How Doctors Think

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huckleberry
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Date Joined Sep 2007
Total Posts : 317
   Posted 11/13/2007 7:19 PM (GMT -7)   
I was listening to NPR today and there was a program featuring Dr. Jerome Groopman, a cancer doctor and Harvard professor who is well known for his medical writing in the New Yorker magazine. His new book is "How Doctors Think." Two interesting tidbits from the radio show (I didn't hear it all...it was during my commute and I got home before it ended.)

1. Doctors make a decision or judgment about you or your condition within 18 seconds of your arrival in the office. Then, all of their questions during the interview with you are likely to lead up to or support the conclusion they came to within those first few seconds. He spoke about how truly difficult it is to have a doctor really listen openly and evaluate what you are saying objectively.

2. Does your doctor like you? 100% of doctors polled said they would switch doctors if they perceived that their doctor didn't like them. This speaks to how powerful the personal relationship is in terms of the care you will receive.

Food for thought for everyone, and especially those (like us) with chronic conditions. It's making me realize I need to switch one physician of mine (not my GI) who I've always felt doesn't "like" me for some reason and wondered if that was a good enough reason to make a change.
Official dx September 2007.
Medications: Pentasa, Prednisone (tapering), 6 mp, Prilosec, Synthroid.
Supplements: probiotics, calcium, vitamin C, vitamin E and a multi-vitamin.
History of hypothyroid (dx 2004), and gall bladder surgery (1997).
44 years old; single mom to three wonderful kids, ages 9 to 15.


dustspeck
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Date Joined Sep 2007
Total Posts : 565
   Posted 11/13/2007 7:29 PM (GMT -7)   
i feel fortunate. although my gi is young (he's only been licensed since 2004!) which made me nervous at first, but he works with 7 or 8 other gi's at his office and consults with them about my case. he is also in close contact with my regular pcp, so when i went in to see my pcp yesterday, he already had all my endoscopy info from the previous week! and my gi has been known to call me randomly on the weekends to check in with me and see how i am feeling. my only fear is when i get back to work, what will i have for insurance and will i be able to keep both of them as my doctors :/
.: stephanie :.
32 y/o female diagnosed 8/8/7 with crohn's of the terminal ileum w/ stricture/scarring
currently taking 15mg prednisone (getting there!), 4000mg pentasa daily & vicodin for pain


FitzyK23
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Date Joined May 2005
Total Posts : 4219
   Posted 11/13/2007 8:08 PM (GMT -7)   
I read a great book about how to be a good patient and it was about how doctors think. There was a script of how you should being each visit, re-capping some of your history and refreshing your doctors memory of who you are. Some of it was too formal for my liking but I adopted some of it and Ive had my pcp comment about me being a "model patient." I answer all her questions before she asks them. But unfortunatly, for the life of me, I can't remember the name of the book. Sorry!
26 Year old married female.  Diagnosed w/ CD 3 years ago, IBS for over 10 years before that, which was probably the CD.  Currently on Pentasa 4 pills/4x day, hysociamine prn, nexium, and ortho evra.  Good times!!!
 
 


pb4
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Date Joined Feb 2004
Total Posts : 20576
   Posted 11/13/2007 8:13 PM (GMT -7)   
You'd think docs of all people would know better than to judge a book by it's cover...in regards to "how doctors think" from my experiances many of them don't.

:)
My bum is broken....there's a big crack down the middle of it!  LOL  :)


MDdave
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Date Joined Nov 2007
Total Posts : 74
   Posted 11/13/2007 8:29 PM (GMT -7)   
I was in the ER back in 05 I have not been on any meds since 97 when I went to a bag and every time I go to the ER the doc's freak out...now the last 2 times I have gone for dehydration they end up going the whole crohns route and CT's blood and stool samples ect
the works...I tell them that it ant Crohns and its dehydration do to me having a flu that cased me to have water for a stool for the last 24 hours and I am not able to replenish the body fluid fast enough. I had this one young ER doc actually yell at me from the end of the bed that I should be on meds and I know what meds he is talking about and he know all...I said you don't have a clue what you are talking about and he should talk to my family doc and that I have more knowledge on crohn's than he could ever know. I felt this particular hospital just views people like me as a insurance money maker and they just want to slam me in a hospital room and run test on me...BTW I got my dehydration therapy that day and walked out the hospital better than when I came in and had no crohns issue or any other since then, HE WAS wrong and yes Docs don't know all and yes they run a ER like a business to make the hospital money.
 I threatened to report them to my insurance after they sent me a bill for a room I never had b/c I refused to be admitted.

Post Edited (MDdave) : 11/13/2007 8:32:20 PM (GMT-7)


belleenstein
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Date Joined Feb 2007
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   Posted 11/13/2007 8:31 PM (GMT -7)   
I've read the book and highly recommend it. The more you understand, as a patient, how your doctor thinks -- what goes into making clinical assessments -- the better you are able to steer and influence that thinking.

Interestingly, one of Dr. Groopman's personal narratives involved his care of a young man with cancer, a lymphoma I think. This was a young college student, gifted athlete, an a-one kind of guy. Really likeable and Groopman felt a deep connection to him. His bedside visits were more than perfunctary. They would chat about philosophy, exchange reviews of the latest books and journals, etc. Groopman believes it was the respect and caring he felt for this patient that led him to make a decision that ultimately almost cost him his life. That decision? Not to subject him to an uncomfortable examination on a day when he was already feeling miserable. As a result he failed to identify the source of the listness -- a brewing skin infection. Because of his weakened immune system, the infection almost killed him.

So sometimes we need to be as vigilent against the possibility that our caregivers might over-empathize with our misery and defer that test or procedure that they know is going to hurt us.
Belleenstein:

30+ years living with Crohn's.


Sarita
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Date Joined Mar 2005
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   Posted 11/13/2007 10:44 PM (GMT -7)   

I read this book this past summer just before starting med school.  I think it's a great book and it would be great if all patients and their doctors could read it. 

If you read the whole book, Dr. Groopman does, at least partly, go into WHY many physicians don't think more "outside-the-box." There are several reasons, but one of them is that docs are pressured to see more and more patients (partly because they have to pay higher malpractice insurance premiums, which is partly because more patients are bringing up frivolous lawsuits against them).

Another one is that with the explosive advancement of science and medicine, we are expected to keep up with gazillions of new pieces of information and research every single day, but medical training itself takes essentially the same amount of time it did 50 years ago.  I think people tend to ignore this extremely obvious fact.  Though I would hesitate to voluntary put myself in the position of a med student for even longer than four years, it probably wouldn't be the worst idea in the world.

I could go on and on, but my theories about the theories of medicine are probably pretty boring...although I feel pretty lucky to be able to come at this issue from both points of view!

 


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belleenstein
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Date Joined Feb 2007
Total Posts : 1010
   Posted 11/14/2007 7:02 AM (GMT -7)   
I don't know how medical training works in other places but here in Nova Scotia, the medical school changed the way it trained physicians about 10 years ago. They use a case-based model now that requires all students to work as part of a team to solve complex medical problems. After the four year program there is at least a two year residency required for every physician where family physicians used to only require a one year residency. And those who opt for specialty areas are looking at longer periods before full licensure in their sub-specialty.

Sarita is right -- there is a lot to stay on top of and physicians face the constant pressure of trying to stay current while watching their clinical caseload expand. That's why it is so important to be the expert in you and your case.
Belleenstein:

30+ years living with Crohn's.


Sarita
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Date Joined Mar 2005
Total Posts : 2486
   Posted 11/14/2007 8:49 AM (GMT -7)   

Here in the U.S., students first earn a bachelor's degree (4 years), then an M.D. or D.O. in 4 years, do a 1-year internship, then continue with residency for an additional 2-6 years in whatever specialty we decide to pursue.  For family docs, the total post-post-graduate training (i.e., post-medical school) is 3 years; for a neurosurgeon, it's at least 7.  It's a good amount of training but, like I said, it's a LOT of material.  I wouldn't hesitate to say we've been responsible for more material in the first 10 weeks of med school than we were for probably an entire semester (maybe two) in college.

Not whining here...I chose this!  But I know that it helps me, as a patient, actually empathize with my doctor, and figure out how I can best help him help me!


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rootsmith
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Date Joined Jan 2004
Total Posts : 598
   Posted 11/14/2007 8:57 AM (GMT -7)   
I know this is straying a bit from the original intent of this thread but I'd like to know what doctors are "thinking" when they send you to a specialist (of their choice thanks to managed care) and then don't believe the specialist. My primary NP sent me to the gi doctor after I asked her if I should do that (again)*or* just take an antidepressant and maybe my gut won't bother me as much. She said I should go to the gi doc. Well, the gi doc diagnosed probable crohn's and is treating me for that and the last time I saw her she said, looking at my record "Hmmmm, they usually can see crohn's" Not true according to the gi doctor. Some might say well you should be going to a doctor not an NP for your primary care but I've had this happen with MDs as well.
10 years, many tests, 3 gi doctors, Pentasa 1000mg 3x day
diovan, simvastatin and now trying good ol' zoloft


Matthew
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Date Joined Oct 2004
Total Posts : 3932
   Posted 11/14/2007 12:55 PM (GMT -7)   
An EXCELLENT book, read it several weeks ago. Many great points, though not all lay people will pick up on them. He also makes a few of the same mistakes, but has the cajones to admit his own biases..
We need more docs like this.

Matthew
I also appreciated the views different docs take based on their own branch of medicine.

Umm
Regular Member


Date Joined Dec 2006
Total Posts : 41
   Posted 11/14/2007 1:48 PM (GMT -7)   
I seem to have a continual problem with the way doctors view me. For some reason I translate pain differently, so they take one look at me and dismiss me as healthy when I should be under immediate treatment. I cannot count the number of times that doctors/specialists have told me to go home and then received my test results and consequently rushed me to hospital in a panic. After going through a number of doctors, I've finally found a GI specialist who understands this. I came out of hospital three days ago and there he told me that he couldn't understand how I was coping, that everyone he has seen at my stage of the disease comes in on a stretcher and is severely malnourished. (I still run my own business.) But instead of immediately performing surgery on me he consulted with his gastric surgeon and they both decided to try some more anti-inflammatory medication. This is a first for me - that doctors treat me as a specific case. I would be over the moon if I then hadn't found out that my GI specialist is emigrating to Australia. I don't think we should accommodate the ridiculous way in which doctors treat their patients. It is time doctors learnt to view health and people in a holistic manner. (I say this as part of a family filled with doctors and homeopaths.)
37 yr old F. Crohn's Disease symptoms appeared at 12 yrs old. Officially diagnosed at 24 yrs old. Rediagnosed with gastric CD at age 35. Been flaring since 2004. Currently large intestine dysfunctional as completely ulcerated, narrowing in small intestine and narrowing at pyloric valve. Consistently anaemic. Currently on revellex/remicaide, as well as intravenous steroid treatment when hospitalised. Recently been for pyloric dilations. Sister, late father and paternal aunt all have CD. Cousin (paternal side) had UC and died of colon cancer at age 37.


Sway_79
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Date Joined Nov 2007
Total Posts : 47
   Posted 11/14/2007 1:59 PM (GMT -7)   
I had a funny moment in the ER one time. I had a young intern, and he very seriously looked at me, with such a caring expression, and said "I can't cure you!". I looked at him, laughed, and just told him it was okay, that I wasn't looking for a cure, I just wanted some anti-nausea medicine, fluids, and to feel better. The look of relief on his face was priceless.

I always question my doctors, the medicines they put me on, and what they will do to me. It's my medical background, but it's always a good idea to find out exactly what you are taking, what it can do to you, and why your doctor believes it might help you. As Umm stated, I have an "unusual pain tolerance" as well. So my doctors and I have had to learn different pain scales to compare how I feel and what I need to combat it. Pretty much, when I say "I'm in pain"...they know I'm really in pain, and I mean it, and that I need something ASAP to kick it.

~Sway

MMMNAVY
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Date Joined Jul 2006
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   Posted 11/14/2007 5:57 PM (GMT -7)   
I really like Dr. Jerome Groopman and have read all his books. In particular the second options one was really good too.
Forum Moderator 
We will find a way, or make one.-Hannibal (crossing the Alps in the 15th Century on war elephants) 
Make sure your suffering has meaning...


Driver37
Regular Member


Date Joined Jun 2007
Total Posts : 93
   Posted 11/14/2007 6:47 PM (GMT -7)   
I was in the hospital recently for a resection. On the fifth day I knew I was getting out because the surgeon had already told me. They took the IV out of my arm and I was basically just waiting to have a BM. Since I'm a smoker, I thought that it might help to smoke a few cigarettes to get my bowels moving so I put my clothes on and walked out of the hospital. I had to walk to a nearby sidewalk as no smoking is permitted on the hospital property.

When I came back, my GI was standing outside the hospital talking on his cell phone. I sort of smiled and lifted up my hand in a half wave and he looked away from me. Then he got off the phone and walked back into the hospital as if he hadn't seen me. I don't think he saw me smoking, but I guess it's possible. I think rather he didn't wish to associate with a patient outside of a doctor-patient setting. Or maybe it bothered him that I was out wandering around the hospital. I went back up to my room not long after that as I expected he was making his rounds. It seemed business as usual when he came in and didn't say anything about me leaving the hospital.

I think he's been kind of annoyed with me for awhile now because, with my job, I've had trouble sticking to appointments, though I always cancel with sufficient notice.

Sway_79
Regular Member


Date Joined Nov 2007
Total Posts : 47
   Posted 11/14/2007 6:52 PM (GMT -7)   
Sometimes I think doctors can be in their own worlds. I saw my doctor at the store one day, and I waved at him, and he had that "I know you, but I can't remember your name" look. I went up and introduced myself, and he admitted that he felt stupid not knowing me right away. I just laughed and realized that this man sees hundreds of patients, and most for short periods of time. It must be so hard trying to remember everyone's names and faces.

I'm sorry your doctor treated you that way, Driver. Maybe you should talk to him about it sometime? Maybe he thought you had tried to escape the hospital before he was done with you!! Perhaps he was on the phone calling off the search parties and hounds when he saw you. :-)

Driver37
Regular Member


Date Joined Jun 2007
Total Posts : 93
   Posted 11/14/2007 7:20 PM (GMT -7)   
Thanks Sway, I thought about bringing it up when he came up to the room but thought it was best not to. And you're right, there is a good possibility he didn't recognize me in regular clothes expecting I'd be in the hospital.

Sarita
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Date Joined Mar 2005
Total Posts : 2486
   Posted 11/14/2007 9:18 PM (GMT -7)   
Don't worry Driver, I'm sure he was just having a moment...when you're used to seeing a patient sitting on an exam table, it's weird seeing them walking around somewhere, even in the hospital.  Actually, I recall seeing a dude walking in the hospital one day a few years ago, and I saw him and thought, "Hmm...I know that guy from somewhere..." I felt like a moron when I realized a few steps later that it had been my GI!  Guess he didn't make that great of an impression on me. 
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pb4
Elite Member


Date Joined Feb 2004
Total Posts : 20576
   Posted 11/14/2007 9:31 PM (GMT -7)   
It's a good thing...that means he can tell the difference between how your butt looks and your face LOL!


:)
My bum is broken....there's a big crack down the middle of it!  LOL  :)


Matthew
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Date Joined Oct 2004
Total Posts : 3932
   Posted 11/16/2007 12:36 PM (GMT -7)   
LOL. I had this happen on Halloween, in reverse! My pain doc came by escorting some kids trick or treating. I never even realized it. I can also get lost in my own world. Had a good laugh last office visit.
****
What are some more titles Dr. Groopman has authored?

Matthew
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