This is a 3am idea for a thread, and therefore may not make sense, but I have been struck by the lack of curiosity by medical staff to look into things, either when Tests are not normal but not " bad" enough There is an unexpected response to something There are signs that something is not right. I thought it would be interesting to start a thread to both compare experiences, and to see if there are common ones. So for my daughter Test Spirometry test - not normal but not as test defined outcomes ( so no asthma/ copd) GP and nurse practitioner didn't know what to make of it. Nurse thought she had " not been trying" even though we advised she was trying her hardest Response Treatment for H. Pylori- we were geared up for a big negative impact. She felt great on the treatment protocol. Paediatrician and GP flummoxed. ( she may be metrodiazole responder which could hint at gut issues) . No curiosity Something not right Shingles when at primary school . Very weird. Interesting to hear of others' experiences
In the West: If you are curious you are not going to pass the board exams. If you investigate further, your administrator will wonder why your time metrics are down per patient. Also, more young women are becoming primary providers, and they have the least impersonal or mechanical curiosity out old/old/young/young MFMF matrix but that also helps them fit better into modern medicine given the above. Doctors are not scientists. That change happened forever ago.
I watched a bit of Doc Martin on UK tv last night. Amazed to see a (fictional) GP examining a patient and concerned about her tachycardia and actually pushing physical investigations. No mention of anxiety. So far from my experience of real GPs since ME & POTS onset.
If it's the UK we're talking about, GPs tend to be under so much pressure that I don't think many of them have time for, independent thinking, shall we call it?
There is such a doctor shortage here in Canada that they don't have time for curiosity. Same goes with the specialists. If your tests are borderline, there are people much worse off who are waiting to see them so you aren't even considered.
I am not an M.D., but am a former nurse and now patient. I think docs think according to an inner medical algorithm and according to their specialty. And some docs aren't as curious or as intelligent or emotionally empathetic as others. And they have to practice under strictures: the medical standard of care, their institutional rules (big factor) and cost/benefit and risk/benefit calculations. So, if something is not abnormal enough to reach a diagnosis thresold, and the patient (or parent) is perturbed by the symptom, then why not refer out to a specialist? You can always ask to be referred if you aren't satisfied. Though, I don't know how that works in the NHS. Here in the States, the doc will usually comply unless it's truly a wasteful endeavor, as they are also plagued by malpractice fears (and do a lot of over testing, in my opinion). That said, it is distressing. Edit: Office visits are so short as to be virtually meaningless, except in the range of normal acute and curable illnesses.
It's a systemic problem. Physicians don't have the time or resources for that. They are often thought and instructed to minimize investigations into complex cases because they always come at the cost of pushing back acute cases that will quickly deteriorate if not addressed quickly. Truth is, a thorough differential diagnostic for a case of ME would likely amount to close to $1M in tests, consults and procedures, probably over 100 physician-hours. It's just not possible. (There's obviously the alternative of developing specialist services with actual competence in the disease but that's just not happening anytime soon) Everything is under-staffed, overworked and there is a constant pressure of near endless cases of acute emergencies that make chronic diseases take a back seat, there's always a more pressing issue and the queueing system doesn't take that into account. The solutions are systemic as well, but the culture of medicine doesn't really allow for that. It will take patient rights and non-negotiable engagement to make it happen, as most of the problems we face are deliberately obscured by prioritizing strictly for acute problems. Physicians are still ordinary people facing enormous uncertainty and a wide range of competence. They can't fix what they don't know and the system explicitly hides those problems from them, especially in lacking any feedback mechanism. This is the main benefits AI will bring. It's not so much that it will be superior, though it will be, but that it will free so many resources that currently cannot be spared. The most precious resource in all of health care is time. AI will give unlimited time with zero response time to every problem that has been neglected.
My experience with specialists here in the Vancouver area of BC is that if after looking at your medical tests they don't feel that there is a problem that warrants their time, they turn down the GPs request for the patient to be seen.
This is the only redeeming feature of the US system. The notion of a physician being concerned about missing a diagnosis is so laughable to me as to be dismissed as delusional. Most of my consults have been less than 5 minutes and many asked me zero questions about what I said, only general questions to find an alternative framing. Some were much more thorough but health care in Canada is explicitly no fault so there are no concerns about that, the idea is that if there really is a problem someone else will find once it gets worse. Both have their own problems but a balance would be ideal.
