IGX

When I schooled pre-meds and MD's in physics, engineering and related topics, I came away with a distribution that said about 10% legitimately intelligent people, quick to pick up on abstract ideas and apply them, 50-60% being hardworking mediocrity, doing the requisite studying while riding their big state school curves to the requisite GPA and on into medical school, and the remainder not being aptly described without the words dumb fuck.

Recent issues with my wife post-surgical recovery has me wondering if that distribution isn't fatally skewed far too far to the high end. She had her gall bladder removed some 7 months back and continues to be in excruciating pain. Went through all the checklist items of adhesions, infection, materials left behind by the surgeon (a real peach, her), related GI problems, scoping, multiple batteries of blood tests, you name it. No answers, not even suggestion of the same. The pain is highly localized to the area where the surgical clips are. She has a family history of metal allergy and a sister who had the same symptoms after multiple Ti-based implants and clips from surgeries related to a car accident. Upon removal of those implants, all pain symptoms ceased.

Yet, after throwing their collective hands up at the end of these 7 months, they still out-of-hand reject the possibility of metal allergy or rejection. "Titanium is inert", "the probability is too low", you name it. Any attempt at engaging them on a scientific level, be it basic chemistry, probability and statistics or even their ability to read, comprehend, and critique their own literature leads to laughable discussions, which quickly conclude when they realize the whole of their intellectual contribution over the course of the discussion was finding a way to stick both feet in their collective mouths.

We have some MD's here, I know, so what gives? The charges are exorbitant for what amounts to a technician level approach to problem solving and an attempt to bluster their way out of it through pseudo-science. I know the canned answers are about managed health care and insurance, but you can't fake this kind of dumb. Are you folks schooled in anything but rote memorization and checklists?

I'm sure you've seen this, but maybe get your own melisa test

Titanium allergy is barely recognized in mainstream medicine – yet laboratories using the MELISA technology have reported that about 4% of all patients tested to titanium will be allergic to it ... For those affected by titanium allergy, the symptoms...can range from simple skin rashes to muscle pain and fatigue.

Like all metals, titanium releases particles through corrosion. These metals become ions in the body and bind to body proteins. For those who react, the body’s immune system will attack this structure. This starts a chain reaction which can lead to many symptoms including chronic fatigue syndrome. The MELISA test is the only scientifically-proven test which can objectively diagnose titanium allergy and measure its severity.

http://www.melisa.org/metals-disease/metals/titanium/

Thanks. After the most recent interaction with the medical profession, it's a next step.

This has been looked into before now, but just by me, not the MD's. This is what I refer to above about an unwillingness to engage. "Never heard of it, must not exist, because I would, of course, never be hearing about about it from a mere layman." The more specialized the MD, the more you get this attitude. The MELISA test does throw false negatives at a higher than desirable rate and has not seen full study but what has been done, looks promising. I don't expect definitive answers at this stage, I do expect intelligent interaction and collaborative problem solving. A lifetime of opiate-based pain control for a 35 year old isn't an acceptable answer.

I had finished my Basic EMT class, but needed to spend 8 or so hours in an ER in '88. The first night at South Fulton Hospital ER I was approached by a Black M.D. who
was filling out some sort of report. He pointed to his lower arm and asked me what that area was called. For a second I thought that he must have determined that EMTs
were idiots, but soon realized that bastard didn't know the proper name for a humerus.

Small sample size, but I'd say he fits your criteria.

I've had some experinces with MDs that made me just think WTF. Particularly ER docs. As someone who works in the medical field, I find it inexcuseable.

Like they say, "What do you call the person who graduates last in medical school?"

Doctor.

Bob Wildes wrote:He pointed to his lower arm and asked me what that area was called. For a second I thought that he must have determined that EMTs
were idiots, but soon realized that bastard didn't know the proper name for a humerus.

Upper (proximal) arm is the humerus. Lower (distal) is composed of the radius and ulna afaik.

Sorry to hear about your wife's pain. It may be that they are stupid or that they are covering their ass to prevent opening up the proverbial pandora's box of litigation. I would take a guess that they probably won't be of much help until you do the legwork to figure out what is going on (on your dime of course). One other thing to consider is that gallbladder pain continuing after surgery seems to be pretty common. Maybe the docs have seen this happen a lot so they are not very responsive. Anyway, good luck with this. I hope your wife feels better.

Sorry about your wife. Doctors as a group are comfortable above the mean when it comes to smarts.

Imagine being a doctor who has to deal with all the WebMD self-diagnosing hypochondriacs out there, to say nothing of the liars. It's got to be agonizing, and no MD is going to forget that a patient who comes in with his own ideas is completely unqualified to make a diagnosis, which leads to dismissing patient diagnoses out of hand.

If you want to be taken seriously, be serious and distinguish yourself from the crazies. Bring paper. Get the write-up from the other medical professional noting that the sisters' symptoms subsided after removal of the titanium. If they still don't listen, get another doctor.

There are good ones and bad ones just like any job.

Get a second opinion. Good friend of mine's husband was having weakness and fatigue (not the "oops forgot to take my test a la seahill kind). She was frustrated by her family doc who told him he needed vitamins. My husband, an er doc, told her that he needed a neurologist. He was quickly diagnosed with progressive multiple sclerosis.

Yes, indeed, there is probability that the pain remains even after gall bladder surgery. It is unusual, however, for its nature to change and its severity to so decidedly increase. It does make a case that the surgery might be too quick a resort for surgeons who see every problem as a nail.

The established and recommended procedures and testing prescribed were followed faithfully for the intervening 7 months, without any attempt on either my or my wife's part to render a diagnosis. The documentation of test procedures and results across multiple doctors, of multiple specialties, has been exquisitely maintained and presented to the each MD in turn. Some, just a scant few, even bothered to read it in its entirety. The most recent of the endless parade of 'second opinions', a well respected GI MD at the Mayo, who did bother to read the several hundred pages of history, look at all the images from the CAT scans, MRIs, sonoscans and scopings commented on how poorly some procedures or tests were performed/analyzed and how contraindicated some measures taken were. Each, however, was monetarily compensated for quite well and perhaps that was the driver. It's only after these efforts that the specter of a metal allergy was posited to the MD's as a real possibility, backed by the contact information of the surgeon who performed the removal on my wife's sister.

The idea that because some patients attempt self-diagnosis and therefore any patient input should be ignored smells of the same stench I described in the opening post. Even if such had been attempted, any competent MD should be able to explain why the suggestion is in err. Leave aside for the moment that most medical diagnoses are wrong, leave aside that most of the medical literature is statistically and procedurally invalid, and leave aside that medical science is woefully short of scientific content, what comes from the MD's mouth should not be wrong in terms of known science, statistical fact, or common reason. The MD shouldn't be back pedaling when he learns the guy he just tried to pawn off some nonsensical explanation to isn't quite as dumb or uneducated as he assumed. I have a PhD from MIT but if I were to tell you gravity is a repellent force, it wouldn't for one moment change the nature of the universe. There's no such thing as "proof because I said so."

Metal allergies *are* a low probability, but they are not a low conditional probability when other known or suspected causes have been eliminated and the symptoms are consistent with known cases of metal allergy or rejection. It's no more difficult a concept than to say the probability you are above 6'6" is low but the probability you are above 6'6" given that you play in the NBA is significant. If you can't grasp that you are a dumb fuck, if you are so arrogant you can't consider it then you are as good as a dumb fuck. The fact it seems to be so systemically rooted in the profession at large is the reason the question in the subject line was posed. Simply recommending a different form of pain management rather than further seeking causation is no different than a guy who thinks his cold is cured by Nyquill because it addressed his symptoms.

I wonder how many doctors are over 6'6"

Depends on what percentage are playing in the NBA.

Doctors, by definition, should be specialists (even the ones in more general fields of medicine IMHO). Tunnel vision has it's advantages and benefits. I've found that experts in many fields hate it when their expertise is questioned, and that generally the worst experts hate it the most. Some experts are comfortable with it, and they're usually the best ones, or at least have the best bedside manner.

Perhaps more importantly, not all hospitals are created equally. See the link here:
http://www.kaiserhealthnews.org/Stories ... ogram.aspx

Props to you for being an effective pain in the ass husband, a lot of people would not have followed through. I hope your wife is doing well.

Sua Sponte wrote:The idea that because some patients attempt self-diagnosis and therefore any patient input should be ignored smells of the same stench I described in the opening post.

I'm trying to explain how this works, rather than chalking it up to "Docs are dumb."

Even if such had been attempted, any competent MD should be able to explain why the suggestion is in err.

And they often can. But since many people are not persuadable that sugar doesn't cause cancer, that Aspartame doesn't cause Parkinson's, or that Mercola does not = God, there's not much point. It's also common for an MD to have to research something, because "medicine" is a pretty broad subject, and rare diagnoses like allergic to titanium is by definition one of the less likely scenarios.

You don't get to have your unqualified opinion taken seriously just because you think you're right, or even because you are right. If you're right but you act exactly like the crazies, you're expecting a lot from somebody who has to dismiss crazies to get through their day.

Following up and being persistent is exactly what you should be doing. But if you don't take into account the professional's mindset and adjust your strategy accordingly, you're gonna have a bad time. I would bring the written opinion of an MD who found the same symptoms and diagnosis in a relative, or something similar, and you'll get a lot farther.

The conclusion doc's are dumb came after the months of interaction not before.

The presumption that valid attempts to reason with the doctor by providing explanations, research, chemistry, and actual probabilistic arguments is as presumptively wrong as is the mindset that "if you were doing it right you wouldn't be having this problem." This is an evidentiary-based description of an outcome not an approach taken. MD's don't research what they have already dismissed. Your assumption of the facts doesn't supersede my possession of them.

To your last, one does not simply acquire another's medical records, family or not. It's but a phone call or an email from one MD to another to validate what has been presented to the MD, to date not pursued perhaps for the same reason as the last sentence of the last paragraph.

Medicine is mostly a skilled trade

Shafpocalypse Now wrote:Medicine is mostly a skilled trade

Total agreement....and among tradesmen, they some of the least analytic.

For most physicians, creativity is not rewarded.

Sorry to hear about your wife.
The problem is not practitioners but the increase in reliance on 'evidence based medicine'.

You'd think this would be a good thing, and it can be but the end result is the sort of thing you saw with your wife.

Good practitioners (of any modality) have always been good problem solvers... You're a detective who starts with a tree and slowly removes leaves and branches until you get to the trunk and then under the trunk is the root, of the problem. From there you seek the safest, most effective manner in which to help the person's system move beyond the problem. You apply that as deemed necessary and with a humility that allows you accept that there could be a better way and change tack at any given time.

The misapplication of "Medical science" and its ability to somehow blinker out what could be called 'basic science' is just another symptom of this problem. This is what you have experienced, both as a teacher of practitioners and with your wife's case (btw, sorry to hear about her challenges.

There's probably a lot more to it but it becomes inevitable when you combine laziness or ridiculous workload (or both), and the 'appeal to authority' type of reasoning that abounds in the world of god-like practitioners and patient-doctor separation. Add to this the sad fact that a majority of research out there is flawed and you have a situation where a good idea (EBM) actually doesn't lead to advances across the board for patients (or practitioners). A case of not seeing the forest for all the trees.

I see it in my profession. A culture of research awareness that the move toward EBM promises is a positive. The negative is that suddenly we have a case where practice by menu may be enforced because some meta analysis that has nothing to do with helping your patient as an individual may be used against you should your clinical decision not have exactly the desired outcome.

There are lots of problems with modern medicine. We are dogmatic, inflexible and overspecialized. On the other hand, patients expect us to solve all their problems and are very happy to blame us for their health problems.

The reliance on evidence in medicine is excessive. Most important things cannot be studied in double-blind randomized studies, and outcomes in most instances are multifactorial. Attempts to separate one cause from another by some fancy statistical massage are pretty useless, but very few understand this fact.

And, of course, just like in any field, there are some good professionals and some bad ones.

Terra, check your PM.

Shafpocalypse Now wrote:Medicine is mostly a skilled trade

SOOTH

Of course it's a skilled trade, what else is it supposed to be? We're not creating pieces of art, we fix things gone wrong. WHen we can. We are not different from car mechanics or electronics repairmen. Just the subject matter is in many instances more complicated and less predictable.

Bedlam 0-0-0 wrote:

Bob Wildes wrote:He pointed to his lower arm and asked me what that area was called. For a second I thought that he must have determined that EMTs
were idiots, but soon realized that bastard didn't know the proper name for a humerus.

Upper (proximal) arm is the humerus. Lower (distal) is composed of the radius and ulna afaik.

Sorry to hear about your wife's pain. It may be that they are stupid or that they are covering their ass to prevent opening up the proverbial pandora's box of litigation. I would take a guess that they probably won't be of much help until you do the legwork to figure out what is going on (on your dime of course). One other thing to consider is that gallbladder pain continuing after surgery seems to be pretty common. Maybe the docs have seen this happen a lot so they are not very responsive. Anyway, good luck with this. I hope your wife feels better.

Right you are. The doc was pointing to his upper arm when he asked the question.

Sua, recommend you go to an additive manufacturing facility, get some titanium powder (it's like dust), mix it with some bag balm, and then rub it on your wife's scrotum to see if there is a reaction.

Seriously, it will be a Feynman dropping the O-ring in cold fluid at the Challenger hearings moment.

Medicine is hard, and I am frankly amazed at all the things they can actually fix. After nearly killing my MIL, they somehow managed to manage all the shit that was going wrong simultaneously while she healed and gave her back her life. But in the end, there's a gazillion things in the body that can screw up, and 2^gazillion ways they can interact. Hard to know everything.

I blame medical TV shows for unwarranted expectations. People always left Marcus Welby smiling.

Smet, you are totally right. My Mother in Law, for example, cannot understand why a doctor couldn't fix her ailing and depressed mother, whom broke a hip, then passed away due to some kind of bloot clot incident.

I've seen the spectrum. My son's neurosurgeon was an amazing, humble, and gifted surgeon. My last GP was a whore for the pharmeceutical industry.

Give the MDs a break. They're just doing their job as dictated by big Pharma. Big pharma owns all the medical schools and plans the curriculum there in. The first trap is to start taking the drugs that starts one on the slow downhill slide to early doom.