Just wondering

Rayland · Apr 9, 2024

tallslenderguy said: ↑

i graduated college with a BSN about 12 years ago. Prior to that, i was in a totally unrelated field of executive business management. i also ran a side business of flipping/restoring houses. i've been a doer my whole life, i have the weird notion i can do whatever i set my mind too.

Always been somewhat conscious about health, grow my own organic produce, 'natural' supplements for this or that. my medical education helped me understand something i didn't realize prior, and that's just how complex human physiology is. i've been a critical care nurse in a teaching hospital for 11 years, and i am always learning something new. Medical science is always learning something new.

The difference is, my education in anatomy, physiology, microbiology, pharmacology, etc., are all a foundation on which my healthcare practice is built. There are infinite numbers of variables that can affect a diagnosis and healthcare is a lot less exact and precise than culture has presented it.
For example, sepsis is a common disease process we treat in the hospital. We know the signs and symptoms, it's an emergent infection that has advanced to a stage that, if not treated, typically results in death. We have standard septic protocol: draw blood for cultures, also usually a urinary analysis (UA), rapid infusion of fluids for blood pressure drop that is one of the sepsis symptoms, start broad spectrum antibiotics (in that order). Thing is, we usually don't know what we're treating at that point, we just know the effect. i often explain to patients that we are killing an ant with an elephant gun. Blood cultures, if they show anything, take 24 to 48 hours to grow and result, but if we waited to treat until we have an exact diagnosis, most people would die. So, we hit them with antibiotics that pretty much kill everything, then when we get an actual diagnosis of cause, we refine the antibiotic to fit the pathogen. But much of the time, we are not able to pinpoint the cause or pathogen, the elephant gun just does its job.
And there's all sorts of complexities involved in that one protocol (and there are myriad protocols in medicine). For instance, most of my patients have several complex chronic co-morbidities (disease processes), like diabetes, kidney disease, lung disease, heart disease. Not unusual for them to have all of these. So, for instance, a patient comes in with sepsis, but also has heart failure. Giving that patient the fluid bolus they need can also kill them with fluid overload, or a kidney failure patient's kidneys may be harmed by the antibiotics needed to save them... most of the time, we are doing a complex balancing act like that.

my point is, there is rarely a simple diagnosis or a simple solution, and it's impossible to give a definitive answer and understanding to someone who doesn't have a complex education and experience to go with it. Even then, what we do, is best done as a team effort vs one person. i'm with my patient for 12 hours a day... the doctor sees them for 10-15 minutes. We are trained differently and do different things, but one doesn't work completely well without the other. Then there are also social workers, pharmacists, physical and occupational therapists, respiratory therapists, specialist doctors.

And patients/patient families come along and question our treatment because of something they saw on the internet. i go to great lengths to explain the disease process to my patients as part of their care, but i cannot give them the same understanding i have, they simply do not have the background, education or experience. And i am a firm believer that patients should be informed, so i am not against looking stuff up on the internet. i actually have sites that i refer patients to. It's really a matter of perspective. By all means, i want patients to get as educated as possible, but it's important to understand that their understanding is not equal to the person who has the education and experience. There is always going to be a trust factor, and it's not always warranted. i don't have the same kind of education that a pharmacist, doctor, physical therapists, etc., has, but we play on the same team and we have to trust each other for it to work.

i could go on, but this is reality. Medical professionals are flawed human beings working with incomplete knowledge about the infinite universe of the human body and mind. But, most are going to be better at treatment based on education and experience than someone without those qualifications.
Click to expand...

I know. Before dropping of med school I did complete anatomy and phatology exams and learned about the diagnoses and how complex they can be.

I'm not saying doctors are perfect.

Mostly I'm disturbed by the attitude here. I won't say it's like this everywhere, mainly in my city and maybe I'm critical, because I've seen the differences between doctors and their attitudes. There is a dermathologist here who I wish would be my gp instead.
She was attentive and prescribed medicine and tried different treatments withouth being dismissive or telling me it's my fault that I don't get better or I'm doing stuff wrong. Finally my skin actually got much better thanks to her.

tallslenderguy · Apr 9, 2024

Rayland said: ↑

I know. Before dropping of med school I did complete anatomy and phatology exams and learned about the diagnoses and how complex they can be.

I'm not saying doctors are perfect.

Mostly I'm disturbed by the attitude here. I won't say it's like this everywhere, mainly in my city and maybe I'm critical, because I've seen the differences between doctors and their attitudes. There is a dermathologist here who I wish would be my gp instead.
She was attentive and prescribed medicine and tried different treatments withouth being dismissive or telling me it's my fault that I don't get better or I'm doing stuff wrong. Finally my skin actually got much better thanks to her.
Click to expand...

i'm sorry if i came off 'sounding' critical. my feel from you as an individual is that you are fair, considerate, intelligent... all i have are good impressions of you. my desire was just to throw in a healthcare workers perspective. Something i should have emphasized more was how awakening the experience has been for me. Prior to being a nurse, i was one of those people i describe, thinking i understood something better than i did. Not saying that about you or really anyone else here, just speaking in general terms.

On the flip side, i think, like any relationship, balance is called for. Some medical professionals have a 'god' complex, which i don't think is ever useful. There are situations where the patient knows more about their issues than the healthcare worker... they may not have the knowledge to understand it in the way a licensed practitioner can, but they know stuff that will benefit a good practitioners understanding, diagnosis and treatment. So yeah, totally right to be disturbed by attitudes, especially when that person is responsible for your welfare. The sword cuts both ways, each would benefit from caring about the other.

Another element is it can be hard to hear about peoples troubles all day long. If affects even the best of us. It's impossible to know this effect before getting into the profession, it just happens. It's hard being in a constant war zone. There was a study i did a paper on in school that showed 60% of bedside nurses quit the profession in the first 2 years. Not just bedside nursing, but nursing. Period. The rest of us adjust and are adjusted by the work and working conditions. i have people yell, curse, question my integrity, throw stuff at me, treat me like a waiter, on a daily, routine basis. i also have some of the most wonderful, profound connections with people that i ever have. i've found ways to keep my heart open, but it's costly.

i do a very thorough exam on all of my patients as part of my care for them. One of my first questions is: "when was the last time you had a bowel movement." Which is a pretty funny introductory question from a stranger coming into your room and waking you at the crack of dawn to ask. Yet, some people can wax eloquent for what seems forever on their bowel habits lol... and though i've asked this same question of thousands of patients, i still have to look fascinated while gathering vital information, and this is only the first question.

Rayland · Apr 9, 2024

@tallslenderguy It's okay to be critical. I think it can be useful learning more about the other person and for me to learn too. I'm not perfect either. I'm flawed. I let my emotions get the best of me often. I've been very anxious about loosing acces to healthcare, because other trans people here have had bad experiences too, where doctors don't take in transgender patients at all and refuse to write prescripions for hormones and so on.

My dad had sepsis and he was at the hospital with it. Almost died. He's not fully in wheelchair, but needs to use cane. He has wounds on his legs and it's something I need to help with. I always properly follow what doctor says, since I hope they know more than me. None of it has helped. The doctor accused then me, that I'm doing stuff wrong. Even if I'm doing things perfectly, then none of it matters. I end up being doing something wrong anyway, even though following instructions. I shouldn't be even doing all of this. I want to live my own life. Despite I'm trying hard, because family is important to me. He needs an hip replacement, but because of the persistent inflammation in the legs he can't get it, because infection risk would be too high to perform a surgery.

I've had too many bad experiences with doctors. Not just regarding me, but other family members too.

Just wondering

Rayland
Moderator Full Member

tallslenderguy
Regular Member

Rayland
Moderator Full Member

Just wondering

Thread Tools

Rayland Moderator Full Member

tallslenderguy Regular Member

Rayland Moderator Full Member

Rayland
Moderator Full Member

tallslenderguy
Regular Member

Rayland
Moderator Full Member