[Dr. Smith]

...So your doctor prescribes a new medication, and being the diligent patient, you read the insert and/or look the medication up on the web, and acquaint yourself with the list of known side effects. Ever wonder how that list is determined/compiled?

What does your doctor hear when you talk?

Doc

[Hopeless]

Hi Doc,

I enjoyed the article. Thanks for sharing it. When completing my disability form and was attempting to respond to the side effects of the medications I take, it was difficult to specify that some of my symptoms were a direct side effect of the medication or may not be related to the med. Fatigue is listed as a side effect on almost every med I take and I do suffer with severe fatigue but is it the meds? or is it a symptom of some of my medical conditions? or a combination of both? I listed as a side effect on my disability form only the side effects that I knew for a FACT that were directly attributal to a specific medication. The majority of my medications are not ones that I can stop and see if there is any difference in any of my symptoms.

Also, as a result of obtaining my medical records for the purposes of disability, I found that a lot of what we tell our physicians is most definitely filtered, omitted, or mis-stated.

Thanks again for the article. I found it very interesting and glad to see that some doctors realize that patients need to be heard and not dismissed. My personal experience has been the more vague or common the symptom, the more it is just dismissed.

[zygopetalum]

Thank you, I needed that.

I tried to explain what I fear may be a damaging med side effect (my inhalers seem to be causing airway irritation) to my bleeping pulmonologist 5 weeks ago. I returned yesterday for a routine CT scan follow up and he said "What meds are you on?" He either did not remember my complaint or pretended not to in hopes he could distract me. He doesn't chart things that he feels are trivial either. He's very into 'evidence based medicine', if he can't test for it or it isn't the most likely scenario as far as he is concerned it does not exist. I have spent the last year observing this and trying to make sure it was actually occurring, it is.

The article hit home in another way. The med is also causing stomach irritation so I have been having to take Zantac which makes me short of breath in higher doses (a big deal when you have 45% lung capacity). I told him that too last visit and he ignored it and got mad and flounced out of the room. Dyspnea is not listed as a side effect on the package or in the drug sites I looked at but there are FDA reports of it. I hate this man, I asked to see one of the others in his practice and he said "No'. My only alternative is a 70 mile drive to another city and I don't keep a car anymore so it would be pretty hard. Plus if I became critically ill I would end up in the hospital being take care of by him anyhow.

judi

[Dr. Smith]

Originally Posted by zygopetalum

I returned yesterday for a routine CT scan follow up and he said "What meds are you on?" He doesn't chart things that he feels are trivial either.

Routine CT scan? The first time I was given a CT scan, I was told by ER staff that it was "like an x-ray". After the fact I learned that that was "not entirely accurate."* The scan dose of CTs can be hundreds to thousands of times the radiation of a typical x-ray.

In some cases, the potential benefits outweigh the risk; in others there are other scanning methods that are safer.

You are probably aware of all this; it just raises my hackles when (I perceive) doctors order/use CT scans so cavalierly.

He's very into 'evidence based medicine', if he can't test for it or it isn't the most likely scenario as far as he is concerned it does not exist.

I get that to a point. Doctors are trained to think that way—to verify or rule out the most likely cause/reason, and work outward from there. (We see this often in the PN forum.) How far to go (or not to go) can be a tough call for anyone. I often/usually lean toward 'most likely scenarios' vs. 'remotely possible' ones myself. I often opine in posts when I think something is more/less likely. However I try not to go so far as dismissing something as non-existent/impossible.

Things can look very different depending on which side of the fence we're on.

Doc

* One of my favorite movie quotes—this one from Independence Day (a little past halfway down the page).

[zygopetalum]

Oh that, well yes I do save a little on nightlights because I have a nice green glow in the dark. I am one of the lucky 15% to survive lung cancer over 5 years (in my 8th) and the only way to check is by CT. They now recommend anyone who smoked 30 years have a yearly one. I think its 45% of lung cancer occurs in people who have stopped smoking, it takes a long time for the risk to drop. I am down to one every 2 years now, I know I have had too many but the alternative from lung CA is not attractive. Don't smoke people, it eventually mutates the inflammatory genes in your lungs which destroys lung tissue and can cause cancer. It doesn't stop when you quit smoking if you have smoked long enough, the damage continues due to the inflammation. Your genes essentially go berserk and cause inflammation every time a mote of dust flies by and you have to take evil steroid medication to control it.

I am also a science oriented person, I did a lot of rat lab and worked on research projects in college. I don't know if 'evidence based medicine' is exactly what either of us think however. It is based on population studies like epidemiology and doesn't seem to allow for a great deal of individual variability. People like me, and many of the people here with neuropathy are not going to thrive with it in my opinion. the link is a dreadful Wikipedia explanation but it hits the high points. I think in my case it is like trying to pound a round peg into a square hole.

judi

http://en.wikipedia.org/wiki/Evidence-based_medicine

[skutters]

Interesting read.
You proposal for a patient entry section is technically very easy.
we do that for our client on certain medical forms. There are patient booths where a patient can complete their part of outstanding forms.
Makes a lot of sense and could allow a DR to scan it before they see a patient.
Don't forget electronic med docs are still in infancy so will change drastically over the years.

[Rocker Dan]

Originally Posted by Dr. Smith

...So your doctor prescribes a new medication, and being the diligent patient, you read the insert and/or look the medication up on the web, and acquaint yourself with the list of known side effects. Ever wonder how that list is determined/compiled

Doc

Hello Dr.Smith,I am rocker Dan and i saw the question "Does your doctor hear you"and i wanted to say after 44 years of Doctors for pain(most were Neuros or G.Ps) as The pain clinics are semi new to me up until 2007.I have seen the looks and i can tell which ones are really listing and a couple who were the "Know it all"kinds!I am lucky to have a doctor who is my general age(56-60) and my Doctor even asks"where did you learn that?"and i am most Happy to let him know and as of late give him print outs of what i speak.So there really is a warm Happy feeling when someone who controls your pain along with yourself!I was about two years out of 5 with his P.A.s and one woman was great,and the younger high healed know it all was a true nightmare so i asked to bee seen again by the doctor who hears and asks about medications and how i arrived at what i think would benefit me better! Peace RD