Doctors

Just a random question-

As a medical student, I am told the bleeding obvious- that different people expect different things of doctors in general and that behavior is affected accordingly. Aside all the formal theory which essentially describes society, I am simply curious to find out what each of you thinks of/expects from doctors as a whole.

If you're feeling bold, since I have a particular interest in neuropsychiatry, I would also be interested in your thoughts on psychiatry in general.

 

:twocents: In general i dont trust doctors. I think they are in it for the money and not necessarily to help people. Ive seen a few doctors hold to much arrogance on diagnosis and general treatment for my liking.

I have also known (on a personal bases) enough shrinks that are nutter then the patients. For some reason the profession attracts the ones that need the help the most. :twocents:

 

It kinda saddens me because I expect to see alot of this kind of reply (still, be honest people!) It's a very common complaint and most of my US based friends have a general distrust of doctors and the medical practice in general. It also seems that the general impression of doctors is either they're unhelpful or they are paternalistic ("you do this, or you don't get better") because of an erroneous reification of the clinical diagnostic framework. One thing that does become apparent in the course of medical study itself is that it involves a lot of regurgitation and not necessarily a whole lot of critical thinking (this, while encouraged actively, only gets in the way of scoring well in exams).

As far as I am aware, the Australian Universities that do offer medicine do wish to change this emphasis and are now heavily involving a more up to date, less arrogant (biomedically focused) syllabus which, if the student takes on board as they progress to clinical years, hopefully would produce effective clinicians. The problem that many medical students are there because they are expected to be, or because they're in it for the money, or the status. Plainly they're in it for the wrong reasons.

Your comment about psychiatrists is ironic. First, all the psychiatrists I know (on a personal basis) are well aware of the spectrum of people you see in the medical profession (especially psych)- and in general doctors can be a pretty nutty bunch (is there some kind of prerequisite that we be perfectly normal individuals? I think not.) Also, it is not least my personal mental history which has specifically triggered a broader interest in psychiatry and the neuropsych fields. Previously having been said to be autistic, and more recently bipolar, the unanimous consensus is that my experience (and the fact I am critically equipped to manage myself without being dependent on treatment, cognitive or pharmacological) will in fact aid me in empathising and perhaps aiding patients more effectively, not just because I actually care, but because I have additional insight and a perspective that most other doctors wouldn't possess. Of course, this means that I'm not one of those nutty types that you'd be referring to (I myself would refer to, say, the bitter homophobe clinicians who maintain that sexual orientation is a medical condition and so forth), but if I gave people a rap sheet of my history, people would either a) think me a liar or b) get freaked out.

 

HEHE great reply. Gives me a good idea of why i see what i do on each topic. I also like the fact that the universities are aware of the "emphasis" and are trying to change it.

As for the psychiatrists part again that's a great response and ill try and look at it from that perspective. Although if i needed help i always try and self analysis and would never ask for outside help. I never did understand why people need to talk to someone else when they could mediate or write it out.

Oh more thing. Did you say your bipolar with no treatment for this chemical condition inside your brain? ISnt this the classic reaction of bipolar personalities to refuse meds? Ive seen a few bipolar people destroy lives without meds.

 

Doctors are obviously in bed with the Pharmacueticals. Why is it Pharmaceuticals have a 'Sales' department? They sound out agents to the doctors, with a new medicine (Last I checked, when I want a restful night, I don't want to have a coma in the morning) the side effects are worse than the original illness. Many peolpe over-look the natural, proven, and safe cures to illnesses.

People take Viagra for ED. Guess what, sensible individuals would take L-Arginine, which not only takes care of your ED, but the circulation in your body. You have insomnia? Take melatonin, which is a natural hormone found in the human body. I take 8mg's nightly, and it helps me fall right asleep. (I started school last Thursday, and I had no a single problem falling right asleep) The list goes on, and on. But, people would rather see a doctor, get a prescription, and potentially harm their bodies.

 

I dont want to discount the role that medicine has but I do think that Americans are over-medicated. We rush to see a doctor in hopes that he/she will be able to provide a prescription that will make our illness go away.

 

Have you looked into osteopathic medicine? It's treating the whole person not just the symptom.

Also, to most people doctor's are suppose to know it all. After all, they are doctor's. If you have a good bedside manner, you shouldn't run into many problems.

 

I'm not sure whether this is the case in the US colleges/universities, though. Any ideas?

Also, worryingly, in some courses, students are taught so much of the social perspectives and bedside manner that they forget to learn any of the medical knowledge! Surgeons at one of the hospitals were recently distraught to find that a bunch of interns could not tell a heart apart from a pancreas. Lying in their proper location. In a functional body.

I believe self-analysis or at least self-awareness should be promoted highly as it's not a prevalent feature of people in general, despite the popular belief that it's supposed to be a defining feature of humans. However while one is licensed to know themselves best, unless one has a disassociation of sorts, one is also inherently limited in assessing themselves. For this reason asking for outside help in the form of feedback or gaining a broader spectrum of perspectives can be particularly useful in sorting out various cognitive issues, so long as one remembers that they can treat outside sources as they wish. Specifically a good psychiatrist would tell you what they think according to their interpretation of what they've learnt, but will also inform you that really it's up to you and your values (patient centered approach).

Specifically, I'm juggling around with the diagnosis of a possible bi-polar II (mild form). What we're trying to discern now is whether it would be more convenient or rather more accurate to say that I did have a biochemical predisposition to periodic variability that was discernibly greater than normal, and if so, whether there would be any point in treating it pharmacologically. At least so far as I've heard recently, the general ethos of psychiatry is medication is one of the last treatments in line due to the very imperfect nature of our medications and research in this field, and previously I have been doing well enough to manage myself on a cognitive and behavioral level- so it's reasonable to believe that my "bipolarity" is not necessarily pathological.

But to address your point more directly, the general rule is that people who present as mentally disturbed do not usually possess even a typical level of insight. Denial is a very common symptom as the relevant neurological changes also affect perception. Also, people may refuse medications due to the stigma of having a "mental" disorder, as taking drugs might validate claims that they are somehow "imperfect", or else, like in my case, would rather not take them because of the extensive side effects and a very significant risk that it will either be ineffective or cause loss of function, affect cortical plasticity, etc.

Some random trivia: Ironically, doctors and dentists have among the highest rates of drug and alcohol abuse of any population demographic. Your comment that perhaps shrinks need the most help mightn't be inaccurate at all- approximately 1 in 4 doctors will have some kind of clinical mental problem, the most common being depression. It's not the easiest job in the world, after all. And most likely you will have easy access to pure, very high quality drugs.

 

Two good points there- such things as natural and wholistic medicine, while not specifically medical in origin and not regulated, are gaining popularity (and economic significance...attracting a number of quacks along with it, sadly). But I personally think that western medicine has much to learn from adopting a wholistic approach. The focus of treating the cause needs to be tweaked although like Brandon points out, patients generally want to be able to walk into a clinic, get a bottle of pills and walk out with the assurance that their troubles will be relieved and they can get on with their life. Also, medicine is already changing focus in many areas to encourage considering every known domain of function in any consult.

The sad truth is that doctors can't possibly know it all- this view perhaps stems from the historical views of the doctors of old. Medicine used to be paternalistic, as in "you follow what I say and you'll get better," which of course presumes that we do know everything...but we know better than to be able to claim that now.

 

While there is this depressing trend linked by pressing matters of politics and economy, I would be loath to make a generalisation that strong. Well...if this is your impression of doctors in the US, I suppose (but again this is something being actively preached against by my course, at least).

That pharmaceuticals has a sales department is indeed indicative of a much greater problem, regarding marketing and profits, which often gets in the way of optimal distribution of pharmaceutical healthcare (much in the same way of oil companies, really). Doctors or medical bodies can be swayed or commissioned into promoting certain drugs and companies, or even other "health" products (like baby formula) and this is flagrantly unethical.

That drugs, especially centrally acting agents have nasty side effects is not the fault of the doctors who prescribe them specifically, but the dismissal of natural alternatives might be. I do think that the general pharmacological aim of specificity and isolated effect, while successful in some aspects might be a misguided process. On the flip side, lack of regulation of natural alternatives may have dangerous implications if the effects are unknown...and there's always that well established placebo effect.

In the end, the most approved practice would be if you're happy with the way you manage your health, then that's excellent. We would rather not try to burden you with advice of this or that unless we were fairly certain that you were doing something bad for your health...and you didn't know it.

 

For a lot of the illnesses people encounter, osteopathic medicine is not applicable. Osteopathic medicine is also extremely expensive. What I'm talking about, are the common sense, grandma-told-me-this remedies. Everyone knows that Calcium and Boron are good for your bones. I'm sure there's a pharmaceutically manufactured drug that is advertised as an enhanced calcium. What about mental acuity? Studies have PROVEN Zinc and Ginkgo Biloba to be extremely effective in not only making your brain operate faster, but also increase your attention span. There are also herbal medicinals that are shown to work for some individuals. I drink two tea bags of Kava-kava daily, and the stuff works miracles. I am so relaxed by bedtime (I used to have insomnia, and would take melatonin to fall asleep, but I no longer need it) I don't even need to take my melatonin. My younger sister also has really bad mood swings, and when she does, she prepares a nice cup of St. John's Wort tea. And it works for her. It's simple things like this, that can help people achieve a harmonius, healthy lifestyle, without big corporations jamming a new product in their face. There's no reason, why when I ask for a good night's sleep, I in turn wake up in a coma. (Obviously exaggerated)

I work at a Health Food store, and we have an in-house, retired doctor, who practiced medicine for 30 years. He himself told me that he is against the pharmaceuticals, and the way doctors today hand out prescriptions like they are candy. Have you ever had a relatively, small, but annoying illness? I do. I get in-grown toe nails at least twice a year. I follow the guideline for prevention, I cut my nails the correct way, and yet I still get them. So about 3 weeks ago, I got another one, went to my doctor, and what did he prescribe me? Anti-biotics. People fail to realize the danger in taking anti-biotics every single time they get a scrape--your body builds up an immunity. Thus, making you more vulnerable to illnesses. I can happily say, I am 17 years old, and haven't gotten sick for about 4 years now. I eat a mainly healthy diet, don't consume artificial fats or sugars, and take almost 20 supplements daily. I wish I was older, so I could ramble about how I feel better than I did x amount of years ago, but in the past few months, I generally have more stamina, patience, and utility than I have in previous years.

 

Actually, my brother just started medical school here in the US for osteopathic medicine. It was the specific route he chose when he decided to follow in our family's medical footsteps.

 

George, you make for a difficult patient For the record, I would be the same as I tend to have a marked distaste for taking any medications or pharmaceuticals whatsoever. Hell, I don't even seek first aid when I injure myself...I do my own and walk it off. Of course, I do feel more aware of the risks I am taking thanks to detailed medical knowledge...which is why doctors make the worst patients of all.

Agreed, living a healthy lifestyle and altering out outlook on pathology and pathogenesis could really reduce the wasted and perhaps even dangerous usage of resources and pharmacological goods. But really, like any pharmacologically active agent, those natural goods will behave in manners still explainable by pharmacology. There's not much of a difference except that natural isn't engineered for specificity. In terms of holistic general healthcare that's a benefit, but it can be dangerous to think that we can identify a feature of a natural herb and treat that as a substitute for specialised medication, which often is the case.

Also, that a healthy lifestyle means a high quality of life does not necessarily apply to everybody, but this is a different arena.

 

I think that the osteopathic medicine is becoming more and more accepted which is why there are now colleges that offer that as a medical career option.

And I think that people are becoming more aware of the natural remedies. Having many family members in the medical field, I just don't agree that the doctor's are in bed with the drug companies. Most of them are trying to do what they have been taught is best for their patients.