Perhaps the most useful question a doctor can ask a patient

I was interested to read the column of Dr Des Spence (a British general practitioner/family physician) in this week’s British Medical Journal [1]. He has chosen this week to lament the fact that modern medical practice has become more “tyrannical, hierarchical, controlled, intolerant, and dogmatic.” There is pressure on doctors to ‘follow the evidence’ even though the evidence may be deeply flawed and biased due to considerable conflicts of interest. Another concern is the fact that doctors are remunerated for doing certain things, which can make it difficult for them to take a truly objective stance of some of what they do.

Patients who dissent and question or refuse treatment are openly scolded. There are many potential examples of this, but mammography and treatment with statins readily spring to mind.

The end result is that patients can end up being exposed to interventions for which there is little indication or evidence of benefit. Worse still, they can feel pushed or cajoled into things that they feel are not right for them. Dr Spence asks: “Are patients really getting the doctors they deserve?” As usual, Dr Spence demonstrates an ability to think for himself – a quality that is I think is not as widespread in medicine as one might imagine.

I think it’s right that, as Dr Spence points out, doctors can sometimes do too much. However, it occurs to me that they can sometimes do too little as well. I have heard time and again from patients whose concerns and thoughts about their symptoms have been all-too-readily dismissed by their doctors. Here’s a couple of examples:

A couple of weeks ago I was visiting a friend. She told me she had been suffering from a very sore tongue. I asked to look at it and it, to me, had the characteristic of what is sometimes referred to as ‘beefy’ tongue – dark red, smooth and shiny (quite like a piece of beef). This observation was helped perhaps by the fact that I know my friend has been vegetarian for 20-odd years, and for much of this time has been vegan. The relevance of this is that beefsteak tongue is a recognised symptom of B12 deficiency, and vegans (and to a lesser degree vegetarians) are at risk of this.

She went to see her doctor, and asked if her tongue issues might be caused by B12 deficiency. She told him about her dietary history too. Trust me when I tell you none of this line of thinking is implausible or illogical (if anything, the reverse is true). Her doctor’s reaction? He said nothing. On looking at her tongue he said that she had oral thrush (a yeast infection) as a result of the steroid inhalers she takes for her asthma. She remarked that she did not take a steroid inhaler for her asthma, though. No comment from the doctor on this. She asked him what he thought of the idea that it might be B12 deficiency, and he replied that it wasn’t that.

Now, exactly what caused my friend’s doctor to put intellectual barriers up to her reasonable suggestion is unknown to me (and maybe him). One possibility is that he knows little about B12 deficiency and its signs, and does not want to make this evident (there’s a tendency for doctors to ‘be down on things they’re not up on’). Another possibility, though, is that we doctors have a habit of liking to be the ones make diagnoses and be in control. Even unconsciously, we can reject ideas that come from our patients because, well, they have come from our patients (and not from us).

Another friend of mine was telling me recently about some bladder symptoms she was having. She had googled her symptoms and felt them to be a very good match with the symptoms of a condition called ‘interstitial cystitis’. For what it’s worth, I believe she made the correct diagnosis. She took her symptoms and a printout on the condition to her doctor. Her doctor would not entertain the diagnosis at all, though, and did not want to look at the literature. Instead the doctor told my friend that symptoms were coming from a scar from surgery from a long time ago (highly unlikely, in my opinion). Again, I have no idea what caused this doctor to reject an entirely logical and plausible potential diagnosis, in favour of something far less likely.

Particularly in the information age, individuals have much more access to medical information than they used to have. While doctors can be dismissive of ‘Dr Google’ I, for one, am not. The fact is patients often have more time and more motivation to research their health issues and arrive at plausible diagnoses. Whatever insecurities we doctors have about the fact that the patient may have made the right diagnosis (and not us) need to put to one side, I think.

In my experiences, patients are not infallible, but rarely do their ideas have no merit. Usually, they are highly useful. My personal view is that patients should be listened to when they offer their views on the cause of their symptoms. And even if they don’t, my experience tells me that perhaps the most useful questions a doctor can a patient is: “What do you think is going on?”

References:

1. Spence D. What happened to the doctor-patient relationship? BMJ 2012;344:e4349

59 Responses to Perhaps the most useful question a doctor can ask a patient

  1. nonegiven 1 July 2012 at 6:05 pm #

    I used the Stanford medical search, Highwire, to get my insurance to pay for a vaccine that they wanted me to wait 8 more years for. They said they usually didn’t approve things like that coming from a patient but “it was so well documented.” It took literally 10 minutes to find the 2 free papers I referred to, it took longer to print them out.
    My doctor had already written a letter to them about it and they had denied coverage. Her insurance had denied her when she tried to get it for herself, also. I took her copies of everything I had sent in so she would have an example of what it takes to get approval for things.
    I don’t know if she is getting things approved more often now, or not.

  2. Radiohelen 1 July 2012 at 7:47 pm #

    I used Google to diagnose my Dad with Hughes Syndrome. He was in the cardiac ward of the local hospital at the time after collapsing at home with a suspected stroke. They gave him heparin on the ward and it was suddenly like someone took 10 years off him. Walking and talking clearly and decisively! I went home and googled his symptoms and the Hughes Syndrome website popped up. I took the details in and showed the doctors and nurses but they told us to go back to his GP. We did after he was released from hospital and the GP referred him back to the same hospital where it was eventually confirmed after a few weeks. Sometimes the doctors should just trust the people around a patient to have better knowledge and observation than they do.

  3. Frances K 1 July 2012 at 11:20 pm #

    I know this sounds slightly childish but, with some GPs you need to let them feel they have made the diagnosis all by themselves. I have one such GP – you can see the barrier go up when you sound like you’ve done your homework. I prefer to see another GP who is open to my suggestions & will often carry out the appropriate tests. I think you’ve hit the nail on the head John about the ego issue with some doctors, however it also applies to other health professionals too. I’ve met nurses & midwives who struggle to deal with knowledgeable patients. Thank God for Google.

  4. tess 2 July 2012 at 12:59 am #

    bravi to you and Dr. Spence! as one who has had trouble with physicians listening AT ALL, let alone listening to my ideas, i find your breed is far too rare in the world!

    after all, it’s MY health in the balance — i get the feeling that doctors would like the satisfaction of bringing off a cure, but really don’t CARE about my well-being.

  5. FredB 2 July 2012 at 1:20 am #

    As I became an experienced heart patient I mutinied twice. Both times it has proven to be the right decision.

  6. Paleo Suz 2 July 2012 at 2:53 am #

    My concern is the number of patients who will trust whatever the doctor tells them – and not seek a second opinion

  7. Mark. 2 July 2012 at 7:02 am #

    I’ve had type I diabetes since 1971 and after a move I’d hoped would be temporary, but may well be permanent, I’m looking for a local doctor. The board-certified endocrinologist I’ve had for over ten years was on my last visit pleased with my low hemoglobin A1c but horrified that I’d gotten it by eating as little carbohydrate as possible, twenty grams a day typically, fifty on a bad day. He insists that the human brain cannot survive on that… has he heard of gluconeogenesis? I do understand a doctor wanting a patient to just shut up: as something of an expert myself on some things, it takes humility for me to be open to the possibility that I might be wrong…

  8. Dr John Briffa 2 July 2012 at 7:15 am #

    Mark

    it takes humility for me to be open to the possibility that I might be wrong…

    Or for a doctor to be prepared to be educated by his/her patient.

  9. Lee 2 July 2012 at 7:35 pm #

    My GP completely dismisses me and anything I say because I’m morbidly obese (slowly losing weight on low carb and IF). Every symptom I have she tries to attribute to my obesity. I have balance problems – I suggest this could be otosclerosis, which I was diagnosed with 17 years ago – she says no its because I’m very obese and virtually accused me of making up that I’d been diagnosed with otosclerosis, saying that I knew an awful lot about it – I explained that oddly enough I like to actually know about medical conditions I have. An ENT consultant confirmed the diagnosis and that it was causing the balance issues. I asked for metformin for PCOS, she insisted this wasn’t appropriate and referred me to an endocrinologist who prescribed the metformin. I have other health issues but she says I have had too many referrals – but she is unwillingly to treat and unwilling to refer – even though the referrals were unecessary and at her insistance

    I am left with trying to treat myself for chronic diarrhea, interstitial cystitis and thyroid issues and now avoid the doctor as much as possible. Google is my friend, and I firmly believe that I’m more knowledgeable on my medical issues than my doctor.

  10. Ted Hutchinson 2 July 2012 at 8:04 pm #

    People who can’t get access to BMJ may like to read the original article on Des Spence’s blog bad4umedicine
    He’s got some really powerful articles. I liked this one.”Leave the kids Alone ”
    The BMJ article Dr Briffa is writing about is here.
    What ever happened to the Doctor Patient relationship ?

  11. Dan 2 July 2012 at 9:50 pm #

    This has been my experience as well. My lifetime of chronic heartburn could only be treated with PPIs according to my doctors. I found that avoiding grains and sugar solved the problem completely. All with a little bit of time and self experimentation.

    I also found a dietary intervention for mysterious esophageal spasms, for which my docs and multiple ER visits had no explanation. Again, it was grains and sugar causing the pains. The only solution I ever got from the docs was, “keep taking your PPIs”, which never helped.

  12. Fiona 2 July 2012 at 11:00 pm #

    As patients, we moved GP practices when told by our GP when trying to provide good evidence for an alternative view “do you think I have time to read, I have a social life to lead”. The practice we moved to had a similar attitude.

    When trying to push Statins we asked “if you can give us good evidence properly referenced, then we may consider” – but knowing full well there was none. The best they could present was a print out from the NHS web site supporting the need to lower cholesterol. With all our knowledge on Statins, we still felt intimidated when refusing to follow that advice.

    When GPs and consultants have so many patients, how do they have the time to read every patient’s notes and the detail of their symptoms? As you say, patients have the time to research and now the resources are available. Including picking up on errors made in our notes when they are made available. We have two classic examples:

    1. A hospital investigation that reported the right leg when it should have been the left leg.
    2. The second a cardiology angiogram report stating “coronary angiogram shows obstructive coronary disease” when it should have stated “coronary angiogram shows NO obstructive coronary disease”. A simple typo with huge implications.

    Our experience has led me to search for the basis of GP’s remuneration. Can you provide a guide as to where that is publically available?

  13. jake3_14 2 July 2012 at 11:19 pm #

    In the U.S., we have large health-care companies called Health Maintenance Organizations (HMO), a misnomer. Their doctors are salaried and can be penalized, including being sacked, for giving out non-mainstream advice. Because it’s half the cost of plans where you can pick and choose your GP and specialists, though, it’s a popular option. HMO doctors are, for the most part, thoroughly orthodox in their approach to their jobs. It’s as if they turn off their creativity at the front door. I’ve brought in research papers to support my idea that cholesterol isn’t a villain in the past, and they just don’t care. They’re not allowed outside the HMO box.

    For example, according to the HMO orthodoxy, my cholesterol, recently tested at 208, is “elevated,” and my LDL is way out of range at 138. Never mind that the Friedewald equation that calculates LDL is known to be inaccurate when triglycerides are below 100 (mine are 86), and that I gave my doctor two research studies that explained this. I received a letter in my medical record telling me to eat a low-fat diet and exercise more (I exercise 6.5 hours/week).

    With such nonsense prevalent in the US medical structure, I have no hope of ever getting medical advice that relies on good research. I just hope that a hospital stay doesn’t kill me!

  14. Rachel 3 July 2012 at 12:19 am #

    I am very thankful that my GP listens to me and treats me and my opinions with respect.

  15. Margi 3 July 2012 at 1:01 am #

    As a military spouse, I’ve gotten used to being my own (vocal if necessary) advocate. I am fortunate that my PCP is a wonderful, open and considerate doctor but that has not always been the case and I’m sure I’ll get a new one when she’s transferred. So bless you for being open, caring and considerate. There are far too few who practice medicine that can allow their egos to take a backseat to patient care.

  16. Ressy 3 July 2012 at 1:19 am #

    My motto…my body, my science experiment! I have a team of doctors but I lead the team!

  17. iRememberWhen 3 July 2012 at 9:14 am #

    OMG I think this was written about me. My entire life I have been ignored by doctors. They don’t ever listen to fat women. They just tell you to go to Weight Watchers and please get the hell out of the office, we’ll bill you the US$300 anyway, so drop your check at the receptionist. I haven’t been to one now in 15 years. I may never go again.

  18. PhilT 3 July 2012 at 1:12 pm #

    I’m open minded to the possibility that the algorithms of Google combined with well crafted search terms could be a powerful diagnostic tool. I enjoy watching House MD and wonder if differential diagnosis is practised in my GP’s head or whether instinct and recent experience dominates the thought process.

  19. Lynn 3 July 2012 at 3:04 pm #

    I am now 64 but since puberty I have had huge legs despite following every diet known to man or beast. My GPs over the years have put any ailment I might have had down to obesity despite me assuring them that I ate healthily and virtually lived on lettuce and cottage cheese and of course always low fat! Grrrr. It took years of reading articles on the internet before I finally came to the conclusion that I have a condition called lipodema so I took various print outs to my doctor along with photos of my legs and left it with her and came back a week later. She did agree with my diagnosis and said she had heard of the condition but that it was not well known in the UK. I watched as she wrote my notes on the computer and she added ‘the patient eats a very healthy diet’. She admits that she finds my low carb high fat diet a bit odd and doesn’t really understand it but I did manage to lose a few stone but sadly not from my legs. Ok so it took until I was pension age but at last I have the validation I have searched for most of my life. Pity my doctors were so blinkered in the past as I might have lived without guilt and with more self esteem.

  20. Christopher Palmer 4 July 2012 at 3:44 pm #

    I’ve just re-read George Orwells’ ‘Nineteen-Eighty-Four’. Within the package there are some observations and use of terminology that seem especially insightful, inspiring, or otherwise well-observed. There’s one term that I know has great gravitas but I just cannot narrow down precisely what may have been Orwells’ intended meaning, nor can I satisfy myself I’m hitting on the full magnitude of its’ gravitas; ‘Oligarchal collectivism’. Can you, Dr Briffa, (or anyone else) help me grasp Orwells’ intended meaning? Does it fit circumstances described above, do you think?

  21. Christopher Palmer 4 July 2012 at 4:05 pm #

    Pity my doctors were so blinkered in the past as I might have lived without guilt and with more self esteem.

    The diet-heart hypothesis, the machinations of the dairy industry and marketing, and the general willingness to embrace or promote the false idea that low-fat eating is automatically healthier has been hugely beneficial for GDP. A big slice of GDP (or GNP) now results from income and profit given over to treating the consequences.

  22. nonegiven 4 July 2012 at 5:04 pm #

    ‘Oligarchal collectivism,’ to me says one size fits all and the oligarchy dictates the size, even if it fits no one.

  23. Jennifer Eloff 5 July 2012 at 1:00 am #

    B12 deficiency is one of the first things a doctor should think of when someone has been a vegetarian for quite some time. That is one of the biggest dangers. Such a deficiency can also cause irreversible nerve damage.

    It is important, in my opinion, to be pro-active in one’s own health. I have found doctors do not have enough time to devote to one person, nor do they have as much interest in my health as I do. First I go to the best physician ever in prayer, then I do my research and only if I’m stumped do I consult a doctor. To be honest, my husband’s Dad is a retired medical doctor (86 years old now and he had bacon and eggs for breakfast every morning of his life practically) and the kind that used to be able to diagnose accurately without lab work being done first and my husband, although a computer expert by profession, has inherited an incredibly logical brain and is able to diagnose accurately after researching a condition. I don’t suggest everyone does this, however, I do suggest everyone be pro-active in their own health. I would not still have my thyroid today if I had trusted two doctors in Canada who said I had thyroid cancer and should have it removed. A fine needle biopsy which was not recommended, but that we insisted upon, showed that I had Hashimoto’s thyroiditis. This was more than 10 years ago and I’m still fine. In fact, my thyroid has recovered to the point where I need very little thyroid hormone (less than 40 mcg of synthroid-style hormone). It’s great to still have my thyroid. So much for medical doctors knowing everything and being so caring. Trust but verify!

  24. Jennifer Eloff 5 July 2012 at 1:04 am #

    Sorry, I meant to also say that I had the Thyroid antibody test done after the fine needle biopsy which definitively pointed to Hashimoto’s Thyroiditis.

  25. Alison Lester 5 July 2012 at 7:33 am #

    Bravo Dr Briffa
    My forward thinking doctor has also quickly grasped the possibility of exponential CPD to be gleaned from his band of unpaid internet savvy researchers (erm….patients). Why not let us do the leg work, we are the experts on our symptoms after all. This year, after many years of research I discovered that I am unable to adsorb Vitamin B12 with all its dire consequences. My doctor is now not only treating me but other patients presenting with similar symptoms of this long forgotten and very serious disease……and importantly, not just vegans!
    By way of explanation, my lengthy google searches eventually led me to a thirty year study on B12 deficiency carried out by an NHS doctor in Durham. See here:

    http://b12d.org/sites/default/files/PDF/B12-A_Retrospective_Study.pdf

    This important study has been acknowledged by this doctor’s Primary Care Trust. 

    And here for a B12 deficiency symptom checker: http://www.b12d.org/content/b12-signs-symptoms-assessment.
    First class blog Dr Briffa.

  26. Alexandra 5 July 2012 at 3:44 pm #

    @Lynn Think about another possiblity: estrogen dominance, the last weight I lose is leg weight and this is likely the reason. Robb Wolf talks about Estrogen Dominance on his podcast… Robbwolf.com has a search feature so you can locate each reference.

    Love your blog Dr. Briffa… if all doctors were as interested in their work as you are, I might actually see a doctor… it’s been 18 years.

  27. Janet Singer (ocdtalk) 5 July 2012 at 7:16 pm #

    Excellent post which everyone who ever sees a doctor should read…..and more importantly, doctors should read it.

  28. nonegiven 6 July 2012 at 12:24 am #

    I read somewhere on the web that 1 out of every 11 women have lipodema. I’m assuming most don’t know it.

  29. George 6 July 2012 at 3:39 pm #

    Great Article Dr Briffa.
    I recently went to see the consultant at the hospital for my yearly check up for Crohns disease.
    I treat this condition very effectively using the paleo diet and GAPS diet.
    When the consultant asked me about medication I told him that I treated my condition with diet, he looked over to the trainee in the room and laughed, saying that he “wouldn’t know about that”
    When I explained a little about my diet he treated me as if I was completely stupid, saying that the condition had “little to do with diet”.
    I have studied this condition for years and found a way to live with it without medication. I run my own business and if I treated my customers with the same disdain then I wouldn’t expect to work again.
    Is it just me? or does the statement that a digestive illness has little to do with diet make no sense? especially when, if I go off track with my diet the symptoms come back within hours.
    Why cant I speak to my consultant and get support and enter an intelligent conversation with him? Why do I feel like I’m being sent to the headmaster every time I have to see him, because I’m naughty for not taking steroids which carries side effects often worse that the disease itself?
    As far as I can tell, he is just there to hand out drugs and anything that stands in the way of that is a pain to him, he might actually have to do some research into the condition he is supposedly treating!
    I just need to add in closing that my GP is great and very supportive, weather or not he believes in anything I say, I don’t know.
    But he doesn’t make me feel stupid when we meet up.
    Things really need to change.

  30. John Walker 6 July 2012 at 3:45 pm #

    My own Doctor asked me if I had been ‘medically trained’, because I knew the anatomical names of some parts of my own body!
    The latest question was, ‘When did you have your heart attack?’
    ‘What heart attack?’
    ‘Well you have had an attack haven’t you?’
    ‘No.’
    ‘Then why are you prescribed Bisoprolol?’
    ‘For my hypertension.; or so I was told.’
    ‘Well you must have suffered a heart attack too, because that drug is prescribed to prevent a repeat attack.’
    ‘Very well Doctor I’ll take your word for that. So I don’t remember my heart attack!’
    What is going on? I am 73, and yes I’m overweight; but now by six stones instead of eight. I can walk with the aid of a stick, (osteoarthritis) and when my left knee is replaced to match the right one, maybe I’ll be able to do better, and lose weight quicker. My blood pressure is hovering around 119/85 sometimes 122/90. I live in a very hilly area.
    I have never had any distress, or pains in my chest and I don’t get breathless with exertion. I undertake woodwork for a hobby, and handle that well enough with sensible rests.
    All things being equal, I’ll just keep on taking the powders, (Maybe) and let the Doctors figure it out. They clearly don’t want my input, thank you very much.

  31. Jill Fraser Halkett 6 July 2012 at 3:51 pm #

    Bravo John! I have just been through a very similar experience with doctos here in South Africa. There was no sympathy in blurting out their findings and giving the “required” list of treatments and I could literally see the walls of exclusion going up when I told them I had had no conventional cancer treatment. Their registration of shock and horror at this revelation made me feel bullied and excluded and has left a lasting feeling of distrust

  32. Mistral 6 July 2012 at 3:57 pm #

    Thanks Dr Briffa.
    I too trained in medicine but have never practiced. My background comes in handy when I visit my GP, or when my family is ill. I have recently had a similar experience as the ones describe before, that leaves me a little worried. I am mid thirties and after many symptoms (…) I had an endoscopy which showed a hiatus hernia and duodenitis. I am not overweight but I was very concerned about my diet. My gastroenterologist told me that diet modifications would not affect my reflux, only alcohol and tobacco (I do not smoke and hardly drink), so the only way to improve my symptoms is to take omeprazole daily. I have looked at research on this and of course it is difficult to find studies that look for instance at the effect of carbs vs non carbs in GERD patients but this is not the point (who is going to fund the studies anyway?), it is the lack of empathy and open mildness that there are more things a Dr can do to treat someone than prescribed a tablet and send them home. At that point you can imagine the look I got when asked if Yoga could help (I have never practiced it but read that diaphragmatic breathing could improve the condition)… So I am now on my journey to discover what I can do for me, and hopefully in wed sites like yours, books, journals and others I will find the answers to achieve better health!
    Many thanks

  33. audrey wickham 6 July 2012 at 3:57 pm #

    I had a small bump in my groin. GP said it was a hernia and sent me to a Consultant who confirmed that it was a hernia. I went for my pre-op with a very young doctor at the hospital and he said “That’s not a hernia, it’s a bit of fatty tissue”. He was right.

    Another G.P. once asked me “What do you think?” and without much thought I told him. He agreed with me and we were both right. Unfortunately he died and I have never had an intelligent replacement. G.P’s seem to be set in concrete with tunnel vision but how much intelligence can you get from any of them in ten minutes?

  34. Sherry 6 July 2012 at 4:37 pm #

    On visiting his GP, my husband asked if a magnesium deficiency (which I had diagnosed from Google) might be causing his many symptoms. These were throat spasms,heart fluttering, leg cramps,tics and a strange nervous feeling in his chest. The doctor told him it was not possible and in his 30 years of practice he had never known of a case. After prescribing PPIs and getting a ECG and an endoscopy done,all to no avail and getting worse , my husband went and saw another GP at the same health centre who had kept horses at one time. She knew all about magnesium deficiency and was able to print out for him several pages from an old text book on her shelf. Standard stuff, but the first guy`s knee jerk reaction was to dish out pills which actually made the deficiency worse. He just didn`t like being asked about a possible diagnosis he hadn`t thought of himself.

  35. John Evans 6 July 2012 at 4:41 pm #

    Hi Dr Briffa
    I tripped in the garden and fell on to a short wooden pole sticking up, with my elbow taking the whole impact. Ouch! I was sure I’d dislocated my elbow, especially as I felt it click back into place as I writhed on the ground. At A&E the nurse said “No, no, it’s impossible to dislocate your elbow”. When I saw the consultant and told him my story, he said “You’re the expert on your body; if you say you dislocated your elbow, that’s good enough for me”

  36. Dr John Briffa 6 July 2012 at 4:58 pm #

    John

    In medicine, orthopaedic surgeons have a bit of a reputation for being low of the intellectual scale compared to other doctors. I don’t agree with that myself, and even if it were true, I find them to have lots of common sense which can be lacking in more ‘intellectual’ doctors. Plus, for what it’s worth, they do a job which generally gets real results.

  37. David manovitch 6 July 2012 at 5:11 pm #

    doctors are lamentably defensive, rigid in their thinking and prone to dismiss patients ideas. I’m proud to boast that I will routinely ask my depressed patients: “why do you think you have become depressed?” unfortunately a lot of them will say: “I thought you would tell me that, you the doctor”! it is always worth asking the questions though as occasionally one gets very useful information. Patients can teach us a lot. They have certainly educated me.

  38. p[eter Killingback 6 July 2012 at 5:24 pm #

    Dr Briffa, the late Prof Pepys of the Brompton Chest hospital, told an allergy conference that a patient complained of a severely swollen arm some 12-36hrs after a desensitisation injection. the prof did not believe her, for all the usual reasons. The patient complained after the next dose and the next. Eventually, the Prof had the patient in for two nights and showed the conference the outcome, a grossly swollen arm probably resulting from an antibody driven neutrophil infiltration. The patient had described the effects accurately, but BECAUSE THE PROF HADNT SEEN IT, HE DIDNT BELIEVE IT!!! The general advice to those medics present was ‘listen to your patients, they KNOW their bodies, but careful questions will detect the hypochondriac and others who are shamming’. Dr Briffa, you would do the world a service if you could persuade the BMJ to publish again the original article followed by the contents of this blog. The medical profession has to wake up to the realisation that Continual Professional Development is essential, and this should include serious questioning of the reps who push the drugs, and then refer to the GSK debacle covered in another blog this week. I find medics tend to be complacent in their original learning and if challenged at all, fall back on something they feel comfortable with and in control of. It takes a ‘big Man’ (M/F) to accept they may be wrong, whatever their profession. One way to get the GP to change is to ask them how they arrived at their diagnosis, and gently question each stage…you of course will have explored google, Briffa and Mercola beforehand and will be fully prepared to ask those questions!

  39. Pippa 6 July 2012 at 5:28 pm #

    I once saw a very elderly doctor who had been brought in when my own G.P had been taken ill. It was a revelation! Firstly, as I entered the room he stood, smiled and courteously shook my hand. He then sat and facing me full on, asked me what was worrying me.

    He really examined me. He looked into my eyes, at my tongue, and really listened. He then wrote some notes & read them back to me to check whether I agreed with what he had written as a fair report.
    The consulation has no longer than usual. I felt seen & heard, & comforted. (He also cured me)
    My normal G.P doesn’t even look at me, only at his computer. Even when asking me a question or while I speak. He doesn’t look at me or touch me. I feel I don’t need to be physically present, but could be diagnosed via email.
    Needless to say he has in the past told me to go on a low-cal diet. The sad thing is, I think he is a kind man, who has just lost his way with patients, or never knew the way.
    I avoid going to the doctor unless at death’s door.

  40. Mistral 6 July 2012 at 5:36 pm #

    David, I completely agree. My brief pass though medicine taught me that great doctors always ask their patients what they thought, specially they trust “mothers’ gut feelings” .
    The gastro I saw is an excellent doctor, with good reputation among its peers and with a vast number of research papers published, and maybe he is afraid of giving advice unless proven, I can understand that, but what surprised me was the complete rejection to other ideas or approaches. This closes many doors to discovery, not great for medicine.
    Re: orthopaedic surgeons, the ones I know (2 only admittedly) are really good fun, but have never worked with them or being there patient! Good to know!

  41. Bee Hepworth 6 July 2012 at 6:01 pm #

    Sherry – 4 years ago I began to suffer from palpitations which, after investigations, turned out to be ectopic beats. The cardiologist said if they’d been Atrial Fibrillation they could be treated but I just had to live with the ectopics. They got worse and worse and, after 18 months of this, I began to do my own research. I discovered that it is thought that many older people are deficient in magnesium especially if they’ve been on Thiazide-type diuratics which I have, plus the fact that we absorb less of the magnesium as we age. I discovered that one of the symptoms can be heartbeat irregularity and that magnesium is a tissue stabiliser.

    My husband is a vet so I asked him about taking magnesium. His reply was “Good idea – I used to give it to sheep who had magnesium deficiency when on spring pasture. They had irregular heartbeats and fell over! They recovered after one injection.”

    I bought some magnesium and the palpitations stopped after 4 days – the relief was enormous and I’m still ok apart from a brief stressful period when a relative was ill – I’m fine now and take the RDA of 375mg per day. It also helps with twitching legs but if they do recur I massage almond oil (which contains magnesium) into the muscles before bedtime. You don’t say if you tried it but I hope it works for you!

  42. Bee Hepworth 6 July 2012 at 6:05 pm #

    Apologies for misspelling diuretics!

  43. hilda glickman 6 July 2012 at 6:11 pm #

    I really do think that we all ahve to be on the ball with our own health. The problem is that we have handed over our health to the medical profession
    too much. They are surprised if you show any knowledge and want to be totally in charge. It is a monopoly of thought. Maybe it is due to our educational system but many do not feel that they can understand scientific concepts but this is wrong.

  44. Ian Day 6 July 2012 at 6:55 pm #

    Long ago I had a groin lump which came up & hurt when I coughed. If I stood up for an hour I had to lie down to recover. I went to the Dr – “I think I have a hernia.” “No- it’s your piles – drink 5 pints a day.” No rectal examination, just his opinion.

    I went to the firm’s Dr who confirmed my diagnosis & referred me to the hospital. The day before my op, I went back to my Dr, as I would need a medical cert. “NO! You have NOT got a hernia.”

    I changed Drs. We found he had a bad reputation with everyone.

  45. Ian Day 6 July 2012 at 6:59 pm #

    My ‘new’ Dr listens to me – he is interested in how I react to his advice – & how I have gained control of diabetes T2 by low carb. He is learning from his patient!

  46. Janet 6 July 2012 at 8:19 pm #

    “‘Oligarchal collectivism,’ to me says one size fits all and the oligarchy dictates the size, even if it fits no one.”

    Nonegiven, you have just defined modern orthodox healthcare!

  47. Sandra 6 July 2012 at 9:13 pm #

    The best and truest lines in this article are: ¨Doctors do not like to be down on things they´re not up on¨ and ¨doctors like to be the ones to make the diagnois and be in control.¨ Believing their own publicity of having people´s lives in their hands, and being human, not the Gods too many of them come to believe themselves to be (a great danger in the medical pfofession)… Doctors often deeply resent the patient expressing any opinion on their own health. Millions of people die due to doctors´s bad diagnoses and refusal, for ego´s sake, to consider any ideas from the patient. My grandmother was a nurse, who used and believed only in homeopathic medicine for herself and her personal patients. She worked alongside reputed physicians who often turned over to her patients they had given up on. She, in most cases, put the patients back on their feet to a useful life….with herbal medicine.
    After almost being destroyed by allopathic doctors and their promiscously prescribed medication, I haven´t seen a medical doctor in 20 years and don´t miss them. Natural herbal medicines, proper eating and a liife one enjoys, are the prescriptions for health. By the way, both my grand and great-grandmothers, who only took herbal medicines, lasted into their mid-90´s, active and still working. One died from choking on a piece of meat, the other from a prescription for a drug to alleviate a bronchial cold, given her gainst her willl by an allopathic doctor sent her by a neighbor, who felt he knew better than a mere nurse. Her system was not used to pharmacoepia and she was too weak at the time to fight against it. Had she been able to use a herbal remedy, she might have survived.
    And, as a last comment, many good open-minded alllopathic docitors are switching over to natural medicine.

  48. Mistral 6 July 2012 at 10:46 pm #

    Sandra, I cannot agree with your comments, I think your approach of completely rejecting conventional medicine is as bad as a doctor rejecting everything that is not a conventional prescription. Ultimately many medicines are based on natural herbs, i.e. Digoxin is extracted from the leaves of Digitalis… Also this is missing the point of the debate, which was whether doctors take patients views into consideration, rather than homeopathy against conventional medicine, which is another question.

  49. annette wass 6 July 2012 at 10:55 pm #

    just to be pedantic homeopathy is not herbal medicine and vice versa!
    as a herbalist it drives me up the wall to be confused with a homeopath!

  50. Lynn 7 July 2012 at 12:01 am #

    @Alexandra Thanks for that suggestion but I have none of the symptoms of estrogen dominance thankfully, not even a rotund belly. Since low carbing for the past 3 years I am fit as a fiddle with good skin, hair and nails and lots of energy. It is just my legs that let me down in terms of looks and the inability to let me walk far without pain. It is relieved a bit with manual lymphatic drainage massage but unfortunately that is not offered on the NHS and it is a bit beyond the means of someone on a pension to have regularly.

  51. Nina 7 July 2012 at 1:53 am #

    Patients don’t just Google symptoms, but also write about their experience online. Here’s one that doesn’t make personal attacks, but looks at the general trend of development in the health service and patient behaviour:

    http://suzanneloomscreativity.blogspot.co.uk/2011/03/patient-has-gone-awol.html

    Nina

  52. MikeS 7 July 2012 at 10:27 am #

    This is what Ivan Illich, a philosopher, called “the expropriation of medicine,” the subtitle of his insightful 1975 book, “Medical Nemesis.” It is a scathing account of institutional medicine. Doctors have stolen our knowledge of ourselves and our bodies. Worse, medicine has become “clinically iatrogenic,” that is, the enterprise itself causes harm (statins, anyone?). “Unfortunately,” he writes, “harmless but futile care is the least important of the damages a proliferating medical enterprise inflicts on contemporary society. The pain, dysfunction, disability and anquish resulting from technical medical intervention now rival the morbidity due to traffic and industrial accidents …and make the impact of medicine one of the rapidly spreading epidemics of our time.” Thirty-five years later, things have only gotten worse. Our salvation may reside in the information now available to us on the Internet, and wise practitioners like Dr. Briffa.
    Illich’s book (with a preview) is available on Amazon: http://www.amazon.com/gp/product/0714529931/ref=kinw_rke_rti_1 It deserves to be widely read.

  53. Marie 7 July 2012 at 6:22 pm #

    Thanks for your news letters.
    I enjoy reading them although I live in Sweden .
    I recognise many aspects of your article – Perhaps the most useful question a doctor can ask a patient (2nd July, 2012) – and the comments.
    Here are some stories about people close to me. They made me look for information about drugs/side effects etc. Thanks to the Internet I also “discovered” many Enlglish/American books, sites etc. It started in 2003 and I learn something new everyday.

    My father (1)
    Melleril, Aricept etc.

    In 2003, my 95-year old father was drugged during a one-week-stay at a nursing home.
    I became very angry.
    I had just been connected to the Internet and looked for information.
    It did not take me long to find out that Melleril (antipsychotic) was withdrawn in England because it could cause serious heart problems/sudden death. The list of side effects was very long.

    They had also given my father Aricept (for dementia).
    I saw, on the Internet, that its efficiency was being questioned, that it had numerous side effects and that you should be careful if you had asthma. My father had suffered from that since he was about 35.

    My father had 12 different drugs before his visit at the nursing home. Drugs that had been renewed,year by year, without proper evaluation.

    He had no signs of dementia but was old and had just gone through a bacterial infection
    in one of his arms (wrongly diagnosed as overuse, and plastered, to begin with).

    My mother told a visiting nurse about my Internet-search on Melleril and Aricept.
    She sent a message to me – don´t believe in what you read on the Internet!

    P.S. Melleril was prescribed for another year in Sweden.
    When it was withdrawn it was totally silent in the media.

  54. Marie 7 July 2012 at 6:28 pm #

    My father (1, continued)
    Melleril, Aricept etc.

    I wrote several letters to the prescribing doctor asking for a stop of the two “new” medications and a total evaluation of the rest.
    After some weeks my mother received a phone call from a nurse at the doctor´s office.
    She was told that she could stop giving my father Aricept, but the rest of the medications, including Melleril, should continue.
    After some months my father died and I received a reply to my letters.
    The doctor motivated the Aricept-prescription with the words – I thought about your father`s future!

  55. Denise 8 July 2012 at 1:14 am #

    why oh why do so many docs take the lab ranges as gods say so? Why do lab techs have the overall say so which tests will be carried out? Why when we are desperate and offer to pay for ‘tests’ are we frowned upon and asked ‘WHY’? And why are people like me left until the cause becomes so bad we end up needing hospital treatment when the ’cause’ could of been maybe sorted before things end up in costly treatment and hospital stays? What happened to prevention is better than cure?

  56. Marie 8 July 2012 at 11:54 am #

    My mother (2)
    Zocor = simvastatin

    After a small heart attack, my mother was prescribed Zocor (=simvastatin) , aspirin and Toprol (=metoprolol) at the hospital. After some time she started to have sleeping problems, cramp and weakness in her legs etc.

    She phoned her doctor and asked if it could be side effects. My mother doesn´t like to “bother” her doctor unless it`s absolutely necessary.
    His answer was no – and the conversation ended.

    One day, when I visited the library, I saw the front page of a health magazine.
    It was a special cholesterol-number and I started reading.
    I learnt that there were doctors/scientists who disagreed with the “Cholesterol Hypotesis” and that some of them had formed a network – thincs.org.

    I discovered Uffe Ravnskov – and his books (some translated into English/other languages).
    I also read books by Duane Graveline, Malcolm Kendrick and Anthony Colpo.
    I found patient stories on spacedoc.net, askapatient.com, medications.com and peoplespharmacy.com. Many of the stories were similar to my mothers.

    I offered my mother to come along on her next appointment, but she refused.
    I offered to write – she said no.
    But I wrote a nice letter to her doctor telling him that I only had my mother´s best at heart and wondered if she could lower her Zocor-dose and eventually stop.
    After several weeks I received a reply. He didn´t think it was a good idea.

    I wrote again and included many American patient stories.
    I told him that I realised that it was impossible for medical staff to keep up with all medical information and that I was not giving him critique.
    After several weeks I recived an answer.

    He did not think it was a good idea for my mother to stop because Socialstyrelsen (=The National Health Institute in Sweden ?) had decided that even lower cholesterol numbers should be treated.

    I translated five patient stories at a time for my mother and gave her Uffe Ravnskov`s books.
    Then I left it. It was up to her to decide.
    A year passed and I asked – are you still taking Zocor?
    Oh no, she answered.
    She had phoned the nurse and asked her to tell the doctor that she wanted to stop with Zocor. The nurse had returned the call telling my mother that it was okay.

    I am convinced that my mother, now 92, would not be in such good shape had she continued with Zocor (or any other statin).

  57. Christopher Palmer 26 July 2012 at 8:07 pm #

    ‘Oligarchal collectivism,’ to me says one size fits all and the oligarchy dictates the size, even if it fits no one.

    @nonegiven,
    thanks, that’s truly helpful! I wonder is a your inspired definition worthy of a minor refinement?

    ‘Oligarchal collectivism,’ to me says one size fits all and the oligarchy dictates the size, even if it fits no one, but where there are other benefits and rewards to be enjoyed by the oligarchs.

    The farm gate price awarded in return for a litre of raw milk in the UK seems to work to the rules oligarchal collectivism.

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  2. August Blog | Health & Wellness from Helix House - 21 March 2013

    [...] It sounds less and less fun to be a GP these days. We all have to be careful about rejecting our patient’s suggestions as to what may be wrong with them, and not to feel threatened by such ideas. ‘Dr. Google’ may well get things wrong at times, but she deserves a hearing, at least before we scuttle off behind our professional shell. See what you think? Perhaps the most useful question a doctor can ask a patient [...]

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