I would rather have a Doctor that cannot even read, but has worked as a technician/laborer in a medical institution for decades than one who spent just the eight years reading and passing tests with no real life experience. In my experience that goes a lot further than all the "Book Smarts" in the world. To put it in focus, in the average hospital there is just a handful of "Nurses" that do all the real work of deciding treatments and tests and such to help people get better. The Doctors may know more on specific subjects, but if it is an uncommon condition that the patient has, a competent Nurse with a decade experience is hundreds of times more likely to recognize the signs that a Doctor that spent a decade reading, doing tests, and walking around in a daze while the Nurses do the work. I know that sounds critical of Doctors. But it is more that I respect experience. And people often do not recognize that the experience a competent Nurse has can easily be much better than all the experience a newly minted Doctor has.
Experience does mean a lot in medical settings. But don't trust a GP with years under his belt to diagnose you correctly if you have anything out of the ordinary either. They get used to seeing the same sorts of things, anything that looks more complicated gets you referred to a specialist.
People, not just doctors, once they form an opinion, can only change their mind with great difficulty. But, that's not ALWAYS a bad thing -- doctors who are not 'sure' don't have as much of an air of confidence, and thus may not inspire confidence in their patients. Unfortunately, the same may ALSO be true of the patient. But in this case, it was the doctor who was wrong, and you were correct. But it easily could have been the other way around. All that said, the phrase, i always prefer that someone tell me "I don't know" rather than giving me some half-assed opinion. "I don't know" is your friend. Learn it. Live it. Use it. (BTW, I once got a job offer, partly because I admitted to a prospective employer that I didn't know the answer to a question, because all of his other interviewees had tried to bluff their way through the question).
Doctors try to help as much as they can usually. 99% of them do their very best, but they're only human. I worked as a nurse's aide for a few weeks to see if medicine was right for me, and the doctors were all good guys. But in the hospital, they're extremely stressed out and have 10 hour shifts or more, often actually 24 or even 36h shifts. Obviously they try to delegate, but even a nurse with 30 years of expierence doesn't have the theoretical background to treat you. Sure, they know the symptoms of all major illnesses and anything that occurs often on their station. Often doctors just put the diagnosis down if it's a common one and leave the nurse to do the rest, but a nurse cannot do the diagnosis. There are just too many things to go wrong, small telltale symptoms for allergies or similar but completely different illnesses. That's why my mother, who is an Anaesthesist, usually doesn't treat me, because she usually doesn't deal with the common illnesses. Not to say that an experienced doctor isn't better than a young one, but medicine is actually one of the few subjects where the teaching plan and time hasn't changed drastically (less time, more stuff) in the last few years, at least in Germany. But give the young'uns a chance, they have to learn as well
I actually got a good note from a really strict lecturer on a final exam once (physics, to be exact) that way. Most other guys who were asked this question just tried to bluff their way through, and he kept on asking them more and more "random" questions (he really just asked them to clarify what they just said, or asked them normal questions concerning stuff they mentioned in their not-so-accurate-knowledge-wise answers) as their "answers" got more and more ridiculous over time (one guy even went from molecular structure to theory concerning atomic bombs and failed when the professor asked him to describe the difference between various types of "atomic" bombs from the viewpoint of physics, and some other guy failed when suddenly his theories started including negative temperature, and by that I mean negative Kelvins, in the requirements for it to work). When I got to that question, on the other hand, I said "I do not know. I could try to answer based on what I know on the topic, but even if I did the answer would not be entirely accurate." and got a reply that amounted to "Then tell me what you know on the topic." and after that got a 'B+' even though I only answered one out of his two main questions. Ah, but I'm derailing the whole thing... Yeah, I agree with that. The doctors are often overworked, and thus often they resort to simply examining for what the patient was known to suffer from in the past. When that fails, they try but they aren't infallible even if they wanted to be; this is why older doctors are able to find out about more common stuff, really. But sometimes, in some areas, it is better to get a good doctor. In the past I had a "more experienced" dentist, and she was really making me angry because while she was good at what she was doing, she kept on "suggesting" (sort of like hitting someone with a frying pan is prodding him lightly to get his attention) that it's my fault that my teeth aren't in the best condition. Erm, no, lady, it's because they are just naturally weak (every time I had to go to get a filling, it was either because my tooth got an internal fracture on its own, or because it broke on something that wasn't even hard) and there isn't even really anything more I could do to take better care of them. And the dentist I'm going to now is pretty young for a doctor (I'd place her at 29~30), but not only is she capable of doing the job just as well, she asked what I was doing to try to keep my teeth healthy instead of flat-out assuming that I take pleasure in breaking them, which made the appointments much more pleasant. But I'm ranting, aren't I?
You don't have to be young or old to get things wrong (or right). I'm sure that doctors keep learning as they get older. But that doesn't mean that they won't still make mistakes. Even being 'smart' doesn't guarantee being right. (Someone recently pointed out that there's a whole long list of Nobel prize winners and famous scientists who also had some pretty loony ideas and have said some really dumb things). I had a friend who wasn't sure about evolution but wanted to believe in it because some very smart person also believed in it. All well and good, until you realize that he could have said the same thing about a whole range of stuff, not all of which is actually true. I didn't want to disuade him about evolution, but his reasoning was faulty. Being smart is not the same as being right. It's the myth of authority -- you tend to trust people who you think are smart, even when they say dumb things. One of the issues that I've read about is that people who specialize tend to give diagnoses within their own specialty. But this isn't specifically an issue with doctors, but with human beings themselves. People WANT to give the right answer, but our specific focus creates a bias that we may not be consciously aware of. I want to relate a story that is not exactly an example of what I said, but is still relevant to the whole older or younger doctor thing. I lived in Jacksonville, Florida for a short time, and I hadn't yet gotten a doctor. But I needed to see one because I had a problem with my neck -- the muscles had tightened up to the point where I could not move my head, and trying to do so caused me intense pain. Anyway, the doctor I was referred to was very young -- without him even opening his mouth, that alone did not inspire confidence in me. Anyway, after he examined me and discussed my medical history (I had been in a serious automobile accident several years earlier, where I had suffered neck and back injuries), he decided he wanted to prescribe some medication, and so he presented to me like 3 different choices of medications. None of my previous doctors had ever actually given me choices before. And I didn't want choices. I just wanted to be able to move my head without pain. How am I supposed to choose -- he's the one who's supposed to be the expert. Do I need a stronger pill? A weaker pill? that pill, this pill? It was weird because he was probably taught to do that -- empowering the patient had become a big thing by then (though that's not how I felt about it at the time, and I wasn't used to that). I simply was in pain, and wanted it to stop and I wanted to be able to drive (I actually managed to drive myself to his office to see him, when I probably should never have gotten behind the wheel of a car). Anyway, I know my reaction to him was partly age bias. That doesn't mean that it was wrong or right. But I was glad to get a different, older doctor after I moved to Ohio.
When all you have is a hammer, everything starts to look like a nail. Re: Doctors, I find changing doctor to be OK if it's a one off kind of thing - like "I have a hacking cough, had it for a week", my regular's not here, I'll see thing other guy. Dentists, on the other hand, you really don't want some new guy sticking his hands in your mouth, lol.
A good Doctor will give you a choice if you have an interest in determining what you will take. But they should know how to deal with you if you do not understand the choices or just want them to decide for you. When my doctor advises a medication, it is just that. I speak freely and ask him what the medication is, how it works, and why he thinks it is the best choice. If I find it lacking, I ask for details. If he does not know, then I accept the prescription and go home to look it up and read up before I decide if I will fill it or not. The Doctor Patient relationship is a partnership. He helps me figure out what is best and work towards that. I help us both by reading up, understanding, and taking the medications as they are written if I have no issues. If I cannot or will not take the medications prescribed, I make a follow up appointment and discuss why I reject that medication and ask if there is another option. Sometimes this means I hear about how much worse the other options are and agree to fill the prescription despite my issues with it. If you never feel confidant and free to speak to your Doctor then you do not have one. Period. Doctors are very empathic and usually want the very best for you. My Doctor has my permission to do anything he feels is best for me even if he lacks written permission. I wrote up the whole "Medical Power of Attorney" to my mother, and with her in the room with my Doctor told him if ever he thinks something needs to be done, but he lacks the paperwork, he can do it and she will sign for me afterwards. He was baffled by this at first. Namely why I did it. Until I explained that in the event of a serious problem, I want his hands and conscious clear. This was a few years after I started seeing him. I trust him. And I know he has a very well rounded knowledge and experience.
I'm highly skeptical of the mental health profesion. From what I do know, there are disorders which are clearly biological like manic depression that respond very well to medications. But the vast majority of everything else falls into poorly defined 'disorders' that most likely fall with in the normal range of human psychology. Our actual understanding of the human brain is very limited. The brain is very complex and we are moody irrational beings, my guess is that psychology has about as firm a grasp on the human mind as alchemy had on modern chemistry. That said, I have a cousin who is studying neurochemistry or some such up at Harvard med. And he did suggest taking vitamin D to curb the winter blues and that a lot of research is going on right now over that. That same month I had an MRI after a skiing injury and my doctor told me my bones were looking a bit weak. Seeing as how vitamin D also deals with calcium absorbtion and it is today put in milk to prevent rickets it made sense to start taking supplements. They seemed to work as I had as much energy over the rest of the winter as I do in the summer. But yeah, if a doctor gave me a handful of pills to fight 'anxiety' I'd probably laugh. I'd rather take my chances handling that one on my own.
Among mental health specialists, there are certainly quacks (just as there are among GPs, osteopaths, and so on). The difference is that mental health seems to attract a lot of the flakes much more effectively. When I first needed treatment for my anxiety disorder and depression, the very first therapist I went to was undoubtedly one of those flakes. That said, there is a wealth of science supporting the existence of many mental disorders. Some may be better understood than others. But I dispute your claim that the majority of disorders are not real. First of all, there's a difference between 'anxiety' and an anxiety disorder. We all suffer from anxiety at various times, maybe even for extended periods of time, when we have real life problems -- normal life things can lead to normal anxiety. There's a HUGE difference between that, and the person who cannot leave their home, or who experiences a serious anxiety attack in the super market (I went through both of these). My anxiety is mostly under control nowadays, but that's because of group and individual therapy and good drugs. I had two aunts that were schizophrenic, one seriously so, the other was 'functional'. No one chooses to be schizophrenic. I had a friend of the family (who I called 'uncle ken', but not a blood relative) who was an alcoholic. He literally drank himself to death over the course of several years. Alcoholism runs in families. their are several genetic traits that put you more at risk for it. Human beings are part machine. Even our brains are part mechanical. The only part of this which is up to debate, is if ANY part of us is NOT mechanical. Free will is not a given in all situations Thus, there is a misunderstanding that abnormal behaviors are always totally by choice. That it's something we can just not do. Why can't someone with parkinsons just stop shaking? Why can't someone who's an alcoholic just always say no to the friend offering him a drink? Why can't he just drink one glass of beer or one shot and then stop? Why when I was in the supermarket, could I simply start breathing normally, and relax. If someone is angry, why can't they just hold it in and not act violently? We may be responsible for our actions, but we certainly are not always in control of them.
Rather than pick this apart and be a total jerk about it, I will just say that as a Bi-Polar person, I think you have a general idea, but that never fully applies to any one person. There is no magic pill that fixes Bi-Polar people. As a matter of fact, every medication I ever took made things worse from time to time. Bi-polar is a problem that centers on imbalance and fluctuation. When I am depressed, an antidepressant may help. But all of them are made to last for days or longer, while depression may only last hours or a day at a time. Then I flip like a light switch to mania. And treating mania is even more problematic. So in short, it is not possible to fix. It is simply something I and those I live around have to get used to and try to remain tolerant of. I think mental health is heavily generalized, so in a sense I agree that many conditions are made up as a means of labeling a person to make it easier to categorize them for treatment. But a really competent Doctor/therapist/whatever other title.. can understand that just because a person is diagnosed with Condition A, that does not mean the standard treatment for Condition A will be the best fit for the person.
Exactly so. A person acts in a certain way so he's categorized the same as someone else who acts in the same way, but for entirely different reasons. It can also lead to misdiagnosis. Someone who is bipolar, unfortunately, can sometimes be misdiagnosed as clinically depressed, with disastrous results. That's why when medication is first prescribed, a doctor or psychiatrist will monitor you a lot more closely. No one competent doctor will just hand you a bottle of pills for anxiety. At a minimum, they are going to ask you a lot of probing questions. And not all anxiety is debilitating. Maybe all you need is to learn to relax. Or maybe you have an actual disorder. Is this something that was brought on by being overwhelmed by normal life, or is this something that has going on for a long time, that just recently started interfering with your ability to function normally in everyday situations. In any case, generally speaking, in addition or instead of drugs, you'll often be referred to some kind of therapist or psychologist, for one on one or group therapy. The reason is that a big part of dealing with mental illness is not medical, but learning to cope with it in every day life, because drugs alone don't generally fix everything. It may seem silly, but a big part of getting better is learning to identify our symptoms, learning various coping strategies, avoiding triggers, dealing with stress, and so on. Example -- something they teach about in therapy is 'self-medication'. People don't always realize that some of their behaviors are ways we've come up with for treating our illness. This can be with drugs, food, and/or alcohol. Or it can be with our own body's chemicals through exercise, sex, dangerous activities, or we may isolate ourselves, or stay in bed or avoid anything that can cause pain or anxiety. Because doing so works. To a point. But it generally doesn't actually fix what's wrong. I personally would not even answer the phone or the door bell when I was at my worst. I wouldn't open my mail, and some days I wouldn't get out of bed. Some alcoholics, may actually be self-medicating people who are clinically depressed. which is why there's been investigation of the use of antidepressants for alcoholism. My particular way of coping did not involve alcohol, but it did involve isolating myself from everyone and everything that could potentially make me feel worse. But it was a self-defeating mechanism, just as alcohol would have been.
From what I understand, lithium is very effective at treating manic depression but physicians have no idea why or what causes the disorder in the first place. Our understanding of the brain seems pretty limited. That and every psychology major I ever met or dated has been insane. The field seems to attract nut cases. I'd just be very wary about taking any drug designed to treat a mood disorder. I suspect more than half of what we think we know is wrong. But then again, I'd personally be wary about taking any drug that alters my mind. I don't even particuarly care for alchohol.
Lithium.. Yuck. That shit had me totally nuts for a while. I stopped taking it almost immediately afterwards. I literally was jumping up and down on the hood of my car at the time. When asked why I was doing that, I had no idea. Luckily a neighbor caught me and asked before I totally destroyed the vehicle. Lithium does not treat bi-polar/manic-depression. It just makes you unable to be manic, nor depressed. You walk around in a zombie stupor and have no idea what is going on around you. In my example I was just jumping up and down on the hood of my car because for whatever reason I thought that was what I needed to do. And when I was asked why I was doing that, I forgot entirely what I was doing. I actually had to be told that I did actually damage my car. I have no memory of it. If a person is dangerous to themselves and/or others, then lithium may be worth a try. They absolutely will not be if the dosage is high enough. But we should really hope there was something other than that by now. Lithium has been used in medicine for more than a century. And it is considered the best treatment. Sad...
Yeah, Lithium evidently has kind of blanket coverage. The big difference between Lithium and other antidepressiva etc is this: Lithium is the stuff that's used to transmit information itself, independent of content. It's everywhere. If I'd have to hazard a guess, the body uses all of it that it gets since you usually don't get that much of it.
