Friday, January 21, 2005

Second opinion.

Today my case was a man whose previous doctor told him there were no problems. But there were. It was complex, but the guy clearly had the disease in question. Unfortunately, it's a disease that's progressive and untreatable.

How do you tell a patient that the other doctor missed something? One option, the one that I took, is to not say anything of the sort.

Patients expect doctors to be like machines. Computers I suppose. Input information, then each doctor spits out the same answer. But that's not always how it happens. Sometimes the information changes. Sometimes one doctor thinks X and another doctor thinks Y, even with the same information.

I'm not infallible, but doctors seldom reverse their beliefs about a patient. And I'm as guilty of that as anyone. The worst thing about making a mistake in medicine is the realization that you've seldom learned anything from the mistake to change your behavior in the future. Modern medicine is a bit better, in that we have imaging and studies of all kinds that help confirm and falsify diagnoses. But we're essentially the same doctors who didn't wash their hands for 50 years after that'd been proven to cut deaths, and applied leeches long after that had been shown to be wrong. And let's not forget, there were many doctors who didn't believe in antibiotics or pain killers after their introduction.

It's a sad state of affairs. And there's no solution.


Anonymous Anonymous said...

Do you ever find yourself hating your own profession? Do you love it more than you hate it? What made you want to be a doctor in the first place?

8:52 PM  
Blogger Doc NOS said...

I don't know. I usually do hate it. Sorry. You should try it - hearing people's complaints all day, endless paperwork, the hold button, ever-present legal threat, non-compliance, lack of getting paid for the work you do, lack of appreciation, almost killing yourself to get here - to this horrible horrible summit from which there is no way up and no way back (hey, it's like Iraq), collegues who's last book was read for fun in college - it's no fun. And I'm actually one of the more happy ones.

6:29 PM  
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