From: km@cs.pitt.edu (Ken Mitchum)
Newsgroups: sci.med
Subject: Re: mitral valve prolapse and need for antibiotics?
Date: 6 Oct 92 15:03:22 GMT
Article-I.D.: pitt.16791
Reply-To: km@cs.pitt.edu (Ken Mitchum)
Distribution: sci
Organization: Univ. of Pittsburgh Computer Science

In article <1992Oct5.082050.27991@spdcc.com> dyer@spdcc.com (Steve Dyer) writes:
>In article <BONNIE.92Sep29190907@aigyptos.nmsu.edu> bonnie@nmsu.edu (Bonnie Hargrave) writes:

..OK.  That does it.  I have many other reasons for questioning this
..particular doctor's advice.  Yes, she did pooh-pooh the candida
..question.  She also thought a hypoglycemia test was unnecessary since
.."everyone reacts to sugar".  Her explanation of the latter seemed
..reasonable to me.

Actually, I never order glucose tolerance tests myself. I would
congratulate Bonnie's doctor for being straightforward with her
rather than order a test she doesn't believe useful.

..her inability to handle basic
..questions (for example, would ibuprofen or acetaminophen in large
..doses affect the uric acid level),
.
._Basic_ question??  Um, Gordon, David and Ken: is this a basic
.question?  I'd think not.  Most MD's, unless they're specialists in the
.treatment of gout, might think way, way back to their pharmacology
.course and remember that aspirin has a complex effect on uric acid
.excretion depending on the dose (low doses cause retention, very high
.doses such as you might see used in rheumatoid arthritis can cause
.increased excretion.)  But I doubt that the actions of either
.acetaminophen or ibuprofen are on the tips of anyone's tongue; that is,
.sufficiently to speak absolutely authoritatively.  

No, I don't think it's a "basic question" - at least I would also
flunk Bonnie's test here, and would have to look up the effects of
both drugs on uric acid metabolism. If having to look something up
is a sign of a bad doctor, I'm a real bad one!


..and MOST of all her assumption that
..my symptoms are merely mental led both my husband and me to believe
..she is, well, in my husband's word, "hopeless."
.
.What's wrong with "merely mental"?  Does that make it less of a problem?
.Not that I'm claiming that that's the situation.

This is 1992. Why do people still believe in some type of mind/body
dualism that makes something "merely mental" some type of character
failing? When you have a fever of 104, your mind dosn't work very
well, and people understand and accept that. But when the physical
correlate of behavior is less obvious, people don't want to acknowledge
the connection. People die from problems that are "merely mental"
(depression, schizophrenia). Let's try to stay in the twentieth
century.


..On the assurance that doctors appreciate seeing the whole picture, I
..made up a list of symptoms I've experienced in the last two years.  I
..asked the doctor to look over the list and tell me what she thought.
..Her reply was that the list indicates a "preoccupation with illness"
..and that I should be seeing a psychiatrist.
.
.You seem to think this is an insult.

We were taught very early in medical school to be extremely wary of
patients who bring in lists of symptoms or questions. I only pay
attention to things patients can tell me myself.


..When the patient loses trust in either the doctor's competence or the
..doctor's ability to even _care_, that patient starts to question every
..thing the doctor recommends.
.
.Well, don't do that.  What makes you think she doesn't care?
.Would it be better for her to have strung you along giving
.you sublingual sensitivity tests to "allergens"?

It is very common for patients to not accept what a doctor says, and
to translate that non-acceptance into the idea that the doctor does
not care. "Dr. Mitchum doesn't really care about me. He thinks all
my problems are in my mind, and wants me to try antidepressants.
He thinks I'm crazy!"

 -km
Newsgroups: sci.med