There is no denying the arsenal of tests and results are an aid to diagnosis in family practice but what happens if tests are not so reliable as they are claimed or if the results that are returned are in some way atypical? The lipid profile test (the common test for ‘cholesterol’) doesn’t really report much, for example, and yet medical practitioners invest great faith in the capacity of the results to guide them in practice. Does the growing availability of tests, test kits, and increasing use of them mean doctors are decreasingly willing, or able, to diagnose by the seat of their pants, by which I refer to extensive training, ‘craft skills’ of consultation and examination, accumulated experience, and hard earned intuitive sixth sense?

An increasing eventuality stemming from the information revolution (and several very informative blogs) is that some patients may be better informed about some conditions that are some GPs.

The party line in medicine is that saturated fat and raised cholesterol lead to heart disease (via the pathway of causing fatty (or calciferous deposits called ‘atheromas’ in arteries) yet as far back as 1974 Imai and colleagues identified pure cholesterol is not at all atherogenic but cholesterol contaminated by oxycholesterols is. One of the three possible oxidised cholesterol, one named cholestane triol, is very highly atherogenic. Cholesterol does bot promote growth in atheromas (does not cause heart disease) but oxidised cholesterol may.

I am actually very satisfied with the consultations I get from my GP but I do not visit that often – despite I am on record as being type-2 diabetic. I have huge respect for members of the medical profession whose involvement often save peoples lives, but family medical practice demands GPs must know something about so many conditions. Through researching diabetes, metabolism, and heart disease for myself it seems to me that the conditions GPs must operate under dictate (contrary to popular perception) that their knowledge must be spread a little thinly. If I placed myself in their shoes how would I feel?

I think the conditions GP must work under; pressure to tow the party line, incentives to do so, peoples lives their hands, big-pharma-propaganda, too much literature, and a small but growing number of patients who might contradict something I’ve been trained to consider is true, and do so from a well-informed perspective, would have me feel decreasingly secure, unless I twigged that patients themselves can be a knowledge base to respected. Perhaps the willingness to fix attention on that screen is a sign of increasing feelings of insecurity, and placing more faith in it’s content, is a way of avoiding cognitive dissonance that the patient, or his/her symptoms, may convey. After all the screen and the data within cannot lie, its the patients history in full. (?)

Incidentally, cholesterol guidelines are likely enforced upon commercial airline pilots with more zeal under medical rules that may be applied to them and their profession, and yet low cholesterol levels may associate with diminished visuomotor speeds (reaction times) [MF Muldoon & others]. So if you can glean the sense your pilots capacity to react to situations may be dulled because, in effect, his airline insists he must take statins to keep his (her) cholesterol within arbitrary (read ‘silly’ or ‘senseless’) limits, then you might be glad the autopilot has full control of a commercial airliner for most of the time.

Our world provides many finite resources that cannot last forever, but we’ll never run out of irony.

Whether they are stored on paper, or on a computer, the Doctor still has to take take to read them – and that should take no longer on a monitor than it does on paper.

If the Doctor stares at the records (wherever they may be stored) and does not interact with the patient, then they are a bad Doctor.

Don’t blame the technology.

Firstly I have a trick or two
1. never accept an alternative doctor I am always being told mine is not available so unless its something minor I stick to my guns.
2.Write everything down you need to discuss and in some cases fax or post it ahead of your appointment. Doctor then has a choice to write up your notes in advance

This saves time 1. He/she knows your history 2. You have prepped your doctor and are less likely to forget stuff.

Oh and finally move your chair so you can’t see the screen and your doctor has to look away from the screen to see you. I normally place the chair to the side and slightly behind the monitor they are more likely to make eye contact.

Finally some doctors are just SOB’s and there is nothing you can do with that and others are crap at using computers so they have to spend too much time inputting.

Go figure!

My first ever visit to a GP in that practice saw me walk in, be invited to sit and then the GP said absolutely nothing for several minutes, just sat and looked at me, leaving me feeling embarrassed and not a little bewildered as to what to do next.

Obviously, he didn’t foresee that the doctor would give preference to the screen rather than the patient because: – the computer in-put is really a legal defence in case of trouble plus it is a doctor’s work sheet and usually, but not always, it is a patient’s record. Lastly, and I do sympathise with this, the screen is more interesting, controllable and certainly more pleasant and accommodating than a patient.

Lastly, I wonder if there would be a different attitude if patients actually paid something, however nominal, at the point of delivery. Doctors might be reminded to be more courteous and patients might feel more empowered – not always but sometimes.

Kindest,