Quote:
Originally Posted by drewprops
It took me three useless and expensive visits to a supposed "animal hospital" before I was given a referral to a clinic with real vets and real veterinary specialists.
After my mom was diagnosed with giant cell arteritis I sat in a rheumatologist's office and watched him shush her while he went down a damned checklist, instead of having a conversation with her.
Five years later, that same condition was caused to flare because her young general practitioner put her on a drug for bone density that you are apparently not supposed to go back onto if you've had it in the past.
Some close family friends have the husband in the hospital, finally, after months of various doctors treating him incorrectly for a cough - many Z-packs and butt injections later it turns out he's actually suffering from distention in his abdomen.
We can all give examples of widespread failures in medical AND non-medical diagnostic situations.
My instinct is that critical diagnostic thinking was never as good as I want to believe it to have been.
But it sure feels like it, and so I'm chewing on this one right now.
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It's the insurance companies. To reduce costs and errors, everything has been codified to death. This prevents unnecessary procedures and protects physicians from lawsuits if a patient were to die.
Most illnesses do not require critical diagnoses. It took over two months for physicians at the best eye hospital in the UK to order a nerve test when I lost central vision almost a decade ago, and only then did they order an MRI, which was further delayed by 4 months. All diagnostic criteria for what I had suggest an MRI within 4 weeks of initial onset -- at which point I was still being treated like a drug seeker -- to exclude long term illnesses like MS. But I was 1) the wrong age, 2) the wrong gender, and 3) displayed no other symptoms (and perhaps was calmer than I should have been given the loss of binocular vision).
Statistically, I was unlikely to have had MS, and the entire system is predisposed to operate on those statistics. If I had had MS, I would have been flippant (but really unable to do anything); if they had diagnosed the optic neuritis in a timely fashion I could have had a shorter duration of recovery with appropriate treatment, but no end result improvement. In the end, it took over a year for the eyesight to recover almost to 80-90%, which is again atypical (recovery times are typically 4 weeks-4 months, and recovery of sight is lower). It's bizarre watching (literally) your optic nerve repair itself. And I should have been an academic case study because of all of the atypicalness of the presentation -- I suspect I was infected by a cold from a recently pregnant friend, and my immune system went crazy.
All of which is to say: academic interest in your illness is no longer a driving motivation for physicians. You're more likely to see this in paediatrics. It means progress towards medical improvements are moving out of the clinic and into the lab, where a lot of this physicians-as-technicians dumbness will be overcome with cheaper diagnostic tools and more precise medicines. The Drs. won't be needed for the vast, vast majority of things...