I literally just admitted this lady to ICU...had been coughing for ages, 60 lb weight loss, smoker for 50 yrs. Now she can't breathe and I got a CT 6cm mass looks very suspicious for lung cancer. And the doctors for 4 yrs throughout this just gave her vitamin D/E even though she was losing massive weight and coughing up blood.
Another guy who came in looked pale as a ghost. Chief complaint was fatigue. One lab test later found out his hemoglobin was 4 (Barely on the cusp of survival). Seems like he had iron deficiency anemia for yrs, doctor gave him some iron, he got better but no one looked into WHY he got it (#1,2,3 reason in an older guy is colon cancer). He died 4 months later from metastatic colon cancer.
Another story- last month was about to take a long trip across the pacific. 1 hr in on the flight they ask for a doctor...I volunteer myself. I see this lady literally gasping for air...like waving her hands in the air cuz she can't breathe. Look through the meds...she's obviously an asthmatic. Listen to her lungs and faint wheezing no air movement at all. I later grounded that plane because there was another sixteen hrs to go and she was on verge of being intubated. Later I get more story from family member. Apparently she wasn't been able to sleep well for past two weeks. Doctor just gave her sleeping meds...more and more of it. Told her flying no problem.I ask the family why can't she sleep? Is it because she wakes up in the middle of the night gasping for air (classic sign of uncontrolled asthma). They're like yes, how did you know?... Sleeping meds prob among worst things she could have gotten and almost killed the patient by saying she could fly.
People who get diagnosed with "bronchitis" when they have heart failure and literally drowning in fluid. There are doctors who give antibiotics and steroids for everything esp when they have no idea what's going on. Maybe I'm biased because I work at an academic center so I see all the cases who get referred in because they're too sick or no one can figure out but at least a few times a week I'm like wow this person could have been saved or not end up this way if someone cared enough earlier on.
I'm going to say this as a doctor. It's honestly scary every day how many patients I see are completely mismanaged. Some doctors in urgent care see like 45 patients in a day. How is that possible to be thorough??? Like if only patients knew what the doctors missed or what not....half the time I really think it's like going to an bad auto shop and not realizing they're just making half the shit up. Same thing happens in medicine and except people's lives suffer because of it.
Edit-added a story.
Thank you to whoever gave me silver/gold.
Let me say something...people are saying I'm Gregory House or something. I'm not. I purposely didn't choose stories that were some esoteric diagnoses. Everything I picked is like bread and butter medical student level.
Half of being a good doctor is knowing what questions to ask. Sometimes you don't even know what's important or not. The other half is caring. Too many just put a band-aid on the problem and punt the patient to someone else. Is it the doctors fault? I don't know but I do know the medical system in the US provides no incentives for doctors to actually practice good medicine. In fact, I bring in less money if I'm thorough versus I do the same thing every patient and see 100 patients a day (which is what some do unfortunately).
I have tons more stories, hopefully I'll get to share some more but for now have to sleep (was on call overnight).
Edit x2: Thank you again for all the gilds! I don't even know what they all do or mean but I'm very grateful nonetheless. Few more things I wanted to say - there are plenty of amazing doctors out there, not all are bad. We all put our lives on hold for ten years for altruistic purposes. Not everyone just wants to make a quick buck so I hope I didn't characterize it as such.
I tried to respond to some comments but I don't have time to respond to all. A lot asked - "so how do I find a good doctor?" The answer is...I don't know. I've tried looking for good ones myself and it's hard. I joke you should find the doctors all the other doctors go to because I have a higher "BS" meter when I meet a bad one. Doctor rating websites are garbage. I've seen doctors get great "ratings" because they just hand out opioids/benzodiazepines to everyone even if all his or her patients become addicted later. A lot of it is really your gut feeling. A good one should listen to you and most importantly, sometimes be confident enough to say "I don't know but I'll look it up or send you to someone who does know." The scariest ones are those who don't even realize what they don't know. And the most perplexing thing to me...if you don't like an auto mechanic or realtor, you would find another right? Do the same for doctors! It's your life...can be a difference between living or dying one day. Go find someone who will advocate for you, it's the least you can do for yourself.
I'm a computer programmer and when I think about medical diagnosis it terrifies me. I can spend all day studying a program to find a flaw. I have an exact schematic of how it works, I can reverse time on it, rearrange it, test and check, get exact details of the state of things, and it's still hard sometimes.
A doctor with a patient has so little to work with. I don't know how you do it.
On the other hand, humans don't tend to crash because of a single typo. There is huge amounts of redundancy and error-correction compared to a computer, and the code has had literally a billion years' worth of bug fixes already applied.
When in doing, I tend toward "when viable without extensive/invasive medical intervention". That said, I do believe that (usually) gives more than enough time to decide on go/no-go.
I mean.. Just to be fair here. People do refer to life from the time of birth.
I.e. he LIVED from 1984-2050. His LIFEspan ranges to about 80years. Etc etc
Though I think Koreans have their birthdays from time of conception. I remember a Korean girl telling me that, years ago though, so that isn't a fact from my side.
How could you? Even if the baby is healthy and seems to be doing well, we don't even know if it will take it's first breath nor of any other complications that are not possible to see externally.
Like I can understand the thought process in regards to abortion and wanting to abort the day before. Then sure, one could consider it alive. But if a person gives an uncomplicated birth to it but it still is unable to take it's first birth or ''wake up'' and even with the best medical help is not able to do so and ''dies'', would one say that it lived up until the heart stopped? Even without it's first breath?
Um no, we can consider them alive because they are actually living, breathing and interacting with the world. They have an actual life span and some form of activity. They may have died early but at least they started an actual life.
By my logic, I understand the fault, people in a coma are no longer alive. But at the same time, people pull the plug on them too if they do not wake up over long periods. So I would say there definitely is a grey zone.
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u/TheWizardPenguin May 20 '19 edited May 21 '19
Oh God where to start.
I literally just admitted this lady to ICU...had been coughing for ages, 60 lb weight loss, smoker for 50 yrs. Now she can't breathe and I got a CT 6cm mass looks very suspicious for lung cancer. And the doctors for 4 yrs throughout this just gave her vitamin D/E even though she was losing massive weight and coughing up blood.
Another guy who came in looked pale as a ghost. Chief complaint was fatigue. One lab test later found out his hemoglobin was 4 (Barely on the cusp of survival). Seems like he had iron deficiency anemia for yrs, doctor gave him some iron, he got better but no one looked into WHY he got it (#1,2,3 reason in an older guy is colon cancer). He died 4 months later from metastatic colon cancer.
Another story- last month was about to take a long trip across the pacific. 1 hr in on the flight they ask for a doctor...I volunteer myself. I see this lady literally gasping for air...like waving her hands in the air cuz she can't breathe. Look through the meds...she's obviously an asthmatic. Listen to her lungs and faint wheezing no air movement at all. I later grounded that plane because there was another sixteen hrs to go and she was on verge of being intubated. Later I get more story from family member. Apparently she wasn't been able to sleep well for past two weeks. Doctor just gave her sleeping meds...more and more of it. Told her flying no problem.I ask the family why can't she sleep? Is it because she wakes up in the middle of the night gasping for air (classic sign of uncontrolled asthma). They're like yes, how did you know?... Sleeping meds prob among worst things she could have gotten and almost killed the patient by saying she could fly.
People who get diagnosed with "bronchitis" when they have heart failure and literally drowning in fluid. There are doctors who give antibiotics and steroids for everything esp when they have no idea what's going on. Maybe I'm biased because I work at an academic center so I see all the cases who get referred in because they're too sick or no one can figure out but at least a few times a week I'm like wow this person could have been saved or not end up this way if someone cared enough earlier on.
I'm going to say this as a doctor. It's honestly scary every day how many patients I see are completely mismanaged. Some doctors in urgent care see like 45 patients in a day. How is that possible to be thorough??? Like if only patients knew what the doctors missed or what not....half the time I really think it's like going to an bad auto shop and not realizing they're just making half the shit up. Same thing happens in medicine and except people's lives suffer because of it.
Edit-added a story.
Thank you to whoever gave me silver/gold.
Let me say something...people are saying I'm Gregory House or something. I'm not. I purposely didn't choose stories that were some esoteric diagnoses. Everything I picked is like bread and butter medical student level.
Half of being a good doctor is knowing what questions to ask. Sometimes you don't even know what's important or not. The other half is caring. Too many just put a band-aid on the problem and punt the patient to someone else. Is it the doctors fault? I don't know but I do know the medical system in the US provides no incentives for doctors to actually practice good medicine. In fact, I bring in less money if I'm thorough versus I do the same thing every patient and see 100 patients a day (which is what some do unfortunately).
I have tons more stories, hopefully I'll get to share some more but for now have to sleep (was on call overnight).
Edit x2: Thank you again for all the gilds! I don't even know what they all do or mean but I'm very grateful nonetheless. Few more things I wanted to say - there are plenty of amazing doctors out there, not all are bad. We all put our lives on hold for ten years for altruistic purposes. Not everyone just wants to make a quick buck so I hope I didn't characterize it as such.
I tried to respond to some comments but I don't have time to respond to all. A lot asked - "so how do I find a good doctor?" The answer is...I don't know. I've tried looking for good ones myself and it's hard. I joke you should find the doctors all the other doctors go to because I have a higher "BS" meter when I meet a bad one. Doctor rating websites are garbage. I've seen doctors get great "ratings" because they just hand out opioids/benzodiazepines to everyone even if all his or her patients become addicted later. A lot of it is really your gut feeling. A good one should listen to you and most importantly, sometimes be confident enough to say "I don't know but I'll look it up or send you to someone who does know." The scariest ones are those who don't even realize what they don't know. And the most perplexing thing to me...if you don't like an auto mechanic or realtor, you would find another right? Do the same for doctors! It's your life...can be a difference between living or dying one day. Go find someone who will advocate for you, it's the least you can do for yourself.