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Author Topic: Second Opinions  (Read 6419 times)

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Änσnymσus

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Re: Second Opinions
« Reply #30 on: December 14, 2023, 05:29:28 PM »
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  • Good doctors know about medicine in general.

    It is really pathetic to go to an eye doctor, for instance, who cannot give you a medicine for the common cold.
    Are you kidding me? Medicine for the common cold??? That does not need medicine! We are a soft, over-medicalised society that has lost sight of what is the purpose of our existence.

    Offline Giovanni Berto

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    Re: Second Opinions
    « Reply #31 on: December 14, 2023, 06:04:34 PM »
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  • Are you kidding me? Medicine for the common cold??? That does not need medicine! We are a soft, over-medicalised society that has lost sight of what is the purpose of our existence.

    Common cold was just an example of a very common disease that expert doctors refuse to treat because it is not their area of expertise.


    Offline Nadir

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    Re: Second Opinions
    « Reply #32 on: December 14, 2023, 08:35:06 PM »
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  • Common cold was just an example of a very common disease that expert doctors refuse to treat because it is not their area of expertise.
    In my neck of the woods it is a long wait (maybe a month or so) to see a GP, and maybe a year or more to see a specialist.
    So a specialist is unlikely to waste time on the common cold or any other triviality for that matter. He’s flat out already with his specialty. 

    It is true they we have become a soft over-medicalised society. 
    Help of Christians, guard our land from assault or inward stain,
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    Änσnymσus

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    Re: Second Opinions
    « Reply #33 on: December 14, 2023, 11:44:29 PM »
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  • "Common cold" is a waste basket non-diagnosis that covers a wide spectrum of mild-to-potentially-deadly disease.  Certainly a viral rhinitis does not need prescriptive antibiotics. On the other hand, acute bacterial sinusitis or otitis, often called "common cold," can lead to more serious problems, such as bacterial meningitis.

    An anecdote—In my first month working the Emergency Room I saw a 26-year-old man with exactly such an acute bacterial sinusitis/otitis. It was so severe that I called the Otorhinolaryngologist ("Ear-Nose-Throat") specialist on call asking that he see the patient immediately. The specialist was abusive: "What medical school did you go to? Didn't you learn how to treat a common cold?" He raged on viciously, but I persisted. The specialist relented and saw the patient at midnight in his office. After he evaluated the patient he called me back and apologized for being abusive, agreeing that this was an unusually severe case.

    Three nights later the 26-year-old returned to our E.R. by ambulance—DEAD! I wasn't on duty that night, but my best friend from internship was on that night. He saw my medical notes from the earlier visit and discovered that the 26-year-old never filled the prescription to continue the antibiotic that the specialist had given him at the initial care. The young man died because his "common cold" progressed to a fatal meningitis.

    So, you can pontificate all you want about over-medicalization (it is true), but it may shock you to learn that there actually are cases where we doctors really do save lives. It's unclear to me if over-the-top skeptics dispensing vague snarky platitudes ever save anyone's life.

    And the last time I checked my catechism, we are tenants in our Temples of the Holy Ghost and we have a duty to be diligent in self-care. That is indeed an essential part of our "purpose of our existence."  It is a chosen "purpose of my existence" to help people as best I can. On my way to work I pray a Rosary with the special intention of doing good and begging the Holy Ghost to guide my mind and my hands.
    Ha ha! Nice try. That presentation was not the common cold, regardless of what your haughty specialist said. Exceptions only prove the rule. No treatment is without its risks either. There is a long standing debate in the fraternity, as you would know, whether or not to even treat otitis media with antibiotics, in spite of the rare but serious complications, for this very reason. Another snarky platitude from an over the top skeptic??? Who is being snarky?

    Änσnymσus

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    Re: Second Opinions
    « Reply #34 on: December 15, 2023, 01:02:12 AM »
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  • Like I said, no one should be going to the doctor for a common cold, except in exceptional circuмstances such as the immunocompromised, those on chemotherapy, for example, where what is usually an insignificant malady could be life threatening, and such patients should certainly not expect their eye specialist to deal with it! Similarly, those who develop more worrying symptoms like your ED case. But as Giovanni said, he was only using the cold to make a point. No snarking or platitudes intended.


    Änσnymσus

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    Re: Second Opinions
    « Reply #35 on: December 15, 2023, 07:25:18 AM »
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  • Some of us studied hard in all our classes and clinical rotations, keep up to date, weigh "research" skeptically in light of what we see in practice, don't fall for fads, and there are many specialties that expose us to a wide spectrum and considerable depth of problems in many areas. It is possible that I am one of those doctors. Maybe not. I have given you good advice.

    You want your doctor to be honest. You should reciprocate that expectation by being honest yourself.  You are now seeing a doctor for the third time because you are worried. As best I can tell from your postings, your worry (not an active medical problem) is your concern, so put it up front. Being coy serves no purpose. Being abrasive serves no purpose. Re-read the Golden Rule.
    If I wasn't clear, do know that I really appreciate and respect your posts for various reasons.   Thank you. 

    You are wrong about a "third" doctor, however.  This would be a visit to a second doctor.  My original doctor retired over a year and a half ago (which is why I went to the first doctor).  I mentioned him only because he never brought up the acute angle issue.  So, there is the first doctor I saw in August, and I will be seeing the second one next week (the second visit was set up before the August visit as a back-up plan in case the first doctor office cancelled me a second time. They had cancelled my original appointment in June.  I thought I mentioned those details in the OP but maybe not).  Although your impression of the number of doctors I have seen was wrong, you are correct about the worry. I'm not a crazy worry wart, but I do worry.

    I'm still stuck on whether to tell the doctor first or wait until the end of the visit.  I don't see the latter as being dishonest. 

    Offline Giovanni Berto

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    Re: Second Opinions
    « Reply #36 on: December 15, 2023, 09:46:35 AM »
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  • Appreciate the explanation. //no snark.

    That said, "common cold" is misused by laity and physicians. The short-hand can easily be replaced by "viral U.R.I." for clarity, even better, "self-limited viral U.R.I." It strengthens your case.

    Perhaps you'd be surprised at the thousands of times my polite and detailed explanations that antibiotics are not needed for a "self-limited viral U.R.I." have fallen on deaf ears. That spectrum of skeptics will rage that they "just want to be sure" and insist on antibiotic prescriptions, will even complain to hospital administrators if they don't get their demand. They are in the same patient demographic that brings little Johnny into the ER at 3am "just to be sure that Johnny is OK." Johnny barely bonked his head yesterday morning and has been and still is happy running around like a normal kid. It is readily apparent that Johnny is OK, but his parents are nuts and near-universal coverage gives no financial disincentive or skin-in-the-game to make a rational choice. That is not a small demographic. //still no snark.

    I once read that a great number of medical visits are made for no good reason at all.

    Most people are there just to have some attention and psychological comfort.

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    Re: Second Opinions
    « Reply #37 on: December 15, 2023, 02:29:29 PM »
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  • Perhaps you'd be surprised at the thousands of times my polite and detailed explanations that antibiotics are not needed for a "self-limited viral U.R.I." have fallen on deaf ears.
    No, I wouldn't, that is why I am trying to help you get the message across :-)


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    Re: Second Opinions
    « Reply #38 on: December 16, 2023, 12:49:35 PM »
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  • My observation is that many ER visits are due to mental illness of one form or another.  

    Änσnymσus

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    Re: Second Opinions
    « Reply #39 on: December 16, 2023, 05:52:44 PM »
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  • It will work out either way. Your life, your call. I hope my advice helped. If you have any questions after your repeat visit, I'll keep my eye out for this thread next week. I'll help if I can.

    In these days where the medical profession has been rapidly swirling down the toilet, a healthy (pun intended) dose of skepticism is warranted, even life-saving. That said, too often here on CI unhealthy, life-threatening cases of excessive skepticism erupt, arguably life-threatening because they descend into antagonistic throw-the-baby-out-with-the bathwater quackery.

    I try to keep my balance by reminding myself of the analogy that practicing Catholics ("trads") are hated because of the misdeeds of nominal Catholics. Analogously, good doctors are hated because of the misdeeds of bad doctors. Neither good Catholics nor good doctors deserve the opprobrium; but we deal with it. It's just a part of life.

    Be well and be good. In this morning's on-the-way-to work Rosary, I will ask the patron saints of physicians to guide your doctor at your appointment next week, so that he gives you what you need.
    :laugh1:

    Thank you. Yes, it has, and I will.  I agree with you regarding the excessive skepticism when it comes to the medical profession.     

    Änσnymσus

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    Re: Second Opinions
    « Reply #40 on: December 21, 2023, 11:33:40 AM »
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  • It will work out either way. Your life, your call. I hope my advice helped. If you have any questions after your repeat visit, I'll keep my eye out for this thread next week. I'll help if I can.

    Be well and be good. In this morning's on-the-way-to work Rosary, I will ask the patron saints of physicians to guide your doctor at your appointment next week, so that he gives you what you need.
    I wanted to post an update. Thank you.
     
     I had my appointment yesterday, and it went very well.  My original intention was to wait until the end of the appointment to tell her about the other doctor's findings.  Before going in the office, it did occur to me that I may not have a choice (but I can’t remember why that thought came to me).  It's good that I had that thought because it prepared me.


    The doctor started by asking me when my last exam was AND who the doctor was. So, since I had to give her that information, I felt that I needed to tell her the whole thing. She was great about it all.... very professional. I made it very clear that I really liked the other doctor, but that I thought it odd that my retired doctor never said anything in 15 years about acute angles.  She responded that they could change over time, but that it is less common for someone with such near-sightedness.  She was actually quite interested to have a look-see.
     
     Long story short, she did confirm that I do have acute angles; however, she did say that if it were her, she probably wouldn't have mentioned it to me.  Apparently, I'm not at a point where this is an immediate concern.  To be fair, the other doctor also said he didn't foresee me having an issue soon, but, outside of that, he seemed to make such a big deal of it, including providing me with a printed card with possible symptoms of Acute Angle Closure Glaucoma.
     
     Anyway, I really liked her, so I am considering switching to her.  But the other doctor is only 5 minutes away and she is about 30.  And to be fair, he was not wrong.  Of course, the local hospital is only 5 minutes away as well, so if I were to have symptoms in the future, the hospital ER is always right around the corner.
     
     Some other differences I noticed between the doctors was that she seemed to do what is needed rather than doing anything "extra".  The other doctor had me in the office for about an hour and a half.  I honestly have never had an eye examination take that long.  I think because of the acute angle finding, he also billed for a "special eye evaluation". Is he just very thorough?  Conservative?  Or is there more to it? Unfortunately, my suspicious nature has me wondering.
     
     Knowing all of this, if you or anyone else has any advice on which doctor I should go with, that would be great.




    Offline Quo vadis Domine

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    Re: Second Opinions
    « Reply #41 on: December 21, 2023, 11:55:54 AM »
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  • I wanted to post an update. Thank you.
     
     I had my appointment yesterday, and it went very well.  My original intention was to wait until the end of the appointment to tell her about the other doctor's findings.  Before going in the office, it did occur to me that I may not have a choice (but I can’t remember why that thought came to me).  It's good that I had that thought because it prepared me.


    The doctor started by asking me when my last exam was AND who the doctor was. So, since I had to give her that information, I felt that I needed to tell her the whole thing. She was great about it all.... very professional. I made it very clear that I really liked the other doctor, but that I thought it odd that my retired doctor never said anything in 15 years about acute angles.  She responded that they could change over time, but that it is less common for someone with such near-sightedness.  She was actually quite interested to have a look-see.
     
     Long story short, she did confirm that I do have acute angles; however, she did say that if it were her, she probably wouldn't have mentioned it to me.  Apparently, I'm not at a point where this is an immediate concern.  To be fair, the other doctor also said he didn't foresee me having an issue soon, but, outside of that, he seemed to make such a big deal of it, including providing me with a printed card with possible symptoms of Acute Angle Closure Glaucoma.
     
     Anyway, I really liked her, so I am considering switching to her.  But the other doctor is only 5 minutes away and she is about 30.  And to be fair, he was not wrong.  Of course, the local hospital is only 5 minutes away as well, so if I were to have symptoms in the future, the hospital ER is always right around the corner.
     
     Some other differences I noticed between the doctors was that she seemed to do what is needed rather than doing anything "extra".  The other doctor had me in the office for about an hour and a half.  I honestly have never had an eye examination take that long.  I think because of the acute angle finding, he also billed for a "special eye evaluation". Is he just very thorough?  Conservative?  Or is there more to it? Unfortunately, my suspicious nature has me wondering.
     
     Knowing all of this, if you or anyone else has any advice on which doctor I should go with, that would be great.


    Good to hear! I would stick with the second doctor.
    For what doth it profit a man, if he gain the whole world, and suffer the loss of his own soul? Or what exchange shall a man give for his soul?

    Offline Nadir

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    Re: Second Opinions
    « Reply #42 on: December 21, 2023, 02:57:59 PM »
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  • Sounds to me like you are spoilt with too much choice. It's a problem! Be thankful for even one doctor.
    Help of Christians, guard our land from assault or inward stain,
    Let it be what God has planned, His new Eden where You reign.

    +RIP 2024

    Änσnymσus

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    Re: Second Opinions
    « Reply #43 on: December 21, 2023, 04:14:15 PM »
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  • Good to hear! I would stick with the second doctor.
    Thank you for the charitable comment!

    Änσnymσus

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    Re: Second Opinions
    « Reply #44 on: December 28, 2023, 11:04:36 AM »
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  • I wanted to post an update. Thank you.
     
     I had my appointment yesterday, and it went very well.  My original intention was to wait until the end of the appointment to tell her about the other doctor's findings.  Before going in the office, it did occur to me that I may not have a choice (but I can’t remember why that thought came to me).  It's good that I had that thought because it prepared me.


    The doctor started by asking me when my last exam was AND who the doctor was. So, since I had to give her that information, I felt that I needed to tell her the whole thing. She was great about it all.... very professional. I made it very clear that I really liked the other doctor, but that I thought it odd that my retired doctor never said anything in 15 years about acute angles.  She responded that they could change over time, but that it is less common for someone with such near-sightedness.  She was actually quite interested to have a look-see.
     
     Long story short, she did confirm that I do have acute angles; however, she did say that if it were her, she probably wouldn't have mentioned it to me.  Apparently, I'm not at a point where this is an immediate concern.  To be fair, the other doctor also said he didn't foresee me having an issue soon, but, outside of that, he seemed to make such a big deal of it, including providing me with a printed card with possible symptoms of Acute Angle Closure Glaucoma.
     
     Anyway, I really liked her, so I am considering switching to her.  But the other doctor is only 5 minutes away and she is about 30.  And to be fair, he was not wrong.  Of course, the local hospital is only 5 minutes away as well, so if I were to have symptoms in the future, the hospital ER is always right around the corner.
     
     Some other differences I noticed between the doctors was that she seemed to do what is needed rather than doing anything "extra".  The other doctor had me in the office for about an hour and a half.  I honestly have never had an eye examination take that long.  I think because of the acute angle finding, he also billed insurance for a "special eye evaluation". Is he just very thorough?  Conservative?  Or is there more to it? Unfortunately, my suspicious nature has me wondering.
     
     Knowing all of this, if you or anyone else has any advice on which doctor I should go with, that would be great.

    Wanted to add some information about insurance:

    The first doctor takes my medical insurance (and never took my secondary vision insurance VSP which only charges a $10 copay).  The second doctor currently takes both my medical insurance AND the VSP, but she told me at the appointment last week that as of this May she will no longer be accepting VSP either.  I appreciated her candor.
     
    So, regardless of who I choose for my next annual appointment, they are both the same when considering $/insurance.  Unfortunately, using my medical insurance means I'm paying anyway (until I reach our deductible).