General Medical issues thread

[cove]

I remember my supremely confident heart surgeon saying "take me I am available" and that was 22 years ago. Well that worked out great and he progressed with heart/lung operations.

 

[Pushka]

[Flippant]Your body is full of antibodies. [/Flippant]

But sounds like the first Doc either had a bad day or prejudged by putting you into a certain category, or actually bad.

I had a Professor colleague - wrote many books, articles, and chaired many conferences, committees. but no good clinically. I guess you get all types doing all things.

I think you hit the nail on the head- the good ones get booked out

Yep. Was able to get into the first one within 2 weeks. No pre questionnaire like the second Doctor either. In fact he didn't even start with questions but went straight into a tirade about Royal Adelaide Hospital specialists.

Agree re the research versus clinical. Sometimes not a good mix but great in this case.

 

[Foreigner]

I remember my supremely confident heart surgeon saying "take me I am available" and that was 22 years ago. Well that worked out great and he progressed with heart/lung operations.

22 years is pretty good going. My dad's going better at 31 years since his bypass surgery.

 

[cove]

We are running with an unwritten lifetime warranty. They originally thought bypass would last 10 to 15 years but "they" were wrong. I have both Anginine and DVT medication in my travel bag and haven't ever used them. I believe in just in case so I renew them.

 

[drron]

22 years is pretty good going. My dad's going better at 31 years since his bypass surgery.

I suspect that Cove and your father both followed the advice given on lifestyle.That is a major factor.

But there certainly are some cardiac surgeons that really are great.My particular favourite was one of the originals-Rowan Nicks of RPAH.He was a Kiwi but became the first full time Cardio Thoracic surgeon at RPAH.I met him on several occasions and the title gentleman fitted him perfectly.
when I moved to Queensland I inherited 3 patients who he had done Mitral Valve surgery on in 1953,54 and 57.The first 2 had been operated on in NZ but moved to Australia when he moved.They were all still alive at the end of 2006 when I retired and none had had further intervention.The youngest was 87 then.Incredible results at a time when none of our diagnostic tools were available-just the clinical skills.
Rowan Nicks | Royal Australasian College of Surgeons
https://sydney.edu.au/medicine/museum/mwmuseum/index.php/Nicks,_Rowan

 

[cove]

drron I consider myself very lucky. I was operated on less than 24 hours after the ink flow test failure. One of my arteries was 95% blocked.
I exercise regularly and they won't take my blood at the blood bank.

 

[k_sheep]

I think you hit the nail on the head- the good ones get booked out

Or go into pathology

 

[Foreigner]

I suspect that Cove and your father both followed the advice given on lifestyle.That is a major factor.

But there certainly are some cardiac surgeons that really are great.My particular favourite was one of the originals-Rowan Nicks of RPAH.He was a Kiwi but became the first full time Cardio Thoracic surgeon at RPAH.I met him on several occasions and the title gentleman fitted him perfectly.
when I moved to Queensland I inherited 3 patients who he had done Mitral Valve surgery on in 1953,54 and 57.The first 2 had been operated on in NZ but moved to Australia when he moved.They were all still alive at the end of 2006 when I retired and none had had further intervention.The youngest was 87 then.Incredible results at a time when none of our diagnostic tools were available-just the clinical skills.
Rowan Nicks | Royal Australasian College of Surgeons
https://sydney.edu.au/medicine/museum/mwmuseum/index.php/Nicks,_Rowan

Dad's surgeon was Sir Brian Baratt-Boyes, also a Kiwi:

http://m.nzherald.co.nz/nz/news/article.cfm?c_id=1&objectid=10372038

He himself suffered from heart disease and died at Cleveland following heart surgery at the Mayo Clinic.

 

[Flying mermaid]

Is there a kind of hierarchy in Medicine? .

there are all sorts of hierarchies as we have learnt with Dr FM and her journey. It is a long, long process and very long hours to get to the specialist level.

When you are in the the lower levels you really don't go against the senior doctors and I think that is fair enough, otherwise it would be horribly confusing for the patient! Sort of like a flight attendant telling the pilot they were wrong.

I will always be grateful though to an intern/resident (not quite sure what he was) from Sri Lanka. Mr FM had collapsed at home and been taken to our closest hospital by ambulance and after tests I was told he had two growths in the brain, which could be either metastases or absesses. I went home that night and read everything I could lay my hands on and went in the next morning and asked if they should be starting antibiotics if there was any chance of it being brain abscesses. I had read that brain abscesses had a 90% mortality rate if they burst so I was desperately worried.

Anyway the doctor who was second in charge, told me that Mr FM had no elevated temperature, so they were going with cancer and would do more tests.

A short while later the Sri Lankan guy sidled up to me and told me you don't have to have a temperature in order for it to be a brain abscess. Apparently they are very common in the Indian sub continent, so he knew a lot about them. He clearly didn't feel he could contradict the senior doctors, but it gave me the courage to keep fighting.

Most of the problem arose from the fact that the hospital he was in only had a part time neurologist and in the 4 days he was there he didn't see one. The doctor in charge had a god complex and didn't like being challenged. There were no spare beds in the neuro ward at the main hospital. And no one there understood that a suspected brain abscess was an emergency and he needed to be transferred to the main hospital straight away. Finally at this time no scans were online, so although a spectroscopy was done, it couldn't be viewed at the main hospital.

After the spectroscopy was ready, I picked it up and took it into the hospital the next day. I had spent all night reading it and reviewing research papers on what the results meant. The conclusion by the radiologist who did it, was that it was more likely to be cancer, but I just didn't feel that was good enough given the high mortality rate with an abscess. Also from what I could see from the research papers I didn't agree that it was conclusive.

Anyway went in next day, head doctor did a quick glance at the radiologist's report and told his group of junior doctors that it was cancer. I started questioning him, and he lost his temper, turned his back on me and told Mr FM (who was not mentally competent at this point and had no idea what he was talking about), that he had cancer and he had no other choices except surgery and radiotherapy. he then proceeded to make a note that Mr FM was to be discharged and sent home for some R&R (his words), until surgery could be done.

I immediately rushed home and emailed some specialists I knew at the main hospital and begged them to talk to the neuro department and let them know what was happening. My final step if Mr FM had been discharged would have been to have taken him to emergency at the main hospital and start again. It was not that I knew what the diagnosis was - I just thought there was room for doubt and by this stage it had been 4 days......

Anyway when I got back to th hospital I was told Mr FM wasn't being discharged - the neuro doctors had got to hear about the case and wanted to see him. When we got over there I handed the spectroscopy to them and after looking at it they came back and said they felt it was more likely to be a brain abscess but they couldn't tell until they had done an emergency biopsy the next morning. It was early evening by this stage.

Anyway the biopsy was done, the results were back in a few hours and he was immediately started on a coughtail of antibiotics. Only one abscess could be aspirated, the other was too deep in the brain. He ended up with a lot of others problems, was in hospital and hospital in the home for 3 months and it took nearly a year for the antibiotics to work. I became very good at looking at MRI scans and hoping the abscess was getting smaller!

As I said without a very junior doctor being prepared to give me information which contradicted his superiors, I would probably have accepted what was being said and Mr FM would probably have died during his R&R.

 

[Quickstatus]

Patients and for that matter their body parts don't exist in a solitary vacuum. Involving the family is critical. Ignoring the family increases the risk of failure of diagnosis and/or treatment.

Then on the other hand every family member (not yet the dog) want to have a separate say in Grandma Maude's treatment. It then becomes very difficult when mutually exclusive demands occur. Negotiating this can be frustrating. First order of business then is to request the family come to a consensus of opinion and communicate this through one family spokesman/woman/boyguy/girlguy/trans/queer.

 

[cove]

This weekend we lost a friend to a massive heart attack after he had played tennis in sweltering heat. It reminds me to tell you not to ignore angina chest pain as some do not get a second chance.

 

[suze2000]

He didn't ask me when I developed it (30 years ago) but just that it was an issue that OLD WOMEN get and was clinically irrelevant. Every joint issue he put down to old age. So to him, women in their fifties are easily dismissed as OLD WOMEN.

Studies have been done that show that pain suffered by women is not treated as seriously or as quickly as that suffered by men. I have also be judged and dismissed because I am fat (or female, or both) by doctors and other medical professionals, though I find this is less of a problem now that I am (almost) past childbearing age (and thus allowed to be fat, I suspect, or perhaps it's just that there are more fatties generally these days, who knows what informs people's prejudices?), and I know a woman who was told that it was not urgent to remove a piece of surgical equipment that had been left in her after an operation! (incidentally she was also fat, never mind that she was experiencing intermittent fevers and debilitating weakness and honestly thought she was going to die from it)

Actually I have in my head several medical horror stories that have happened to women I know, and now I'm angry, so I'll stop.

I'm sorry for your experience Pushka, but glad that you are starting to come good now.

ETA: sorry for your loss cove, you must have posted the same time as me, and now my rant feels poorly timed.

 

[Pushka]

My condolences cove.

Ignoring chest pain is not good. But sometimes it just isn't the kind of pain that we seem to be warned about that can be ominous.

Suze2000 - sometimes I think that some medicos look for every other reason other than an illness. Many conditions are put down to being overweight, even fertility issues. But maybe the condition causing the weight issue is also causing infertility.

At the time the RAH kept asking me if I took drugs. I swear I was asked just that question at least five times. I don't, other than the swathe of medical drugs that don't include either pain or sleep meds or stimulants.

I was not overweight - damn, can't blame that. I don't smoke. Another dammit. I drink (when not on holidays) around a bottle of wine a week. Dammit. Stumped them! Nope. Female?

So then they turned to cancer which five months later yielded nothing. That was it. The first specialist blamed the HRT patch. Which was the lowest dose possible and I'd cut it in half. And had been on it for five years.

There was no thought given to auto immune illnesses yet I had already had one for 25 years that they knew about. Thankfully just asking for the correct test sorted it out. An entirely simple test overlooked.

Of course, had anyone thought to go past the HRT patch and ask 'why did she develop a dvt on HRT' then they could have investigated that with further coag tests and would have realised that with APS a hormonal patch/contraceptive was a definite no. But it was stopped at the patch.

Maybe I'm too harsh. APS was only discovered/realised in 1983. I think younger Drs are already trained in it but the first specialist hadn't kept up the training. Certainly the Med student who was at the lab while having a blood test knew about it.

Pesky women.

 

[Quickstatus]

Sometimes heart attacks can occur without chest pain but does not stop the heart. Sometimes a heart attack stops the heart - so no time for chest pain to occur.

Was in a hospital lift many many moons ago when fellow lift traveller collapsed. Nothing could be done - massive heart attack. Packer whacker no effect nor anything anyone else.

 

[Flying mermaid]

This weekend we lost a friend to a massive heart attack after he had played tennis in sweltering heat. It reminds me to tell you not to ignore angina chest pain as some do not get a second chance.

I am sorry to hear that - my condolences.

 

[Flying mermaid]

Patients and for that matter their body parts don't exist in a solitary vacuum. Involving the family is critical. Ignoring the family increases the risk of failure of diagnosis and/or treatment.

Then on the other hand every family member (not yet the dog) want to have a separate say in Grandma Maude's treatment. It then becomes very difficult when mutually exclusive demands occur. Negotiating this can be frustrating. First order of business then is to request the family come to a consensus of opinion and communicate this through one family spokesman/woman/boyguy/girlguy/trans/queer.

it is a difficult line to tread. You can get critical information from the family and they have a need to be involved, at the same time your first duty is to your patient. There is a gigantic amount of pertinent information on the web, but not everyone can eliminate the crank/junk stuff.

Dr FM is a paediatric registrar and so dealing with family is a big part of what she does. She does draw the line at being told what Great Aunt Nellie's next door neighbour thinks should be done....

I think an issue for some doctors, is they start believing that doctors are the only intelligent people. Given the profile of presentations at some hospitals, this is probably not unreasonable, but still something to guard against.

 

[Quickstatus]

Pts and their families come into Drs attention when they are vulnerable and medical treatment makes then even more so and are then unable to process the information you give them.
So then more often than not whatever you tell the patient is not what the patient heard.

Im forever trying to get patients (is that a valid term anymore?) to take more interest in their healthcare. Some do and come armed with questions and write notes or bring a support person which I like. Others don't even know what pills they are on. I often get information from patients that seem very outlandish and improbable (because that's what they heard) and I have to confirm that with the original source and usually then arrive at a different story.

Drs are very intelligent people by selection usually via a high cognitive ability to pass exams and memorise lots of stuff and recognise patterns (No infallible for sure). To get through a rigorous training program requires a certain personality - Type A some say. Eventually we will be taken over by robots. However some don't have high emotional intelligence (which may suit certain specialities). But neither do Robots aka "Emergency medical hologram" on Star Trek.

 

[Flying mermaid]

Drs are very intelligent people by selection usually via a high cognitive ability to pass exams and memorise lots of stuff and recognise patterns (No infallible for sure). To get through a rigorous training program requires a certain personality - Type A some say. Eventually we will be taken over by robots. However some don't have high emotional intelligence (which may suit certain specialities). But neither do Robots aka "Emergency medical hologram" on Star Trek.

Certainly true from what I have seen -Dr FM is very type A (so am I). I think her emotional IQ is OK, although Miss FM is much more touchy-feely. She is a bright girl with excellent problem solving abilities and is doing well in her chosen speciality. However her brother, who is a software engineer, could run rings around her and even Miss FM, who is a lowly high school teacher, has the same abilities as her sister. The two younger siblings just chose careers they loved.

I am following some software called Enlitic with interest - if it is viable it should br a huge productivity tool for radiologists.

 

[Quickstatus]

I should have been radiologist. Was good at it but declined the training spot.

Then I could have read scans anywhere from in the world - just need a good internet connection.

Teachers should be paid more.

Enlitic and other neural AI algorithms : now that's where the smart people are

 

[wandering_fred]

...
Teachers should be paid more.
...

Persons competent in their profession should be paid more. Alas abiding by the conventional wisdom and not rocking the boat seems to provide the best returns.

After viewing what has happened to secondary education in the USA over the last 40 years (or so), I would argue for minimum knowledge levels for secondary (and likely primary) teachers. The AFF grammar thread provides good examples of what has happened in English speaking society.

I need to go back to my wandering

Fred