What Happened to Doctors?

Posted by stumpedandgrumped @stumpedandgrumped, Mar 7 12:30pm

This is a bit of a rant, so I apologize in advance. But I believe that Long COVID has shone a light on the failings of the medical community generally.

Doctors are, at the most basic level, troubleshooters. Their job is to identify a problem and then determine an appropriate course of action. They share this basic concept with lawyers, IT professionals, and even car mechanics; they all use the same basic framework to find answers.

A lawyer who accepts a case is bound to do their best to find the correct path forward. They cannot simply send you to court with a 'best guess' on the law; they have to spend time researching your issue. If they miss law or fail to prepare, that can be their career done.

IT professionals are the same. If you bring your computer in for repair, they don't spend 15 minutes with you, hand yo ua disk, and tell you to schedule a follow-up if the issue persist... they have to dive into the issue, figure out what is causing it, and provide a fix. Sometimes they're wrong, but they're bound to do their best to solve things.

Then... there are doctors. A typical Long COVID pattern:

You pop in for 15-30 minutes. If you have a good doctor, they've done the reading; they know what your issue is and have reviewed the notes you've provided. If they're mediocre, you spend 10 minutes explaining your issue (never mind the notes you provided) and another 3 waiting for them to take notes. Then, they either give you a guess and send you off, refer you, or tell you to lose weight because something something health.

Your symptoms continue. You go back. Repeat the process, the doctor has to catch up. It becomes clear that between appointments, they've not thought about your issue at all. It takes your inquiries to make progress, you spend weeks waiting... and you end up doing your own research, using your doctor as a way to get the referrals because "something something professional." The referrals shrug, say "not my area" and leave you hanging. As soon as you failed to trigger their specialty, they write you off.

Eventually your doctor either runs out of ideas or refuses to consider re-tests. You're still suffering, but they figure you are walking and talking so... not priority. So, you're left with starting anew with a new doc, running your own experiments, or giving in and hoping your body eventually recovers on its own.

To be clear, this is a failing of the entire medical profession. Doctors should be held to the same standards as lawyers: When you take on a client, you take them as they are. You do not get to stop until you have answers. And they should not be the ones having to spearhead the effort.

Interested in more discussions like this? Go to the Post-COVID Recovery & COVID-19 Support Group.

@sushicat

I’m glad you’re starting to feel improvements. For me, heart palpitations, vertigo and unusual histamine reactions are the last to go. But it’s not falling-down vertigo, and the palpitations and rashes are much less frequent. I’m grateful to be moving in the right direction (yet remain terrified by the specter of reinfection.)

That’s really interesting about your anxiety. I have always had anxiety, but in addition to my usual anxiety I have major fight-or-flight types of episodes now. Much different than the anxiety attacks I’m used to. Oddly, those started well after my brain started to heal.

As for the medical community and our government, I agree 100%. Well said. History will not look back favorably on how we handled the pandemic. I do expect a lot more fallout from long covid over the years to come. But that could be personal bias.

Take care.

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That's promising... I'm at the "positional burning in chest made worse with anx" and "shaky heart palps" stage, with some twinges reminiscent of how this started, way back when. I am choosing to believe that is a good sign. Those fight or flight may be things re-balancing, yes? I notice that sometimes before a no symptoms period, I often anx spike beforehand... like my body is battling and winning.

The only arguably good bit about all of this was that my sports injuries have (finally) healed. No more back pain.

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@colleenyoung

@stumpedandgrumped and everyone in this discussion, I get your frustration. Venting can be cathartic.

And I'd also like to use this discussion to ask "what can patients do about it?"

It is a rare person who never needs to see a medical professional. Our health depends, in part, on our relationship with our doctors.

How were you able to work better with your doctor?
How did you get heard with a doctor who seemed unwilling to believe you?
What tips would you offer other patients?

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"How were you able to work better with your doctor?"

I fired my PCP after it was clear that he was going to be more barrier than partner. He resisted changing his diagnosis even when presented with symptoms that did not fit his 'sports injury' theory. So here, I would say 'fire doctors who do not listen.'

"How did you get heard with a doctor who seemed unwilling to believe you?"

I think the better question is "how do you find a doctor willing to believe you?" First, read reviews and pay particular attention to negative patterns. 'Spends the time,' felt listened to' are good. Doctors who also teach can be valuable; they're often well-informed on new developments and may have read studies your standard PCP has not.

"What tips?"

Assemble a good team of curious, diligent doctors. Do your own research, read studies, and don't be afraid to ask your doctor to try things. Push for novel treatments if you're comfortable with them. Be proactive; your doctor SHOULD be working on your case offline but keep them active and engaged.

Don't give up.

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@stumpedandgrumped

That's promising... I'm at the "positional burning in chest made worse with anx" and "shaky heart palps" stage, with some twinges reminiscent of how this started, way back when. I am choosing to believe that is a good sign. Those fight or flight may be things re-balancing, yes? I notice that sometimes before a no symptoms period, I often anx spike beforehand... like my body is battling and winning.

The only arguably good bit about all of this was that my sports injuries have (finally) healed. No more back pain.

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Fight-or-flight episodes are a common LC symptom from autonomic nervous system dysregulation, I believe. And I choose to believe they too will exit my life someday. It’s interesting how our symptoms ebb and flow. Old ones disappear and new ones are revealed. I wish you and everyone here continued recovery!

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@barbarabell

I did read that rheumatologists are notorious gaslighters especially if you are a woman. I hate intellectual laziness as well; these doctors can’t be bothered to familiarize themselves with the literature and latest findings?

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Why do that when they can make more money rolling through patients?

I've kept pretty good notes and I provide a short summary to new docs. The rheumo doc could not be bothered to even glance at them, so we spent our time rehashing things he ought to have already known.

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@colleenyoung

@stumpedandgrumped and everyone in this discussion, I get your frustration. Venting can be cathartic.

And I'd also like to use this discussion to ask "what can patients do about it?"

It is a rare person who never needs to see a medical professional. Our health depends, in part, on our relationship with our doctors.

How were you able to work better with your doctor?
How did you get heard with a doctor who seemed unwilling to believe you?
What tips would you offer other patients?

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When I find a doctor who is willing to "THINK" and be serious about figuring it out - I will let you know...Just saying, I have been to my GP, 3 Cartiogolist, a pulmonologist, and so much bloodwork and CT scans.....it is unbelievable.....NOTHING is from all the results and I get no suggestions as to where to go from here... just silence....

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@stumpedandgrumped

Why do that when they can make more money rolling through patients?

I've kept pretty good notes and I provide a short summary to new docs. The rheumo doc could not be bothered to even glance at them, so we spent our time rehashing things he ought to have already known.

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Couldn’t agree more. My gaslighter encouraged me to describe all my symptoms in detail and seemed sympathetic. He could see my rash that made me look like a human alligator. This was right before he offered me Prozac and a referral to a psychiatrist.

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As others have stated, Covid simply made the problems of our healthcare system visible.
We have been on this road for some time now.

“Managed Care” is looking for profit first and foremost. Hence the 15 minutes doctor appointment that is basically worthless, The perfunctory exam where you are fully clothed, and the doctor barely touches you. Then going over only the protocol of blood pressure, mammography, cholesterol, colonoscopy, blood sugar and of course flu shots, before the doctor will even address why you came in! By the time you get to what you wanted to discuss, your time is up, and the doctor has a hand on the doorknob.

I did not understand the state of our healthcare until Covid, because I was a healthy person.
Now I know firsthand what a nightmare it is.

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I agree with so much, but not all, of what has been said in the comments above. Early on I was advised to keep some sort of track of my symptoms - mostly because my cognitive impairment did not allow me to remember all my symptoms. Whenever I see a doc, I bring an overview of my symptoms and where they stand now. My PCP is incredible and reviews every word before she sees me. Two rheum's looked only for autoimmune answers and dismissed my overviews. The last rheum knocked my socks off. She was beyond thorough, asked me many questions, studied my overview, put me on colchicine for the muscle pain (which helped), and then unfortunately was removed from the list of authorized providers for worker's comp. My long-time cardiologist told me I was crazy and there was no reason for my O2 to be dropping, for shortness of breath, for fainting, etc. Now, 4 years later, he has diagnosed me with POTS, orthostatic intolerance, new heart murmur, and aortic stenosis. My latest negative experience is seeing a specialist who ignored my LC diagnosis completely, took my overview, and then wrote that I was too focused on my symptoms and that there was no research showing cognitive impairment was associated with long covid.

Like every profession, there are the good, the bad, and the horrible. I have met all three types in the past 4 years.

I do believe, like others above, a multi-disciplinary approach would be helpful. The LC clinics I have been a part of are multidisciplinary, but there is nobody coordinating the care. There has to be some type of communication between the providers about the patient. If everyone looks at the patient solely through their specialty lens, potential connections are going to be missed.

Covid was a new virus, long covid is even newer. At the end of almost every peer-reviewed research article is a statement that says they are at the very beginning of finding out the causes of the various symptoms and more focused studies are needed. The good doctors are doing everything they can think of to make our lives easier given the small amount of concrete knowledge they have about it. The other physicians, I am trying to avoid.

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@mydogsbestfriend

I agree there are problems. I have a long time primary in a medical group setting. Recently was having serious abdominal pain but not enough to go to the ER. My doctor was not in so I saw a PA who works with him She examined me with my clothes on including taking BP over my sweater. I asked what the reading was, she replied “ok”. My chart says I take meds for high BP. Then she examined my abdomen ( I was fully clothed). She said probably a strained muscle or possible hernia. Sent me for ct. Results showed no strained muscle or hernia, a bit of fatty liver ( which I knew about), all other organs fine. BUT possible tics in the sigmoid and a questionable focal mass in that area. I had a normal colonoscopy 6 months ago. Now I have to see the gastroenterologist for follow up. I feel the PA should have thought my pain might have been gastroenteritis at my exam. So now on pins & needles until I see the GI doc. He’s good but on vacation. I’d like to go on a vacation too!

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I have good insurance, so I would have gone directly to the Specialist. I avoid PAs - they should not have responsibilities for diagnosing complex cases. They don't have the training.

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@vic83

I have good insurance, so I would have gone directly to the Specialist. I avoid PAs - they should not have responsibilities for diagnosing complex cases. They don't have the training.

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Well I agree but I wouldn’t have gone to a specialist right away, as the question of what was causing the pain had not been resolved. And I agree with you about PA area of responsibility. I don’t think the one who saw me even thought of a GI problem.

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