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Wow! What a Surprise! (Read 2194 times)
Bob Johnson
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Wow! What a Surprise!
Jul 4th, 2008 at 12:59pm
 
J Headache Pain. 2008 Jul 2. [Epub ahead of print]
Trigeminal autonomic cephalalgias: frequency in a general neurology clinic setting.

Larner AJ.

Walton Centre for Neurology and Neurosurgery, Lower Lane, Fazakerley, Liverpool, L9 7LJ, UK, a.larner@thewaltoncentre.nhs.uk.

Cases of trigeminal autonomic cephalalgia seen in general neurology outpatient clinics by one consultant neurologist over a 4 year period (2004-2007 inclusive) were identified. A total of 40 cases was identified (=1.2% of all referrals, 5.3% of headache referrals), most with cluster headache, the remainder with SUNCT or SUNA.

THERE WAS EVIDENCE OF BOTH DELAYED DIAGNOSIS AND INAPPROPRIATE TREATMENT, DESPITE INVOLVEMENT OF OTHER SECONDARY CARE SPECIALTIES. INCREASED AWARENESS OF THIS DIAGNOSTIC CATEGORY IS REQUIRED TO ENSURE EFFECTIVE DEPLOYMENT OF EFFECTIVE, EVIDENCE-BASED TREATMENTS.

PMID: 18594759 [PubMed ]
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Bob Johnson
 
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MJ
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Re: Wow! What a Surprise!
Reply #1 - Jul 5th, 2008 at 2:07am
 
I guess it really cant be said enough.

Its like the constant scolding of a wayward child, many of those doing the diagnostics are supposed to be the most educated, yet they know so little as a whole.
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Bob Johnson
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Re: Wow! What a Surprise!
Reply #2 - Jul 5th, 2008 at 7:34am
 
Well, glad you got my bit of sarcasm in the title.

However, I also have sympathy for any doc who is overwhelmed with more medical information than any human can learn, much less apply effectively. If you have access to a list of medical specialities and sub-specialities you would immediately see that the growing number of categories reflects the specialization and depth of knowledge in medicine.

Finally, we are a very small population (% of CH folks in the population) and docs' focus will be on the most common problems they will see. It's just too much!

If you have access to the NY Times Sunday edition, the magazine section regularly has an article on difficult, obscure medical problems and follows the patient's journey trying to get a diagnosis/treatment. Reading this for a few months evokes some understanding, if not sympathy.

But it makes our efforts here the more valuable and reflects the benefits of the WWW, allowing people to find us.

While we may fuss at institutional medicine for its limitations, we need also to pay attention to the question: Why are some people such poor patients? (and I'm not referring to economics. <bg>)
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Bob Johnson
 
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DonnaH_again
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Re: Wow! What a Surprise!
Reply #3 - Jul 5th, 2008 at 9:19am
 
I would say that age and exposure are factors in one being a poor patient.

Most younger people have the attitude of awe towards the status of the "doctor", and wouldn't question his judgement.

Exposure and personal affliction encourage education, participation and understanding. Their conclusions may be negative or positive as a result of their experiences and degree of research.

Not too long ago, people wouldn't have thought of doing research on their afflictions or question their doctor. The Internet has turned this around.
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Bob Johnson
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Re: Wow! What a Surprise!
Reply #4 - Jul 5th, 2008 at 12:16pm
 
Donna: In general agreement with your observations. There has been a generational change in peoples approach to docs--more open, expecting, even demanding. The web has given people so much information that it has become a problem for docs who are confronted with patients who arrive with piles of articles, etc. and expect the doc to take time to read and discuss--"right now!"

This issue has become so difficult for docs to handle that one of the major web sites directed to medical people, offered a sefl-study course on how to cope with this shift in expectations!

The flip side of this new information for the patient has been the emergence of ignorant demands: I want this treatment, this drug, this is the diagnosis, etc.

One manifestation of the "poor patient" is that roughly 2/3s of all Rx written by docs are never filled! This may be financial constraints in some cases but for ???% it may reflect the patient imposing his judgments on the doc's; a fear of "drugs"; a refusal to accept the diagnosis, etc.

Medicine is an extremely complex social interaction--not a neat technical exchange around the illness.
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BarbaraD
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Re: Wow! What a Surprise!
Reply #5 - Jul 7th, 2008 at 11:03am
 
My 2 cents.....  I think we've become too damn specialized. The days when the old family doc KNEW the patient (hypochondrics and all) and could actually do their own prescribing has gone by the wayside. Now we have to go to a different doc for each part and by the time we've visited all the different docs we forget what our original complaint was to start with.....

We've lost COMMON SENSE! I've been lucky -- I have an old doc who knows all the parts and knows his patients and actually takes the time to "listen" and have a neuro who actually knows what a CH is, so I don't have a gripe, but see this problem with my kids and grandson.

When my grandson's tonsils were rotten and he was having one infection after another, the kids just kept giving him antibiotics and he just kept getting infections. I kept telling them it was his tonisils, but they wouldn't ASK the doc about his tonsils. Finally Granny took him to the doc and Granny ASKED the doc to smell his breath (a dead give away) - we had the tonsils yanked by the end of the week and haven't had an infection since. Sometimes a LITTLE Common Sense goes a long way....

People don't INTERVIEW docs... they just sit in awe of their superior knowledge and take their word for everything -- they don't "question' anything (and I don't mean ask them to READ a bunch of stuff -- just KNOW enough to ASK questions and demand answers - if they don't answer - find a new doc).

I'm not saying docs should know everything, but they should be willing to listen if they don't know something. If we've done the research and do know something - they should at least be willing to listen (the O2 treatment is a perfect example - look at the CHers who are having trouble getting O2). I don't mean be an A-hole, but be pro-active in your treatment. Especially with CH.

Anyhow, like I said, after several years I got lucky and found a doc and a neuro who actually knew how to listen and I got some proper treatment. I just wish the same for all.

Hugs BD
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midwestbeth
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Re: Wow! What a Surprise!
Reply #6 - Jul 7th, 2008 at 11:32am
 
I'll put my 2 cents in with what Barb said.  Very well said.

Beth
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George
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Re: Wow! What a Surprise!
Reply #7 - Jul 8th, 2008 at 3:17am
 
BarbaraD wrote on Jul 7th, 2008 at 11:03am:
My 2 cents.....  I think we've become too damn specialized. The days when the old family doc KNEW the patient (hypochondrics and all) and could actually do their own prescribing has gone by the wayside. Now we have to go to a different doc for each part and by the time we've visited all the different docs we forget what our original complaint was to start with.....


And the right hand doesn't know what the left hand is doing.

This is way, way off topic, but PM me sometime for an accounting of my father's slide into death...  An initial diagnosis of myelodysplastic syndrome (pre-leukemia), with no blasts in the blood--to renal failure six weeks later, after aggressive treatment with intravenous antibiotics, two courses of gamma globulin, and an intractable infection acquired in the hospital.  I often wonder whether he'd have been better off just staying at home and having no treatment whatsoever.

Am I bitter?  No.  Did we sue?  No.  Will I unquestioningly accept the judgement of doctors entrusted with my own care? 

After that experience (and a couple of others)--probably not.

Best,

George
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« Last Edit: Jul 8th, 2008 at 9:22am by George »  

"Whoever loveth me, loveth my hound."  (Thomas More, author of "Utopia", and Chancellor of England.  1477-1535)
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Re: Wow! What a Surprise!
Reply #8 - Jul 8th, 2008 at 12:57pm
 
BarbaraD wrote on Jul 7th, 2008 at 11:03am:
My 2 cents.....   I don't mean be an A-hole, but be pro-active in your treatment. Especially with CH.


Hugs BD

Wink, i'ed throw in the whole 100 cents with this statement. andrew.
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