From: fulk@cs.rochester.edu (Mark Fulk)
Newsgroups: sci.med
Subject: Re: mitral valve prolapse and need for antibiotics?
Date: 9 Oct 92 16:18:24 GMT
Distribution: sci
Organization: Computer Science Department University of Rochester

In article <16791@pitt.UUCP> km@cs.pitt.edu (Ken Mitchum) writes:
>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!

One of the things I look for in a doctor is a willingness to look
things up.  I think it is ridiculous to expect doctors to memorize
shelves of books when I can't program for more than an hour without
consulting a manual.

>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.
					  ^^^^^^

I assume you mean ``themselves.''  I might have trouble getting your
attention them.  Especially when dealing with pediatricians, I find
lists to be absolutely necessary: I can't remember which meds were
given when, when a fever peaked, and the dozens of other facts which
our pediatrician deems important enough to ask about.  Especially when
both kids are sick!  Whenever one of them gets sick, we start a diary
on the fridge, recording temperatures, meds, phone advice, etc.  Then
when we see the doctor, we take the diary.  It has saved us from making
numerous (probably minor) mistakes, and I think it has really saved
Saul a lot of time.  He certainly doesn't complain.

I also made lists of family members medical history when seeing my new
internist.  She wanted to know about heart disease, strokes, etc.

If I suffered a debilitating, long term, illness, like CFS, I would probably
keep a diary of possible symptoms, treatments, medical opinions, any
interesting observations of my own, etc.  I wouldn't just hand it to the
doctor though; I would mention the most outstanding items first and use
the diary to answer her questions.  This doesn't strike me as being in
any sense a psychological problem; I just prefer a paper record to trusting
my own memory.  Far too often, I've left some sort of appointment (not
usually medical) only to remember something I really meant to say as I
got into my car.

If I though I might be having a Lyme relapse, I'd go back to our old
calendars and records and make a list of facts: trip to Nantucket, rash,
prescribed meds, other symptoms then, onset of symptoms in relapse, nature
and order of appearance of symptoms, etc.  I just wouldn't trust my memory
with all of these facts.  Fortunately, I haven't had any occasion to do
this, unless the Lyme-Usenet link becomes more firmly established.

By the way, how would you deal with the neurological patient, who,
unable to remember basic daily details, got through life with a box of
3x5 cards as a surrogate memory?  This woman actually managed to fly
to New York and get a cab to Rockefeller University when I worked there...

(I think she'd had a stroke.  Unlike Jimmy G., she could adapt to new
situations (obviously, she'd adapted to her memory loss).  She could also
maintain a connected conversation; I experienced that myself at lunch.
However, anytime anything came up that she wanted to remember, the box came
out and she made a new card.  Unfortunately, I've forgotten most of the
details.  Guess I'm disqualified for being a patient, doctor, or president
for my faulty memory; this was only in 1978!)

I remember reading a while ago that the the old diagnosis ``maladie de la
petite papier'' had been eliminated.  This as doctors realized that patients
with lists were trying to be accurate, and were probably writing down their
advice as well, in order to follow it better.  Strange to me how perfectly
rational behavior got classified as a symptom of illness!
-- 
Mark A. Fulk			University of Rochester
Computer Science Department	fulk@cs.rochester.edu