What do doctors know? (warning: rant)

My background is in law not medicine, but for us going to court should only be considered after all other means of resolving an issue have failed (even though going to court usually means more money for the lawyer).

In medicine shouldn't it be the same? That is, a drug should usually only be prescribed after non-chemical means of resolving the complaint have been explored. I understand that physicians are pressed for time and are pressured for a quick fix (and get more money when they write prescriptions). However, that is why it might sometimes be safer on the message boards.

**Also how can one determine "[p]rescribing that antidepressant (I'm assuming it was trazadone) ... a really well-informed and up to date move," without having any more info regarding the length or severity of the insomnia or any other particulars?

I have a huge problem with modern medicine, specifically because quite simply it's a business. A business has a job to make money, and as such is biased. Aside from the conspiracy on the modern medicinal society which you can get enough bullroar about by using google, I would also have to point to the statistics of how many doctors make mistakes, and the fact that a nurse working a normal shift will make an error in 1/4 of her decisions.

Also while your doctor is given tons and tons of classes, they don't do a bit of good if they don't know everything about YOUR body. Every time a doctor prescribes something to you it's based on best guess. Yes they take into account what you look like when you walk through the door, your description of the symptoms etc. However in the end it really is just a quick calculation of something that matches around those symptoms.

Also, that physical your describing is actually a pretty thorough physical if he's doing finger-rub and whatnot. Those are physical exam skills that a lot of doctors brush over these days but are legitimately part of it. Like I said, don't brush off something that you don't fully understand - just ask!
The only way to really be sure of anything is to research yourself, know your entire body, and really understand the concept of a drug and what it's made to accomplish. That or get a family doctor who should know pretty much everything about you after 5-10 years of seeing him on a regular basis including yearly physicals.

That all being said, at least a doctors guess is an EDUCATED one. So unless you truly have taken the time to educate yourself on your body and health, and how it all functions, you should definitely take your doctors advice. You may not like the advice, but it is a thousand times better than your best guess, and DEFINITELY a million times better than some random person posting online who hasn't even SEEN you in order to understand what symptoms you have that you don't even know about. Doctors are trained to take everything into account about you from the second you walk in the door, they see subtle things that you likely don't have a clue about.

As with anything, any advice someone gives you should be taken with a grain of salt. Something like your health you should definitely research and fully understand so that you can make an educated decision at any given time. Otherwise you leave yourself at the mercy of others, either your friend who thinks they're a know it all, a random man in a white coat (who you have no idea how well he did in med school), or the internet (good people and trolls a like.).

Indeed.

I was having issues sleeping and my GP prescribed me an anti depressant. I am the least depressed person I know! I never took it but now whenever I'm not feeling well I tell my husband I'm going to go to Dr. X to get an anti depressant.

I am not a big fan of doctors. My "physical" takes all of about ten minutes and it consists of me touching my toes and my doctor whispering a number in one ear while he rustles his hand in the other to see if I'm deaf. The most I've gotten out of a physical is that I have high arches. Seriously. (And no I don't go to him all the time, just use him as the reference for the spot you're forced to fill out when asked who your GP is on forms. I pretty much go to my gyno for everything)

Prescribing that antidepressant (I'm assuming it was trazadone) was actually a really well-informed and up to date move. It doesn't have the addictive properties of benzos or the weird side effects and morning grogginess of some other things like ambien, and most of all it works. It's used all the time - if you were weirded out by the drug class you should have just talked it out with your doctor instead of just dismissing it. That said, melatonin is a good alternative.

I think a lot of our misgivings about guidance from Doctors comes from some of the unrealistic expectations we place on them. It seems to me that most (if not all) of us tend to think in two dimensions; as if they're GOOD or BAD, always RIGHT or WRONG. This is really a horrible way to look at it.

Simply due to the fact that they're human means they're just as often mistaken (on any opinion or idea expressed) as we are. But because of their training and education we'd be woefully arrogant to categorically ignore their advice. Some of the thoughts I try to keep in mind when dealing with them are:

- There's a good chance that any diagnosis/order is a "let's try this"-shot in the dark. Again, while this isn't ideal its a whole lot better than any shot I might take.

- They're human; so be patient and respectful. But temper what they say with the knowledge that in all likelihood they're trying their best. Be grateful and receptive, but skeptical when your gut tells you

- Don't blame the individuals holding the stethoscopes for the woes of the medical industry, capitalism or the last bad diagnosis you got. In all probability they're genuinely trying to help.

So yea, drugs aren't 100% effective, people aren't perfect, costs are too high and mistakes are made. But don't throw the baby out with the bathwater. The current state of the industry and science are all we have at the moment. Make the best of it with a positive spin. The leeches and bloodletting of yesteryear were the 'newest thing' back then and future generations - who'll be just as much in the dark - will look upon our methods similarly.

There's nothing wrong with barking at the moon, but know that doing so won't send it away

I mean, I wasn't trying to diagnose or treat her on MFP. I'm not an idiot. I was simply saying that if her GP decided that her insomnia warranted medication, that certain anti-depressants are first-line drugs and that maybe she should have just asked her doctor instead of disregarding it as wrong. I wasn't making a statement on whether or not she needed medication in the first place.

Most of the instances I've seen include the standard "eat 1200 calories a day and exercise to lose weight". In the meantime, your general practitioner is thinking, "Why is this person here asking me about nutrition? I hope they don't notice that I'm not even going to bother taking body fat measurements.. I hope they leave soon."

I've never met a doctor with that attitude. I've never met one that hopes a person will leave soon or that a person doesn't notice they're not running the appropriate tests. Most primary care doctors that I've encountered do what they can with the knowledge that they have... and then they send you to a specialist if/when they think you need one.

Doctors, like every other profession, come in different flavors of 'competent'. You do, occasionally, find a quack or moron. However, the majority are well-trained professionals and it boggles me that MFPers are so quick to discard the advice on an MD because they think that the IT tech knows more about diet than their doctor.

+1

Or some grifter they see on TV.

This is an interesting and volatile topic.

I'll begin with a quick background of my nutritional experience.

1) I'm NOT a dietitian, no time, full time job plus a part time personal trainer (but if I had the time and money...).
2) 6 years ago I was fat, for the first time in my life, because of life, metabolic changes, and stress I gained about 55 lbs
3) I had no experience in weight loss, but I did have a college education in chemistry, and a brain that is very mathematical
4) I did my own research, had no bias's walking into it, and learned about the human body before I began
5) Because of the above, I was able to see through most of the scams and hype surrounding the weight loss world
6) I lost the weight in a healthy manner, slowly, and successfully. And in the process gained a lot of nutritional knowledge.

My research was based mostly on clinical trials, nutritional expert conclusions, and then, finally on personal adaptations.

After a while I became "addicted" to nutrition and health, and continued studying even after I lost the weight I wanted to (in a healthy manner). So I kept studying, didn't have the money to go back for a masters in nutritional science, but did have the money to buy the masters level text books, and had the academic credentials to start reading them and understanding the complex human anatomical topics discussed.
Learned a load of information over about a 3 year period (and am continuing).

During the course of my study and research, I came across a study done on doctors in the early 2000's where there was a basic nutrition study sent out to a few thousand doctors in the US, about a thousand of them sent the study back. 70% failed this basic questionnaire receiving a 50% or lower. This is somewhat alarming but not surprising.

What does this tell me? Trust your GP until they give you a reason not to. Yes, question their conclusions, but not out of contempt, but out of a real desire to understand your body. Ask them about their background in a particular field, not just nutrition, but anything. If your doctor gives them nutritional advice, politely ask them what their nutrition training is. Then if they answer satisfactorily, go back and do research into that advice before you implement.

there's no reason to hate on a field, especially doctors in the US who are obviously overwhelmed with the volume of clients they are forced to deal with to meet premiums. But like any field, if they are overworked, they might make mistakes, and that's unacceptable and on YOU as much as them if you follow their advice without doing some basic research.

Look, you can be trained as a GP, and you may know a lot about the body, but that doesn't mean you're an expert at any 1 field of the body. The human metabolism is very complex, and consists of not just digestion and energy usage, but also hormone release and balance, chemical homeostasis, oxygen usage, and thermogenesis. It takes more than a few undergraduate classes in nutrition to understand it fully, heck, I feel like I'm just scratching the surface after 6 years of study.

My point is, GP doctors are doing their best, and some of them have the knowledge to help with nutrition, but many don't, but essentially all (in the US) dietitians have the knowledge, and many will give you a free initial consultation, so if you're looking for specific, customized advice about a dietary issue that every day research can't solve, go to a dietitian.

The one thing ill say about GP doctors is that they SHOULD know when to give advice and when not to. Any doctor not trained in nutritional sciences that gives out nutritional advice (of a specific nature) is suspect IMHO and should be spoken to about this, it leads me to question their motives. Why give out advice about something you aren't an expert in? What else are you telling people that may or may not be credible?

Q: You know what they call a doctor that graduates the absolute worst in the class?




A; A Doctor

ding ding ding.

I know quite a few people that just graduated medical school and I would not want ANY OF THEM to work on me or anyone I care about.

I have to agree with the OP. Don't completely discount your doctor's advice. Your health is also your responsibility. So here are the steps I advise anyone to take to make sure they they do not feel that their doctor is a clueless quack:

1. Write down ALL your concerns before you go to the appointment. This way your are less likely to forget a point or blow it off b/c you're ready to leave.
2. If you don't agree with what they tell you, voice that. "Sorry, I don't like what I'm hearing. Can you explain why that's a good idea?" Believe me, they will not mind telling you. That is their job. If they do mind, fire them.
3. If you read something that contradicts their recommendation, tell them that. For example, if they recommend 1200 calories and you heard 1700, tell them that and ask why the 1200 is superior. DON'T HOLD BACK.
4. You have a right to say NO. If your doctor recommends a therapy to which you object, say NO. Ask for an alternative. Most of the time there is one.
5. If you want a referral to a dietician, ask.

And as for insurance not covering the dietician, save your money and go on your own. It's worth it. We are so used to only going to a specialist that is covered. Call the recommended dietician and find out how much a consultation is. Then save the money and GO. Don't use the GP as a substitute b/c of coverage.

HTH

When I went to my doctor because I was concerned that I wasn't losing weight even though I was restricting my calories to 1600 per day and working out 5 days a week (an hour of cardio each day and 30 minutes of weight training), her advice was to "maybe starve yourself a little bit. When you eat something, weigh yourself. If you see the scale go up, that's it. No more food that day."

...

I went to see if I had a thyroid problem, not be prescribed an eating disorder. Needless to say, that was the last time I saw that doctor.

Doctor's, like people, come in all shapes and sizes. Some of them know what they're talking about. Others don't know squat.

In my experience, most general practicioners (ie. the first doctor 99% of people see) don't know much about sports medicine or physiology, and any advice they give is heavily skewed towards protecting their rear. On a broader scale, I find it depressing on how large the number of people who barely cross the competency threshold in their PRIMARY field of specification, its scary how our lives are literally run and affected by people most of whom are nothing but "average" in their field. It is soooo hard to find true experts in their field. Its just that doctors tend to play prominent roles, as the things that they affect in your life are quite major. Do your research and then get multiple opinions on any major item, especially those where the initial advice doesn't mesh with your well executed research.

This is why so many "non doctors" weigh in opposite of "my doctor said" posts.

When you go to the doctor, ignore the aura of "I'm your superior human being, bow down and take my word as gospel". Unfortunately the medical profession cultivates this kind of environment (partly because people on average can be very dumb, and they just get into the habit of not bothering to explain). I remember testing my dentist' patience a bit with questions that he responded to "You are asking third year level medical student classes"--I got nothing to do with medicine/medical fields (am an aerospace engineer), and it made me think "wow, 3rd year medical students aren't as bright as I thought then."

Remember, you ARE the paying customer, and demand value for your hard earned cash.

If you boil it down, all the way to the bottom, somewhere there is the worst Doctor in the world. And someone has an appointment with that Doctor today! :sad:

My GP saved my life twice. Do your reserch and find one who cares and will admit when it is time to call in an expert.