Medicine is misaligned. All the forces in medicine work counteractive to conservative approaches.
In this world of immediate gratification, doctors and patients alike have come to expect immediate answers now.
Waiting is not acceptable.
You go to your primary care doc. They don't have an answer. They send you for an xray or an ultrasound, or a specialist. Some of that is the result of the physician. Some of that is the result of the patient expectations.
Doctors in general have grown very leery of the system.
With insurance companies controlling payment rates.
With insurance companies controlling authorizations
With patients educating themselves with their Google MD's
With lawyers ready to pounce on any indication of a bad outcome.
With patients looking for the lawsuit lottery at every turn.
With expectations unmanaged at every turn.
It is no wonder that physicians have responded to a system that punishes conservative action and rewards aggressive intervention.
Some how, conservative management has earned the reputation of crap medicine.
In a land of amazing and expensive technology, it is not OK to just wait.
When I think of conservative management, I think of watchful waiting.
I think of using medications over surgical or procedural intervention.
I think of the tincture of time.
In the hospital, a lot of what I do is waiting. Time. Time. Time. Time is a never ending resource. It will never run out.
When I admit a patient with pneumonia or COPD, I give them their standard therapies and then I wait. I wait to see how they respond. There is not a whole heck of a lot I can do but wait to see how they respond. Wait until they are stable for discharge.
My aspect of care is just one small corner of the health care universe.
Primary care docs
Procedural docs
Surgical docs
Thinking docs
Hospital docs
Rehab docs
Nursing home docs
ER docs
Trauma docs
Academic docs
Volunteer docs
Traveling docs
Cruise ship docs
Industry docs
VA docs
Every doc in every corner of this country has the power to spend money. Other peoples money. By the millions. Millions and millions of dollars a year ordered by the power of the pen and the key board.
Labs
xrays
procedures
surgeries
rehab of all kinds
durable goods
drugs
supplies
2.2 trillion dollars worth of orders.
When you get right down to it, the extraordinary cost of medicine in the US, pushing $7,000 for every man woman and child is the result of an order, one way or another from every physician in this country.
Physicians spending other peoples money.
That's what it's all about.
And the patients?
They look the other way.
Either out of ignorance.
Either out of acceptance
Either out of fear.
Either out of demand.
Either out of reluctance to speak up.
To understand why a physician orders anything would certainly go along way to explaining why our health care is so expensive. Because, ultimately, money is spent when an order is written.
I contend that a very large chunk of medical care today is the result of defensive medicine.
It is not a secret that physicians are scared to death of getting sued. Even if the chances of a successful claim are low, as they are, most physicians would do what they could to limit their exposure.
I know a lot of limiting exposure has to do with the "service" aspect of medicine.
Being nice to your patients.
Bed side manner.
Explaining.
Understanding
Empathy.
The things that volume medicine has sacrificed in the face of rising costs and decreasing payment rates.
The easy way out is to write an order.
An order for a test. Whether that be a lab, an xray, a procedure, a referral.
In the eyes of the patient, the test was done, so the physician did what they could.
In the eyes of the physician, this gives them comfort against the sharks that could claim they missed the diagnosis because they failed to order a test.
My contention, as a practicing physician, is that billions upon billions of dollars, I would even go so far and say hundreds of billions of dollars, are spent every year in search of the exclusion diagnosis.
The problem with the current system is that the physician experiences all of the penalty for not pursuing the exclusion diagnosis. They take the fall for missing the diagnosis. Just look to the ridiculous Ritter lawsuit that drug a radiologist and a cardiologist through the mud, and actually convinced 3 jurors of the ridiculous contention that it was their fault Ritter died.
That is the daily reality of every single physician that practices medicine in our system today.
Spending other people money, insurance money, the physician has an essentially unlimited bank account for which to order tests.
In an effort to "protect" the patient against an unlikely diagnosis, the physician is actually protecting themselves from a failure to diagnose dilemma.
As a whole, in this system of care, the patient loses. The cost of their care is simply absorbed by the giant insurance companies and passed on to others in the form of ever increasing insurance premiums.
For the individual patient who experiences the assault of technology, they feel medical vindicated. That their workup was complete.
But for everyone else.
The cost of care rises exponentially.
Unfortunately, physicians are not in a position to take the fall. They will not sacrifice the possibility of a missed diagnosis for the good of the economic nation.
I have said previously, physicians are selfish like that.
One result of this misalignment of forces between patient, physician, health insurance company and malpractice insurance company is that none of these 4 forces have a direct ability to control the cost structure of each other.
But they should.
Since they are intertwined so deliciously.
For example: the physician. A patient comes in with back pain.
The physician orders a test because they believe not doing so exposes them to a malpractice claim from a patient who expects everything to be done. The result for the patient is acceptance of the plan to undergo expensive testing because their insurance is picking up the tab. The spigot of money from the insurance company will simply pass those expenses on to the large field of premium paying customers. For that individual patient, their expensive workup is paid for by thousands and thousands of premium paying customers. The malpractice insurance company is happy because more objective data is always better.
Take for example: the patient. A patient comes in with back pain.
The patient expects more than conservative management. In many cases, a physician is not willing to risk conservative management when balancing that with failure to diagnose and the lack of objective data which would open them up to a lawsuit. In the pleasure to please the patient, who is less likely to sue, the physician embarks on an expensive workup. But not to worry, the patient's insurance picks up the tab, the physician feels protected, and the insurance company passes on the cost to tens of thousands of other premium paying customers.
When money is spent in our health care system:
They patient is happy because they are getting something for nothing (or at least a sense that their premiums are worthwhile)
The physician is happy because they feel like they are reducing their malpractice exposure by gathering objective data which makes the patient happier.
The health insurance company is essentially neutral as they will simply pass the costs on to their broad base of premium paying customers.
The malpractice company is happy because a happy patient is less likely to sue.
SO, the brunt of my argument presents you with 4 powerful forces in the delivery of health care. Three of them come out ahead by spending money. And one is neutral.
There is simply no motivation in the major players to control costs.
There is no skin in the game.
Well, ladies and gentleman. I present to you, my skin: THE CARD
This is my proposal to align the forces
The patient
The physician
The health insurance company
The malpractice insurance company
These forces will WANT to align. At the current rate of health care inflation, as goes the affordability for the patient, so goes the payment to the physician, the health insurance company and the malpractice insurance company.
The patient is the center of this formula. It is their health and their health care dollars, their insurance that really drives how well all the other players do in the game.
So the question really is: How do you get the patient to align the physician, the health insurance and malpractice insurance companies and cut costs at the same time?
You give the power to the patient. Provide them with
THE CARD.
The card is like no card every carried before.
It is not the Medicaid card. That card is THE black hole for medical expenses.
THE CARD is the unifying force, in all it's glory
How the card works:
The patient signs a binding agreement with their health insurance company NOT to sue any physician on the basis of a failure to diagnose episode of care. This accepts that bad outcomes does not equate to bad medicine. That failure to diagnose is not negligence, but a part of the complexities of the human body.
For the patient, this voluntary program would result in "THE CARD" discount rates for premiums on their health insurance and discount or removed co pays.
You may ask:
How does a patient signing legal waivers possibly create an incentive for the health insurance company to offer reduced premiums?
Well, I propose that a patient carrying THE CARD will have markedly reduced costs of health care in the form of abolishing defensive medicine by physicians.
It is in the health insurance companies best interest to offer premium discounts to those patients who accept failure to diagnose as a part of medical variability and sign up for THE CARD
In fact, I propose, that it may in fact increase market share for the health insurance company by increasing the population that can afford the reduce premiums of THE CARD holders.
This simple voluntary measure would align all the forces together in the search for cheaper, but no less effective health care delivery.
The physician feels protected from frivolous lawsuits and orders fewer tests.
The patient accepts reality of imperfection and gets reduced, more affordable premiums.
The health insurance company reduces payouts and increases market share.
The malpractice insurance company reduces their exposure with fewer patients suing, making premiums cheaper for the physicians.
IT is WIN-WIN-WIN-WIN.
All forces aligned.
It really involves nothing more a downward shift of the cost structure of delivering health care to our nation.
I'm sure a few lawyers out there will say that a patient can't sign away their rights before an action occurs.
For that I say, my homeowners policy excludes mold. I signed the policy. I don't expect to sue for mold damage, should it occur. Besides, failure to diagnose shouldn't even be considered negligence. It is a part of the uncertainty of illness.
This voluntary program is just that. Voluntary. If you chose not to enroll, pay the higher premium. Just as I would have to do to include mold coverage.
Just another way to look at things, once again.
The forces must be aligned, with skin in the game.
In this world of immediate gratification, doctors and patients alike have come to expect immediate answers now.
Waiting is not acceptable.
You go to your primary care doc. They don't have an answer. They send you for an xray or an ultrasound, or a specialist. Some of that is the result of the physician. Some of that is the result of the patient expectations.
Doctors in general have grown very leery of the system.
With insurance companies controlling payment rates.
With insurance companies controlling authorizations
With patients educating themselves with their Google MD's
With lawyers ready to pounce on any indication of a bad outcome.
With patients looking for the lawsuit lottery at every turn.
With expectations unmanaged at every turn.
It is no wonder that physicians have responded to a system that punishes conservative action and rewards aggressive intervention.
Some how, conservative management has earned the reputation of crap medicine.
In a land of amazing and expensive technology, it is not OK to just wait.
When I think of conservative management, I think of watchful waiting.
I think of using medications over surgical or procedural intervention.
I think of the tincture of time.
In the hospital, a lot of what I do is waiting. Time. Time. Time. Time is a never ending resource. It will never run out.
When I admit a patient with pneumonia or COPD, I give them their standard therapies and then I wait. I wait to see how they respond. There is not a whole heck of a lot I can do but wait to see how they respond. Wait until they are stable for discharge.
My aspect of care is just one small corner of the health care universe.
Primary care docs
Procedural docs
Surgical docs
Thinking docs
Hospital docs
Rehab docs
Nursing home docs
ER docs
Trauma docs
Academic docs
Volunteer docs
Traveling docs
Cruise ship docs
Industry docs
VA docs
Every doc in every corner of this country has the power to spend money. Other peoples money. By the millions. Millions and millions of dollars a year ordered by the power of the pen and the key board.
Labs
xrays
procedures
surgeries
rehab of all kinds
durable goods
drugs
supplies
2.2 trillion dollars worth of orders.
When you get right down to it, the extraordinary cost of medicine in the US, pushing $7,000 for every man woman and child is the result of an order, one way or another from every physician in this country.
Physicians spending other peoples money.
That's what it's all about.
And the patients?
They look the other way.
Either out of ignorance.
Either out of acceptance
Either out of fear.
Either out of demand.
Either out of reluctance to speak up.
To understand why a physician orders anything would certainly go along way to explaining why our health care is so expensive. Because, ultimately, money is spent when an order is written.
I contend that a very large chunk of medical care today is the result of defensive medicine.
It is not a secret that physicians are scared to death of getting sued. Even if the chances of a successful claim are low, as they are, most physicians would do what they could to limit their exposure.
I know a lot of limiting exposure has to do with the "service" aspect of medicine.
Being nice to your patients.
Bed side manner.
Explaining.
Understanding
Empathy.
The things that volume medicine has sacrificed in the face of rising costs and decreasing payment rates.
The easy way out is to write an order.
An order for a test. Whether that be a lab, an xray, a procedure, a referral.
In the eyes of the patient, the test was done, so the physician did what they could.
In the eyes of the physician, this gives them comfort against the sharks that could claim they missed the diagnosis because they failed to order a test.
My contention, as a practicing physician, is that billions upon billions of dollars, I would even go so far and say hundreds of billions of dollars, are spent every year in search of the exclusion diagnosis.
The problem with the current system is that the physician experiences all of the penalty for not pursuing the exclusion diagnosis. They take the fall for missing the diagnosis. Just look to the ridiculous Ritter lawsuit that drug a radiologist and a cardiologist through the mud, and actually convinced 3 jurors of the ridiculous contention that it was their fault Ritter died.
That is the daily reality of every single physician that practices medicine in our system today.
Spending other people money, insurance money, the physician has an essentially unlimited bank account for which to order tests.
In an effort to "protect" the patient against an unlikely diagnosis, the physician is actually protecting themselves from a failure to diagnose dilemma.
As a whole, in this system of care, the patient loses. The cost of their care is simply absorbed by the giant insurance companies and passed on to others in the form of ever increasing insurance premiums.
For the individual patient who experiences the assault of technology, they feel medical vindicated. That their workup was complete.
But for everyone else.
The cost of care rises exponentially.
Unfortunately, physicians are not in a position to take the fall. They will not sacrifice the possibility of a missed diagnosis for the good of the economic nation.
I have said previously, physicians are selfish like that.
One result of this misalignment of forces between patient, physician, health insurance company and malpractice insurance company is that none of these 4 forces have a direct ability to control the cost structure of each other.
But they should.
Since they are intertwined so deliciously.
For example: the physician. A patient comes in with back pain.
The physician orders a test because they believe not doing so exposes them to a malpractice claim from a patient who expects everything to be done. The result for the patient is acceptance of the plan to undergo expensive testing because their insurance is picking up the tab. The spigot of money from the insurance company will simply pass those expenses on to the large field of premium paying customers. For that individual patient, their expensive workup is paid for by thousands and thousands of premium paying customers. The malpractice insurance company is happy because more objective data is always better.
Take for example: the patient. A patient comes in with back pain.
The patient expects more than conservative management. In many cases, a physician is not willing to risk conservative management when balancing that with failure to diagnose and the lack of objective data which would open them up to a lawsuit. In the pleasure to please the patient, who is less likely to sue, the physician embarks on an expensive workup. But not to worry, the patient's insurance picks up the tab, the physician feels protected, and the insurance company passes on the cost to tens of thousands of other premium paying customers.
When money is spent in our health care system:
They patient is happy because they are getting something for nothing (or at least a sense that their premiums are worthwhile)
The physician is happy because they feel like they are reducing their malpractice exposure by gathering objective data which makes the patient happier.
The health insurance company is essentially neutral as they will simply pass the costs on to their broad base of premium paying customers.
The malpractice company is happy because a happy patient is less likely to sue.
SO, the brunt of my argument presents you with 4 powerful forces in the delivery of health care. Three of them come out ahead by spending money. And one is neutral.
There is simply no motivation in the major players to control costs.
There is no skin in the game.
Well, ladies and gentleman. I present to you, my skin: THE CARD
This is my proposal to align the forces
The patient
The physician
The health insurance company
The malpractice insurance company
These forces will WANT to align. At the current rate of health care inflation, as goes the affordability for the patient, so goes the payment to the physician, the health insurance company and the malpractice insurance company.
The patient is the center of this formula. It is their health and their health care dollars, their insurance that really drives how well all the other players do in the game.
So the question really is: How do you get the patient to align the physician, the health insurance and malpractice insurance companies and cut costs at the same time?
You give the power to the patient. Provide them with
THE CARD.
The card is like no card every carried before.
It is not the Medicaid card. That card is THE black hole for medical expenses.
THE CARD is the unifying force, in all it's glory
How the card works:
The patient signs a binding agreement with their health insurance company NOT to sue any physician on the basis of a failure to diagnose episode of care. This accepts that bad outcomes does not equate to bad medicine. That failure to diagnose is not negligence, but a part of the complexities of the human body.
For the patient, this voluntary program would result in "THE CARD" discount rates for premiums on their health insurance and discount or removed co pays.
You may ask:
How does a patient signing legal waivers possibly create an incentive for the health insurance company to offer reduced premiums?
Well, I propose that a patient carrying THE CARD will have markedly reduced costs of health care in the form of abolishing defensive medicine by physicians.
It is in the health insurance companies best interest to offer premium discounts to those patients who accept failure to diagnose as a part of medical variability and sign up for THE CARD
In fact, I propose, that it may in fact increase market share for the health insurance company by increasing the population that can afford the reduce premiums of THE CARD holders.
This simple voluntary measure would align all the forces together in the search for cheaper, but no less effective health care delivery.
The physician feels protected from frivolous lawsuits and orders fewer tests.
The patient accepts reality of imperfection and gets reduced, more affordable premiums.
The health insurance company reduces payouts and increases market share.
The malpractice insurance company reduces their exposure with fewer patients suing, making premiums cheaper for the physicians.
IT is WIN-WIN-WIN-WIN.
All forces aligned.
It really involves nothing more a downward shift of the cost structure of delivering health care to our nation.
I'm sure a few lawyers out there will say that a patient can't sign away their rights before an action occurs.
For that I say, my homeowners policy excludes mold. I signed the policy. I don't expect to sue for mold damage, should it occur. Besides, failure to diagnose shouldn't even be considered negligence. It is a part of the uncertainty of illness.
This voluntary program is just that. Voluntary. If you chose not to enroll, pay the higher premium. Just as I would have to do to include mold coverage.
Just another way to look at things, once again.
The forces must be aligned, with skin in the game.
Wow.
ReplyDeleteAre you running for government, b/c that is a damn fine idea.
Or...come to Canada where, though things aren't always fast, the level of defensive medicine seems to be drastically lower than in the great ole USA.
Many reasons for this, but with punitive damages being much lower in lawsuits, it definitely deters the lawsuit-seeking folks.
Well, good idea, but it would then provide incentive to physicians to provide the lowest possible level of care, because the insurance companies are still going to want to keep reimbursements as low as possible.
ReplyDeleteDustin, what is the incentive to provide the lowest level of care?
ReplyDeleteLike I said before, the public equates conservative managment as crap medicine, or as you call, low level of care.
That's where you are dead wrong.
Watchful waiting is not low level of care. Excessive testing is not high level of care.
A means to a happy medium is determined when you take the fear of failure to diagnose out of the equation for physicians.
That's when you allow physicians to practice medicine, and not defensive medicine.
Until you remove the fear factor, defensive medicine will always permeate with every physician encounter.
While this Card idea sounds great on the surface, I'm about 100% convinced that it won't work and you've already provided the reason for this in your blog post.
ReplyDelete"I'm sure a few lawyers out there will say that a patient can't sign away their rights before an action occurs."
This is exactly what the lawyers will say. They will also contend that the poor victim...er, I mean patient...was not sophisticated enough to understand what they were signing. They will contend that the insurance company salesperson didn't explain it clearly enough.
You will say that such arguments are all stupid. You will point out that your homeowners insurance has a mold exclusion.
And your point is?????
I practice on the Mississippi Gulf Coast.
There are a bunch of folks who built "stick-built" homes right on the beach a couple feet above sea level and never bothered to purchase flood insurance.
Their homeowners policies clearly exlude flooding, including wind-driven water and storm spray.
Guess what, they are all suing their insurance carriers because their homes got flooded by wind-driven water and storm spray from Hurricane Katrina.
(Before I get a bunch of hate mail or hate replies in this comments section, I am no shill for insurance companies. There are also a lot of people who did the right thing regarding purchasing appropriate insurance coverage who are in fact now getting screwed by their insurance companies.
Just saying that there are also a lot of folks who have nobody to blame but themselves, but that doesn't stop them and their plaintiff's attorney from trying to shift that blame onto someone else, regardless of what they signed when they bought their policies.)
Bottom line is that no matter what folks sign or what sort of card they carry, as long as there are big dollar signs for some ambulance chaser to go after, and as long as they can convince some patient or family member to go along with them in this dollar sign quest, and as long as they can populate juries with easily swayed morons, health care costs are going to continue to spiral out of control as physicians desperately try to cover their asses long enough to pay off their student loans and then get the hell out of practicing medicine in the U.S. as fast as possible.
So, how do we fix this mess? We need to eliminate the whole dollar sign jackpot potential.
Caps on non-econ damages is the strategy most tort-reform advocates advocate. I think this is shortsighted and dumb.
I think the real answer is to revamp the whole medical liability civil procedure system and replace it with a new one. I personally think a good model for this is the U.S. Military's Court Martial system.
I commented on this quite a bit in the comments section of Graham's blog on malpractice a week or two ago.
There was some anonymous poster (who I can only assume is either an attorney or law student) who argued nastily against any sort of change, using a lot of poor debate skills such as red herrings, straw man, ad hominem attacks etc., prompting Graham to step in and say "Knock it off."
I had already decided to withdraw from the debate with this individual however once he accussed me of lying. It goes back to that old saying of "Don't wrestle with a pig. You only come out dirty and smelly."
In any case, I encourage you to read this comments section as I think the answer to our medical liability mess lies within.
I intend to put a post on this subject in my own blog in the very near future (hopefully in the next day or two), but to be honest, the comments in young Graham's blog pretty much cover it.
Anyway, I thoroughly enjoy your blog. Please keep up the great work!
p.s. Your response to Dustin above is absolutely 100% spot-on correct.
Your argument makes perfect sense, given your starting premises. The problem is that those premises are flawed.
ReplyDeleteIt turns out that *not* everyone in the community considers conservative management "crap medicine." Not by a long shot! I have plenty of patients happy to wait out back pain for several weeks without expensive studies. I am able to explain to the majority of patients with uncomplicated respiratory infections that antibiotics will not help -- without spending hours and hours and running hopelessly behind schedule.
Don't you encounter similar pressure in the hospital to "do something" instead of "just waiting to see how they respond" to your treatment? I'm sure you do, yet I'll bet you explain your reasoning instead of giving in. Why do you think I [and my outpatientist colleagues] are so much less skilled at this than you are?
Basically what you are advocating is tort reform; caps on non-economic damages would work fine. And you're right: look at the vastly improved professional climate in Texas.
Keep up the great blogging.
Dino, your skill at promoting conservative medicine is related to the long term relationship you have made with your patients. Those who stick with you appreciate your style and will cooperate with your conservative strategy. Those who don't like your style don't come back, and you don't have to deal with them. This is one of the reasons why costs are going up. With the demise of primary care, patients will be increasingly going to unknown physicians for acute care, and the lack of a long term relationship between physician and patient brings everything that Happy talks about into play. A few long-term-minded businesses who are paying increasing health insurance costs are beginning to see this and are starting to promote primary care. If government would look beyond the RUC and realize how much could be saved with more widespread physician primary care, perhaps we would see a change in this trend.
ReplyDeletedino. I don't mean to imply that ALL patients fall into all categories.
ReplyDeleteBut defensive medicine is a big part of a lot of medical encounters. Now if your patient population on a whole expects conservative managment, you have yourself a coup in your practice. That's great.
Defensive medicine doesn't escape hospital medicine either. Not by a long shot.
There are many studies done in the hospital to exclude low probability likely hoods, because the failure to diagnose would lead to the illusion of negligence where no negligence exists.
In fact very often patients are admitted JUST to exclude low likely hood events.
The every popular Chest pain with a negative ER workup comes to mind.
Abdominal pain with a negative EXTENSIVE ER work up.
Head aches.
Back pain.
The list is endless for work ups and of exclusion in the setting of unlikely probabilities.
I didn't mean, by any means, to insinuate that hospitalist medicine is immune. Far from the truth.
On a regular basis I have patients asking me when the cardiologist is going to be here or neurologist, when I have no intention of calling either one. They assume that because they are their with a cardiac problem, they need a specialist and all the bells and whistles that come with it.
So if your practice is comprised of mostly patients who accept your premise of conservative management as acceptable, I would ask that you please send some of those folks my way.
dinosaur, somewhere along the line you got the idea in your head that I think outpatient docs are less skilled than in patient.
Remove that throught from your mind. It doesn't exist.
I am all for it. Where do I sign?
ReplyDeleteMaybe one of very few, I have stopped mentioning health concerns to my doctor, precisely because when I do, I end up spending many hours driving across three county lines to go to three different places to be tested for what seems everything.
First, I already have a full time job and second how can I have faith in a doctor who either apparently has no clue what is wrong with me or mistrusts me so much that his only goal is to cover his rear end.
I'd rather trust a Dr who tells me he thinks X or Z is the problem and sends me to have a couple of tests to verify his assumptions.
The whole body thing is just plain ridiculous.
I want THE card.
Excellent. This is what I have always thought without ever trying to articulate it out.
ReplyDeleteI easily spend a few million dollars a year to make patients happy and so I can sleep well at night.
It's always a shock to people we recruit from the States at the difference in how litigenous the pateints are not. In Canada lawyers were not allowed to collect contingency fees (pay if you win) and that seemed to make a big difference. Most patients seems to have reasonable expectations and take ownership of the illnesses which also helps. Great blog.
ReplyDeleteThe only real problem with your idea is that doctors have already gotten into the habit of overmedicating. I doubt they would be able to consciously distinguish between patients who could sue and those who couldn't.
ReplyDeleteExcellent idea.
ReplyDeleteOne problem: As soon as my practice can be maintained with "card carriers," the others are G-O-N-E. This selects for a certain type of patient, anyway.
Several ideas that show the cracks in the structure that would give away to this model: Dr. Chris Hawk's AMA-meeting proposal to not treat lawyers, the patients-who-have-sued blacklist, and of course retainer medicine.
Great post - and great blog!
ReplyDeleteIn response to your quote:
"In the eyes of the patient, the test was done, so the physician did what they could. In the eyes of the physician, this gives them comfort against the sharks that could claim they missed the diagnosis because they failed to order a test."
I recently could not find a doctor who could discover what was causing all the symptoms I was struggling with - I was diagnosed with fibromyalgia (sp?), RLS, and several other problems - but, I knew that was not what was wrong. So, since I was not sleeping at night - I hopped on the internet and began to research and research...and research! I was so desperate for an answer...and I soon discovered that it appeared that I had adrenal fatigue! My cortisol levels were so out of whack - it was insane. It took me 3 months to find a doctor who would even consider this and set me up for a saliva test. The doctor I found mentioned that insurance would probably not pay for this test - but, I was willing to pay whatever it took to figure out what was wrong! Finally, an answer and a diagnosis! I found that the doctors I had were not even open to any tests - and then there were the doctors who would not even listen to what I was saying...it was frustrating!
While I agree that there are way too many people who are using the internet in place of doctors - in my case, it helped arm me with the information I needed for find a doctor who was knowledgeable in the treatment and causes of adrenal fatigue!
Thanks for all the information you provide on your blog....
Kelly said:
ReplyDelete"internet... it helped arm me with the information I needed for find a doctor who was knowledgeable in the treatment and causes of adrenal fatigue!"
And then, only by direct compensation... you don't know how many physician eyebrows were raised by your story of "adrenal fatigue."
Regardless, good luck, from a physician with "hopefulness fatigue."
feminized...I am a little confused...what did you mean by:
ReplyDelete"And then, only by direct compensation... you don't know how many physician eyebrows were raised by your story of "adrenal fatigue." What would cause the raised eyebrows...?
"Adrenal Fatigue Syndrome" Quite a trendy label these days, at least in the non peer-reviewed health care world. Are the websites which advertise/advise on this syndrome also selling Kenoki Foot Pads?
ReplyDeleteBut it you are happier now that you have that label and if you are feeling better, that's great.
FeminizedWesternMale, I share your "Hopelessness Fatigue Syndrome". Let's start a support group.
Anonymous - why posting "anoymously"? Are you a physician? If so, I would be interested to know your field of expertise.
ReplyDeleteAnd, it's not about a "label" - it's about the fact that the lab results have shown that my cortisol levels are ridiculously off - and just so you don't come up with the notion that the results were "fixed" - I did the saliva test twice - and the results were almost identical from 2 different labs. And now, by supplementing with a multi vitamin and trace minerals - my life has changed dramatically - thank you very much! I am not one to claim to have some "fatigue syndrome" and then sit on my butt all day claiming that I cannot work because I am "sick". I chose to seek out why I was feeling bad and work towards getting my life back - and living it to the fullest - which I have done successfully!
And for your information - I am not one to get my medical advice or treatment from a website (of any kind)! I did however, research in great detail my symptoms - mainly because I would rather spend my time getting some information before spending 100's of dollars going from doctor to doctor to doctor to doctor.....
I will readily admit, I have no idea what adrenal fatigue is. What exactly is abnormal.
ReplyDeleteIs it your cortisol?
Is it your mineralocorticoids?
Is it your sex hormones?
Are they too high or too low?
Generally, to get failure of all three adrenal cortex hormone subgroups would require a catastrophic condition, such as bilateral adrenal hemorrhage or intentional bilateral adrenal castration.
There are definitely disorders of the adrenal gland which can be checked with hormone levels, stimulation and supression tests.
Adrenal insufficiency is something I commonly encounter in the hospital and actually diagnose on a rare occasion.
BUt adrenal fatigue?
What does that mean? The adrenal gland is a very complex structure that has numerous hormone process and separte distinct factories of hormone production. To imply that it is fatigued, would need to clarify more clearly which part of it is fatigued. At which point a medical diagnosis could be named.
In the medical field there is a common saying:
When in doubt, give steroids.
Steroids make everybody feel better.
It is the wonder drug. Even for people with normal adrenal/steroid hormone production.
Okay, maybe "adrenal insufficiency" is a better word! :) Basically, my cortisol levels were backwards - way too high at night...and too low at other times.
ReplyDeleteI know that this next comment may bring alot of reaction - but, basically here is the situation. I am 42 years old and overall very healthy. I have been in an extremely stressful job for about 4 years (no, I am not a doctor, police officer, etc.). My body has been running in "stress mode" so long that when I finally said "enough" - my body did not know what to do! All of the sudden my cortisol, several hormone levels, etc. all got unbalanced - kind of like when you are on a see saw with someone and they abruptly get off and your butt hits the ground so hard it takes you a day or two to recover the feeling in your butt! Ha!
Anyway, thanks for the information. Fortunately, I have a new doctor who is not "RX happy" - and have found a combination of multi vitamins and minerals that are working beautifully! Of course, I should have been taking vitamins before all this happened....ha!
Thanks again - I enjoy your blog!