-functioning alcoholics who deny everything when they mess up. I’d bet there’s a lot more hidden day-drinkers out there than patients like this. I'd rather them disregard their bias than disregard their patients. If someone insists they don't drink when challenged with the BAC data (especially with corroboration like in this case), do a test to determine if they're lying or not. Don't just assume they're lying. But doctors often are arrogant and unwilling to admit error, even to other doctors. The best you can sometimes do in those situations is to get bossy and try to take control of the situation (e.g. I know you're assuming I'm a lying alcoholic, but I don't drink, so explain to me how I could be intoxicated without drinking...what tests would you need to prove that...), but not everyone has the confidence to do that or to do it only when it's needed.
- DoreenMichele 2y ago
  When I was extremely sick, I was super frustrated with the 15 Minute Appointment. It was more infuriating than the things that inspired me to bitterly joke "They majored in medicine and minored in hubris and contempt." Some of my big breakthroughs came in ER visits where they are a little more focused on problem solving and less on getting you out the door in time to keep to schedule. It doesn't live up to the fiction of House but sometimes if I had good rapport with an ER doctor, they took a few minutes to think about how best to keep me out of their ER in the future. This sometimes got me what a relative called "real drugs instead of tea and sympathy." We have a broken system. I don't know how to fix it but some of the criticisms of specific people in the broken system implicitly assume "These people are the problem!" And that doesn't really fit my firsthand experience.
  - nerdponx 2y ago
    > little more focused on problem solving I actually had a great ER experience along these lines. I felt bad being there after it became clear that I was going to be fine while there was a lady wailing in pain about 10 feet away, but at least I left with a lot of things to discuss with my regular doctor and I at least knew when I should/shouldn't worry in future situations.
- 2y ago

DoreenMichele 2y ago

Women get dismissed a lot by doctors. (This is common enough knowledge I'm not going to provide citations in spite of being a woman posting on an overwhelmingly male forum. If you downvote this without doing a quick google: There's your problem.) When I was a homemaker and having serious health issues, I sometimes wore a suit to see a medical professional to try to get them to take me more seriously. I used to bitch to friends that I felt like pinning a list of my academic achievements to my lapel. "Oh, it's a homemaker. Must be stupid! Couldn't possibly have been a good student in school! Smart women all have serious careers." Yeah, sure. That's reality./s

wing-_-nuts 2y ago
If 200 people presented with alcohol intoxication and no history of use, 199 would be secret alcoholics sneaking booze, and maybe 1 would be someone with this condition. The previous case I read about, they forced the poor guy to inpatient for weeks to rule out alcohol use. It's not just 'doctors don't believe women' it's 'doctors don't believe (probable) addicts'.
- roxya 2y ago
  Yeah, as a man nobody would believe me either. I was in hospital with acute pancreatitis and they found at the same time I had a fatty liver. Both are often explained by heavy alcohol intake. The truth is I hardly drank at all (I had perhaps had a single bottle of beer in the whole previous 12 months) but nobody would believe me. I ended up being told to never drink alcohol again.
  - rvnx 2y ago
    Did you find a solution eventually ?
    - roxya 2y ago
      Not really. Since then I've been unable to eat bananas due to a severe bloated feeling (even a tiny bite causes it), and I found a Japanese research paper about a banana allergy inducing acute pancreatitis. But I don't know for sure if it's linked. I've continued to drink alcohol in moderation for another 15 years+ without issue.

s1artibartfast 2y ago

And that is the tradeoff. 99.999% of the time the person is lying, confused, or crazy. I doubt it was lack of attention, but lack of trust instead.

op00to 2y ago
You get much further with crazy people by not directly challenging them.