Do you fear Doctors?

[Au Naturel]

A 'Hidden Curriculum' in Med School Trains Doctors to Have Less Empathy

A lack of empathy in healthcare can be disastrous.

www.sciencealert.com

Read the article, and I both agree and disagree.

"the way that the curriculum is structured to create a stressful workload"

The point of this is to simulate real life and weed out the weak. Most doctors, especially those in an HMO, live an incredibly stressed-out existence. My wife is a retired RN, and she tells me burn-out is rampant in doctors and nurses. If you can't stand the stress as a student, you won't handle it as a doctor.

Empathy is good and well, but too much of it will destroy you in that line of work. All day long, you see the sick, the dying, and the disturbed. How much of that do you think it takes before you become a patient yourself? Medical workers survive by disassociating themselves from the pain of the patient.

Contrary to the article's assertion, empathy does not protect against doctor burnout. What happens is that empathy gets burned out. When a patient presents with screaming pain, it is time to become a dispassionate detective and find the cause. After that, it is time to become a mechanic and fix the problem if it can be fixed and try to alleviate it if it cannot.

Patients teach doctors not to trust the patient. And because patients cannot be trusted, legitimate complaints slip through the cracks because either the doctor doesn't have time to evaluate them or the doctor assumes the patient is being performative.

I want my doctor to have the ability (I don't know if it would necessarily be empathy) to be able to tell when a patient is being performative and when they are being real. But that's a huge ask! Most patients are not particularly rational or honest when seeing a doctor. They exaggerate some symptoms and ignore others. They lie about their history. They don't take their meds. They are taking meds they don't report. There is a LOT of hypochondria out there, a lot of attention seeking, and a lot of just needing a doctor's note as an excuse not to go to work.

Doctors and nurses both have incredibly tough jobs.

 

[Bolletje]

I don’t fear doctors (being one myself) but I am worried at the lack of professionalism I’ve seen in a lot of coworkers. That, and I’ve often felt like I haven’t been taken seriously by physicians because of my invisible disabilities and chronic pain.

 

[Aspychata]

It's good with bad. A good doctor can save your life, any other type can kill you. It's playing the lottery.

 

[Tom]

No. I think the're great.

 

[Rodafina]

I rather appreciate them in theory, but I really don’t like it when they touch me, so that makes me a pretty difficult patient. They don’t seem to appreciate me as much as I do them.

 

[Shevek]

There are also the medical centers that specialize in hypochondriacs. They are far less stress than actual sick people. They know the system, attend their appointments, fill their prescriptions, always get better, and give credit where none is due.
Here, the head nurse made a mistake and made me late for an appointment. I pointed that out, so she then booked appointments I'd have needed a speeding ambulance to get to, so I'd be the bad guy. It is also quite futile to ask for accommodations for any invisible condition. The assumption is that if you are not lying, then there are other specialists to put your head back together.

 

[Bolletje]

View attachment 102711

No. I think the're great.

Hey, stop posting pictures of me!

 

[vergil96]

I'm not afraid but reluctant to go to doctors. They tell me I'm making my issues up too often. Or that I'm exaggerating. I'm aware that I feel body sensations more strongly than most people, but in my personal opinion I deserve living in comfort and not having my ability to do things disrupted because of e.g. chronic pain.

 

[Au Naturel]

Here is an example of how a patient can be their own worst enemy. Son-in-law gets whacked in the ear. Sounds like he might have a perforated eardrum from his description. Off to urgent care he goes.

The ear is swollen shut so tight they cannot see his eardrum but it also looks infected. They give him oral antibiotics and ear drops. He takes the oral stuff but doesn't do the ear drops because he read online that you shouldn't use ear drops for a perforated eardrum.

Two days later, he has yellow gup dripping out of his ear. The infection has gotten bad. What he didn't do was to check the particular drops he was given. Right on the instructions, it says they are for a perforated ear drum. Trip to the emergency room. Now he is on a very powerful oral antibiotic. His ear canal is completely closed off so ear drops can't even reach the source of the infection.

The doctor is correct far far more often than they are wrong. No amount of googling or hearsay or old wives' tales is superior to an MD with years of experience. Yet people will hear something online and decide this random influencer blogging on youtube claiming to be a medical professional knows more about you than the doctor who examined you.

 

[MildredHubble]

The doctor is correct far far more often than they are wrong. No amount of googling or hearsay or old wives' tales is superior to an MD with years of experience. Yet people will hear something online and decide this random influencer blogging on youtube claiming to be a medical professional knows more about you than the doctor who examined you.

Don't forget, the doctor's tendancy to assume that the patient has been googling away and is therefore exaggerating or has whipped themselves into frenzied hysteria.

Doctors, in my experience are as wrong as often as they are right and I may be being generous with that. I have been treated appallingly by doctors that assumed they were right about things without basically checking first.

The truth is the truth, even if it comes out the mouth of an idiot. Doctors often appeal to their own authority and commit the genetic fallacy - "patient can't be right".

Some examples of my experience of Doctors being lazy and useless...

GP failed to check my medical history and accused me of attempting to obtain drugs without a prescription, then denied I had been prescribed them. Also likely added an alert to my file which lead to the following...

An injury to my neck never being fully investigated which has caused nerve damage to my arm. The hospital staff treating me like some sort of drug seeker and not bothering to examine me.

A mental health doc failed to check my medical history and accused me of inventing a diagnosis.

Used this as evidence of a serious pathology that undermined my credibility.

Treated me with contempt and recorded more lies and inaccuracies in my medical notes which incited other doctors to treat me as a hysterical malingerer.

Ignored several serious problems on test results over the course of a year that delayed diagnosis of the following: A blood disorder, a heart condition, vitamin deficiencies and an enlarged spleen.

Insisted I take medication stated on my medical records to exacerbate the condition he claimed I had made up.

Bullied and humiliated me in appointments. Gaslit me and failed to record medication side effects.

Failed to write a prescription correctly, which lead to me not being able to obtain emergency medication.

When informed he had made an "error" and the problem was explained to him, deliberately wrote a prescription with the exact same error again.

Due to the malicious entries in my medical notes my GP tried to deny my abnormal test results required further investigation. Tried to accuse me of being too emotional. And to wait for the next set of results, then the next, then losing the next.

Failed to inform cardiologist that I was having intolerable side effects caused by heart meds.

And more that I can't be bothered to list...

Doctors sadly are human beings, capable of laziness, error and ego problems. Poor experiences will often make people reluctant to visit or talk to them. That's one of the reasons I suspect there's a booming surge in people consulting internet sources.

COVID has been used as a Trojan horse to prevent patients from being able to see their doctor here in the UK.

Doctors have done a fantastic job of deminishing their respect and trustworthiness in my eyes and many other people I know.

 

[WhitewaterWoman]

When I worked in an ER many years ago a woman came in complaining of mice in her stomach; she could feel them moving around.

The ER doc dismissed her as a psych case and discharged her with a referral. One of the female nurses grabbed her going out the door and readmitted her.

She definitely had psych problems too, but the presenting complaint of feeling mice in her belly was a pregnancy.

 

[MildredHubble]

When I worked in an ER many years ago a woman came in complaining of mice in her stomach; she could feel them moving around.

The ER doc dismissed her as a psych case and discharged her with a referral. One of the female nurses grabbed her going out the door and readmitted her.

She definitely had psych problems too, but the presenting complaint of feeling mice in her belly was a pregnancy.

In my experience, it's often the nurses that get it right the most often!

That's a brilliant example of someone going the extra mile and possibly saving two lives!

Nurses are criminally underpaid in the UK. There have been many strikes recently over it. We have a lousy government that is intent on running the country and the health service into the ground!

 

[Crossbreed]

I am thankful for competent doctors, but my general optimism is diminished when there are sharp implements involved...

 

[Crossbreed]

Like A Surgeon, "Weird Al" Yankovic (1985)​

 

[MildredHubble]

I am thankful for competent doctors, but my general optimism is diminished when there are sharp implements involved...

Oh yikes! I hate needles, I feel so sick when I have blood taken. I can't look! Blood is supposed to stay in!

 

[Crossbreed]

Oh yikes! I hate needles, I feel so sick when I have blood taken. I can't look! Blood is supposed to stay in!

I don't look, either, but vaccines/blood draws have never been as bad as I anticipated.
(Lancing a cyst, however, is another story... )

 

[MildredHubble]

(Lancing a cyst, however, is another story... )

I'd probably need a general anaesthetic!

I don't actually do too well with general anesthesia, when they removed my wisdom teeth I took almost a week to not feel like I was drugged. I tried to go to work the day after as I'd been promised I would be recovered enough. I was on the train and I must have looked terrible. There was a woman sitting looking at me with obvious disgust, I think she thought I was on drugs or something.

You'd think the fact my face looked like a bag of bowling balls, she'd have been a bit more sympathetic, but nope!

 

[Au Naturel]

Oh yikes! I hate needles, I feel so sick when I have blood taken. I can't look! Blood is supposed to stay in!

LOL! I like to watch. Doesn't change the amount of pain I feel and it is interesting.

Getting cortisone injections in your knees makes most other shots trivial in comparison.

 

[Au Naturel]

Don't forget, the doctor's tendancy to assume that the patient has been googling away and is therefore exaggerating or has whipped themselves into frenzied hysteria.

Doctors, in my experience are as wrong as often as they are right and I may be being generous with that. I have been treated appallingly by doctors that assumed they were right about things without basically checking first.

The truth is the truth, even if it comes out the mouth of an idiot. Doctors often appeal to their own authority and commit the genetic fallacy - "patient can't be right".

Some examples of my experience of Doctors being lazy and useless...

GP failed to check my medical history and accused me of attempting to obtain drugs without a prescription, then denied I had been prescribed them. Also likely added an alert to my file which lead to the following...

An injury to my neck never being fully investigated which has caused nerve damage to my arm. The hospital staff treating me like some sort of drug seeker and not bothering to examine me.

A mental health doc failed to check my medical history and accused me of inventing a diagnosis.

Used this as evidence of a serious pathology that undermined my credibility.

Treated me with contempt and recorded more lies and inaccuracies in my medical notes which incited other doctors to treat me as a hysterical malingerer.

Ignored several serious problems on test results over the course of a year that delayed diagnosis of the following: A blood disorder, a heart condition, vitamin deficiencies and an enlarged spleen.

Insisted I take medication stated on my medical records to exacerbate the condition he claimed I had made up.

Bullied and humiliated me in appointments. Gaslit me and failed to record medication side effects.

Failed to write a prescription correctly, which lead to me not being able to obtain emergency medication.

When informed he had made an "error" and the problem was explained to him, deliberately wrote a prescription with the exact same error again.

Due to the malicious entries in my medical notes my GP tried to deny my abnormal test results required further investigation. Tried to accuse me of being too emotional. And to wait for the next set of results, then the next, then losing the next.

Failed to inform cardiologist that I was having intolerable side effects caused by heart meds.

And more that I can't be bothered to list...

Doctors sadly are human beings, capable of laziness, error and ego problems. Poor experiences will often make people reluctant to visit or talk to them. That's one of the reasons I suspect there's a booming surge in people consulting internet sources.

COVID has been used as a Trojan horse to prevent patients from being able to see their doctor here in the UK.

Doctors have done a fantastic job of deminishing their respect and trustworthiness in my eyes and many other people I know.

It has become insanely difficult to get a lot of drugs in the States because of the opioid crisis. More people die from opiate overdose than from autos or guns. If you are in hospital and suffering major pain, they'll put something in your IV but good luck getting anything serious as a prescription. The same thing applies to muscle relaxants and anti-anxiety meds.

US doctors are now monitored very closely regarding their controlled substances. If the government thinks they are being too slack, their license is at risk. They used to hand the stuff out like candy. I had prescriptions in the past for codeine and Tylenol 3, among other things, but they won't prescribe it for me anymore. I don't push it because I know I'll lose.

I think they are overdoing it, but the policymakers aren't listening to me. It isn't a policy cooked up by doctors but by the Drug Enforcement Agency. Most deaths are due to fentanyl and other powerful synthetic opioids, and a narrow focus on that might yield some progress. Alas! Governments do not believe in using a scalpel when a sledgehammer is available.

Medical records are computerized. The doctor has them on screen when I see him, but I can access them at home if I like. I've had times when the doc was about to prescribe something, saw on the chart I'd had a bad reaction to it before, and changed it to a different drug. If records aren't computerized and instantly accessible, you don't see the same doctor every time, or if the patient load is high, errors are more common.

Overworked doctors may not have the time to review your complete record, especially if it is very long. (Overworked doctors also tend to be grouchy and looking for the easiest way to get you out of the office. They are human.) In an ideal world, you wouldn't need to, but in the real world, it helps if you keep track of such things as bad drug reactions yourself. So when the doc goes to prescribe XYZ for you, you can say nicely, "Uh, doc, I was prescribed that a year ago and had to drop it because blah blah blah."

My daughter doesn't have HMO coverage, so she's on Medicare. It is difficult to get everything right because doctors are constantly changing, and it is a real PITA to see one. She's always complaining that her records haven't been transferred to whatever provider she was switched to. Doctors will not see you until they have your records. That's a back-office screwup, not the doctor's doing. Until then, you are stuck with urgent care and emergency room doctors.

Covid hasn't been a reason not to see a doctor here for at least a year. When the epidemic was really raging, doctors were overloaded to the point that you didn't get to see one unless you were at death's door. Older nurses and doctors were retiring early because they were overwhelmed with stress and hours. (My wife was one.) Since then, all the medical people I interact with have become curt and hurried to get me thru the office and not prone to having conversations. A much greater emphasis on phone and email visits. It has taken a toll. Post Covid we have fewer medical personnel but still somewhat elevated demand.

Sound like UK medicine has taken a much bigger beating.

 

[MildredHubble]

If you are in hospital and suffering major pain, they'll put something in your IV but good luck getting anything serious as a prescription. The same thing applies to muscle relaxants and anti-anxiety meds.

This is definitely an issue. I've had chronic pain for years now. Before COVID the doctor was finally starting to try to investigate what was causing it but it all ground to a halt and I was back at square one.

I finally, after a lot of pushing, managed to get an in person appointment and get examined for the first time ever! It was damn painful but I was grateful for that.

My dad was with me as I never go to doctor appointments on my own after previous experiences. He tried to suggest some pain meds (I was going to but hadn't gotten that far, to be honest I had gone a bit mute), but the doctor said "Oh according to NICE guidelines, we don't prescribe anything for chronic pain. We don't even give ibuprofen as some studies suggest it worsens pain over time".

I should qualify for some state assistance due to my mental health and chronic pain etc. But the fun thing is that they say if you aren't on pain meds prescribed by a doctor you don't qualify. So that's a ridiculous catch 22. So I'm now dealing with the stress of sorting that out.

As you say, accessing your medical records is very important. I used to be able to access and print my consultants letters but for some odd reason, they have restricted that function recently, I'm told this is the case for everyone, but I'm suspicious that's not true.

The doctor that refused to prescribe my long term meds claimed that I had no record of a condition that would require them and I had no record of ever being prescribed them.

Of course I tried to appeal to his better judgement. After a few minutes of getting nowhere, he claimed "Ah, oh I see, oh that information has just come through! I can prescribe them now..." Seemed a bit odd but I was happy it seemed to be resolved.

The next time I visited that doctor was after a visit to the hospital (where they had treated me badly, I suspect the doctor had put a warning or alert on my medical file). I started to recount the events and what happened, I mentioned the meds they gave me and he launched into a tirade "I'm NOT GOING TO GIVE YOU THAT!".

I replied that I was only telling him what had happened, and that perhaps he should wait until I ask for something before he starts shouting and saying "no". He said "oh I just had to tell you is all, and I can see on your notes what happened at the hospital". I asked him why he didn't mention that earlier. He looked sheepish and was a bit more polite after that.

Bottom line is though, no body ever disputed my diagnosis until he did, and after he did it was like everyone had received the same memo and treated me suspiciously. This was despite it being all over my medical notes!

I absolutely agree they've over corrected with the attitude on pain med prescriptions. The irony here is that I have to resort to OTC meds that contain codeine. I don't think I could become addicted, opiates don't seem to affect me that way. I can go days without taking them, if I really wanted to, much longer. But my quality of life would suffer and I have no wish to punish myself for no reason.