Medicine And Tv

[drdart]

Been reading TV for a while now, love it and find it both amusing and helpfull.

What I really don't like is the amount of personal medical questions and their "expert" advisors....

Beeing a x-doc (5years GP, 5years eyesurgery, a few years psyciatry and a few years lungmedicine- restless soul!) i consider myself resonably well trained medically.

What i NEVER would do is to give any specific advice on a personal medical question on an internet-forum.

Starting my med.carier as a GP on a small island in the North Atlantic, 4000 souls and duty 24/7, sometimes for weeks, i found that 90% of wrong diagnosis/threatments came because I did it all over the phone...

I've been a patient as well- in a field where i'd worked for years- and started out treating myself, which needless to say all went horribly wrong! (Hence premature retirement in Thailand...)

The point beeing:

- It's close to hopless to diagnose and treat somebody properly without seeing them face to face.

- As a patient it's difficult to point to which symptoms are relevant and which not. Thats why the doc actually excamines you...

- If you are sick, see a doc! Don't let (often totally useless) thai-pharmacists or internet-freaks with a med. dictionary be the masters of your healt!

To you (i'm sure well- meaning) advisors: How would you feel if somebody turned up dead after following your advice?

To qoute another of my med.profs: "Nothing has killed so many people in modern times as medical home dictionaries!" (i guess a bit over the top but you get the point)

And please remember: that someone has similar symptoms as you does by no means mean that they have the same disease.

====

As for thai-docs and hospitals:

Seen a few over the last 4 yrs. on Samui and in Korat with friends and family as patients, sometimes serious and sometimes not.

My experience is that they are really not so bad as some of you want them to be.

What they (the docs) sometimes lack is the common (western) politeness to actually tell the patient what they are doing/thinking and why. This of course causes distrust and misunderstandings.

And, they do have a different approach to profylactic medicine.

Happy healthy days in LOS!

[Mobi]

Hello drdart,

This is an interesting topic, and you have indeed made some very good points, and as you are a doctor, I am the last person who would dare argue with you on medical matters.

However, I would like to make a few observations.

Firstly and most importantly, you will find that almost every person who posts advice in this forum almost always highly recommends that the 'patient' consult a doctor at the earliest opportunity. This is a given, especially in the more serious cases.

I hate to challenge you on your contention that diagnosis without seeing the patient face to face is very bad, but that's exactly what they have been doing for years in the UK, where there is a national health help line you can call and get medical advice. Again all but the most minor cases are invariably referred to doctors, but in an emergency, or where it is difficult to get to a doctor quickly, it has been a life saver. And then, although I am not an expert, I believe there is a flourishing practice in the more remote areas of Australia where doctors will diagnose and treat patients over the radio. Two examples which tend to go against your theory.

We all know about the hypochondriacs who spent half there lives pouring through medical dictionaries, but, let's be honest - times have changed. No one reads dictionaries any more -They go on line - where there is such a wealth of good medical information available on every conceivable condition, that IMHO, they would be remiss if they didn't check to confirm a doctor's diagnosis and treatment of their medical conditions - especially in Thailand. Yes it can be dangerous and misleading, but anyone with a reasonable amount of intelligence and common sense can sift through the wealth of information available and get a pretty good handle on their particular ailment, and the treatment available. Much of this info is on there for doctors to read, and much of it is excellent.

We are in Thailand, where the quality of medical practitioners varies enormously. The best doctors, many overseas trained, reside in the major, private hospitals in Bangkok, which even for many farangs are too expensive. For the rest, it is frankly a lottery. There are good and bad doctors - like anywhere, but once you get away from the major Bangkok hospitals, the overall standard is pretty shoddy.

Then there is the 'farang' factor. Most doctors are not used to dealing with farangs, who often react differently to Thais when ill, and due to their larger size, often require a greater amount of medication. Many Thai doctors do not realise this, and "under-prescribe", or assume the farangs will react in the same way as Thai, which is not always the case. An eminent UK doctor who works at a major Thai private hospital,once gave a talk where he explained why they charge farangs more than Thais. It was because farangs always knew more about their condition (having researched it on the internet) and insisted on putting the doctor through his paces and asking many questions. All this takes much longer than for a Thai patient where he will treat the doctor with the utmost respect, never dares to asks any questions, and is happy if he goes away with a heap of pills.

Some of the 'advisers' in this forum, in particular Sheryl, IMHO know more than most doctors in Thailand. I know from personal experience, that Sheryl is dedicated to helping sick people, wherever she comes across them, and has undoubtedly saved a few lives. She never fails to tell a sick person to get to a doctor ASAP, but she does more than that, she tells you where to go and who to see for any given condition. And for those who, for one reason or another refuse to see a doctor, then if it wasn't for people like Sheryl, they would be far worse off.

None of the above in any way conflicts with your advice that the best possible thing for anyone who is sick is to see a doctor, but i do believe that this forum serves a a good and very useful purpose, and long may it continue to do so.

Edited July 24, 2008 by Mobi

[drdart]

Thanks for tha answer Mobi!

Hope I didn't come across wrong. I certainly did not mean to pick on anybody on this forum in particular.

I find that many of you posess impressive knowledge which you must have put in a lot of effort to aquire!

I think we agree on most points:

In a foreign country a forum like this is very helpful, and in the middle of nowhere it's great to be able to ask sombody for directions and help.

But any technology but will always be second to a face to face IMHO.

A few doc-friends of mine in Norway once started a web-page where people could put up their questions. It went down quite quickly (like most others) because the answer most of the time was: "See a doc!" (And the reason was mot money- the guys got paid pr. answer!)

I'll be happy to help out in any way I can on this forum, I've got lots of spare time and I do like to help people.

But I guess my answers are going to be very general!

Thai-docs:

There are good ones and bad ones in all countries. I've had a couple of bad experiences here myself. But after having gotten angry and told them that I'm a doc and I find their treatment unacceptable, most have turned completely and have come up with the good stuff.... So I guess often it's a cultural crash more than anything else.

The status docs have in Thailand compares to europe 100 yerars ago! No (working-class) thai dares to question anything they say!

[FBN]

Well spoken Oh Citizen of Pong!

This an internet forum. A form of cummunication still relatively novel to most and the application and usefulness of which depends on so many variables that it is impossible to define.

This forum, and the advice given, should be seen in that light. It does not intend to, and will never replace actual one on one consultation. It is intended to discuss, not dictate or be absolute in the advice given. Anybody that tries to do so is like a doctor that treats himself; he has got both a fool for a physician and a fool for a patient!

To me, the feedback and input from patients suffering from various conditions, such as the thread on TB, is most informative. The experience of patients here in Thailand with different hospitals and doctors, that are also fed back to this forum, has helped many to get the help and expertise they need in a much more timely fashion, I am sure.

[drdart]

"A form of cummunication still relatively novel to most and the application and usefulness of which depends on so many variables that it is impossible to define. This forum, and the advice given, should be seen in that light."

- Well put and exacly my point.

"It does not intend to, and will never replace actual one on one consultation. It is intended to discuss, not dictate or be absolute in the advice given."

- And you are sure everyboby sees it that way?

"Anybody that tries to do so is like a doctor that treats himself; he has got both a fool for a physician and a fool for a patient!"

- a fool for a patient, sure - I'm not the first and certainly not the last physician who fell in that trap. You can say I learned the hard way!

- a fool for a physcian? Hope not. I NEVER in my life had a complanit from a patient that could not be solved in my office. And that i'm proud of!

[drdart]

Just because I don't like beeing called a fool:

FBN, i guess you recon most doc's as fools then.. You'd be amazed how common self-treatment is among physicians, it's actually one of this proffesions biggest healt-problems!

If you've read and understood my OP you would have seen that i just wanted to make sure that people know the risks they take by telling others what to do.

[cloudhopper]

Hey Dart welcome to TV. I'm an x-doc too but probably way more X than you. I tend to agree with FBN in the sense that on an internet forum one has absolutely no idea whether the poster asking for or dispensing advice has any credibility at all, be it medicine or gardening. Maybe you're really a doc in LOS or maybe you're a lonely 13 year old girl in Chicago. IMO only an idiot would trust anything seen on an internet forum. It's all very entertaining though and I enjoy winding up NHS proctologists like nidnogg. And I really like your avatar!

[drdart]

Thanks Cloudhopper... I had just decided to leave this forum, you made me change my mind!

[cloudhopper]

Ludo est voluntas de vita!

[FBN]

Just because I don't like beeing called a fool:

"..a fool for a physcian? Hope not. I NEVER in my life had a complanit from a patient that could not be solved in my office. And that i'm proud of! "...

After 30 years of practice of medicine I am neither so naive nor so arrogant as to believe that I have solved every problem that I ever came across.. I have been humbled and stood helpless in the face of my own inadequacies many times. When you have diagnosed cancer and stood by the bedside as the patient finally dies, I never thought that the diagnosis was the aspect that I could be proud of... I had failed.. We all failed collectively as a profession because our tools are inadequate, we are inadequate.

We can only do our best when we realise this...

On a lighter note: The "fool for a patient and fool for a physician" is not my own saying; it is from a professor in internal medicine from my student years; the same chap that said " Always leave home in the morning with an empty rectum and a full stomach..!".

[drdart]

To elaborate:

- The main point im my OP: Be careful when you diagnose somebody over telephone/internet and similar new media is actually taught in med.school these days, and is not something i just pulled out of the hat.

- That somebody consider themselves to have such vast experience and/or intelligence to ignore that fact speaks for itself.

[Mobi]

Thinking about it, I believe the incidence of anyone actually attempting to make a positive diagnosis on this forum are few and far between.

If someone posts and says they have such and such a symptom, they may well get some SUGGESTIONS on what may be their problem, but every serious poster would tell them to see a doctor if it sounded in the slightest degree serious.

A lot of medical conditions are discussed here, in particular with folk who have suffered from the condition in question, (or know someone who has had it) and how they were treated and what hospital they attended, etc etc.

Then we have many debates and informative discussions about hospitals. doctors, specialists etc.

And so it goes on.

I personaly have learned a lot from this forum, have benefited from some very good advice about all manner of medical matters, and hopefully have also imparted a few words of wisdom that may have helped someone.

So it is far too simplistic, to categorise this forum as a place where you can have your ailments diagnosed.

IMO, it very rarely happens.

[drdart]

"IMO, it very rarely happens."

I'm a newbie so i really don't have the full perspective on whats going on here. I just came across a couple of bad advice which led me to OP.

That said, 1 dead as a result of following advice on TV is 1 too much, wouldn't you agree?

Edit:spelling

Edited July 25, 2008 by drdart

[Sheryl]

OP, you have made your point -- several times over. One of your posts has been deleted do to content that was flaming in nature towards another member.

I think that those of us who have followed this forum for a longer period of time see a different picture than you have described, including a considerable number of "saves". But you are of course welcome to your opinion.

Most of the people who post here are not so much seeking an online diagnosis as they are seeking advice in where to go for a specific problem or (not infrequently) help in understanding what they have been told by a doctor they have already seen, or help in deciding if they are correct to doubt the quality of the care they received.

This is Thailand and people often find it a bit scary to obtain medical care in a foreign country, as well as frustrating if there was a language barrier. Some people need help navigating the Thai medical system. Frequently Thai doctors, especially those upcountry, do not provide adequate explanation of what they are doing etc. It is reassuring to many posters to have another farang explain in more detail. And, not infrequently, people have consulted doctors who did not provide optimal care and they benefit by having that impression confirmed and being redirected to a well trauined physician of appropriate specialty.

Quite a number of health professionals are on this forum and generally jump in to correct any misleading or dangerous advice that has been given. But, of course, sometimes things slip through. This may have occurred more than usual in the recent past as the Moderator (me) was out of country for a few weeks. As a medical professional yourself, if you saw something of that sort, you might have done better to have addressed it directly rather than posting a generic objection to the forum.

For a whole variety of reasons, people are going to post seeking medical advice of one sort or another, whether it is a recommendation for a doctor, better understanding of what a doctor has done/said, or recommendations for home treatments/self-management (which are appropriate in many minor conditions). As an example of the latter there have been many threads in which allergy sufferers traded tips.

Obviously anyone posting on a forum understands that the replies they receive will come from a range of individuals of differing levels of expertise and that they themselves are responsible for deciding which if any of the replies they receive to listen to. Likewise, it should be obvious that people responding to a post are limited to the information that was provided, and if that was incomplete or inaccurate then the advice will likewise be off the mark. (This same thing holds true in face to face consultations with a doctor.)

[Mobi]

"IMO, it very rarely happens."

I'm a newbie so i really don't have the full perspective on whats going on here. I just came across a couple of bad advice which led me to OP.

That said, 1 dead as a result of following advice on TV is 1 too much, wouldn't you agree?

Edit:spelling

IMO it rarely happens that someone is diagnosed on this forum. Not that someone dies as a result of a diagnosis on this forum.

I am sure it has never happened , and even if it has, what is your point? We are all free agents and we are all free to do consult whoever if we are ill. If someone is stupid enough to believe a diagnosis on an internet forum (which I reiterate rarely - if ever happens) then surely you are not trying to say that we have no business having such a forum?

Someone might equally consult a fortune teller, a witch doctor, a herbalist, or whoever. That is their choice, and if they die as a result, then it is down to their stupidity - nothing else.

On the contrary my good doctor, I would say that a good few lives have been saved as a result of the advice and practical help emanating from this forum, that is surely far more important than some dolt who blindly accepts what has been told to him by another dolt on the internet and then pops his clogs!!

I know more about diabetes than most doctors who do not specialise in that field, and as a diabetic I have been subject to so much ignorance and outdated knowledge about my condition by doctors from Harley Street to Korat that it would make your hair curl.