tag:blogger.com,1999:blog-3045634714760830992.post4520188496346706851..comments2023-06-05T11:51:38.383-04:00Comments on Evolutionary Psychiatry: Ancient Western Medicine Part 2Anonymoushttp://www.blogger.com/profile/04429177284200775781noreply@blogger.comBlogger7125tag:blogger.com,1999:blog-3045634714760830992.post-79084026068432158392011-10-12T11:30:55.936-04:002011-10-12T11:30:55.936-04:00Late comment:
I love your blog first off!
I do...Late comment: <br /><br />I love your blog first off!<br /><br />I don't mean to sound synical, but I feel like they are either diagnosing fictitious diseases OR they are ignoring potentially serious disease by saying: Go lose weight...<br /><br />I know too many examples of the latter. It's frustrating.Zorica Vuletichttps://www.blogger.com/profile/05793548904884383364noreply@blogger.comtag:blogger.com,1999:blog-3045634714760830992.post-58668059779061631312011-06-24T20:14:57.225-04:002011-06-24T20:14:57.225-04:00Obviously I'm drawing from my n=1 experience i...Obviously I'm drawing from my n=1 experience in the States. I understand that it is very doctor-dependent as you say. I'm starting to see though what our old professors refer to as "the lost Art of Medicine". Isn't it why we can now diagnose an absolutely healthy individual with a fictitious disease (hypercholesterolaemia) based on one number on the blood test and then give them drugs to "treat" it? Thank you for your blog. Psychiatry is not my strong suit and I'm enjoying supplementing my education with your articles :)<br />AnastasiaAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-3045634714760830992.post-25356386867171599352011-06-24T08:29:19.004-04:002011-06-24T08:29:19.004-04:00Anastasia - back when I was in med school there wa...Anastasia - back when I was in med school there was always the bemoaning of the loss of learning the physical exam skills. AS is not the best example as it is an obvious murmur - and certainly *we* were expected to do very thorough histories and exams. We had the good fortune of being at a couple of hospitals with lots of people who showed up straight from their home country with all sorts of classic advanced disease you typically would not see in an every day hospital - but our anatomy class was 4 months long. "Back in the day" our professors would say: "you took anatomy for 4 years." <br /><br />Depending on the rotation we were also expected to have our patient's vitals and lab values and medications memorized for presenting during rounds…and during rounds if you did not know your stuff, you would be very readily embarrassed in front of your peers. (Though there were tales of the "good old days" when, if you got an answer wrong during case conference, the head internal medicine doctor would give you a quarter and tell you to go call your mom because you just failed out of med school.) it was not an easy med school, old school even at the time. Which served me well, I think. <br /><br />I don't know what things are like now. I teach second year students at Harvard how to do psychiatric interviews. We expect them to be thorough. We do not publicly embarrass them if they don't follow the appropriate lines of questioning or miss major sections - they are just learning, and we critique them kindly. There is also a ton more to know. All the molecular biology and pharmacology and infectious disease details... in the 1940s after med school you had a year of internship then you were good to go, or if you wanted to specialize, sometimes residencies were a few months long! I spent four years after med school learning psychiatry. Most of my class went on to fellowships after that (a year, or two, or three…). <br /><br />Anyway… the other day a patient came to me complaining of new memory problems. Of course I did a rather thorough "bedside" cognitive exam - the initial evaluation takes me an hour. It is rare that it takes me less time. She had already seen a neurologist. She told me (I'm assuming she's telling me the truth) that the neurologist spent 5-10 minutes with her, didn't ask her any of the fairly standard cognitive testing questions I did (and I had her copy figures, draw a clock, read, etc.), but the neurologist asked her a bit about her symptoms, told her to lose weight and "get off some of your medications" and ordered an MRI.<br /><br />I don't know any neurologists (or psychiatrists) personally who would consider that an acceptable initial evaluation for a cognitive complaint. <br />But it does seem to be the equivalent to the lack of rigor you saw in San Diego.Anonymoushttps://www.blogger.com/profile/04429177284200775781noreply@blogger.comtag:blogger.com,1999:blog-3045634714760830992.post-20115185024463995302011-06-24T00:23:27.373-04:002011-06-24T00:23:27.373-04:00I get the feeling that the Amercian medical system...I get the feeling that the Amercian medical system may be leading us away from the traditional Western medicine towards over reliance on imaging and tests. When I recently spent two months on a rotation in a San Diego hospital I was shocked at how little history-taking and physical examination we were expected to do. History was limited to a few questions on how the patient spent the night. Examination was a perfunctory pulse checking with the vitals copied down from the nursing log. Every patient was getting daily bloods and x-rays. The attending was so impressed when I was presenting a patient's abdominal signs.<br /> Here in Australia we are still expected to be able to diagnose aortic stenosis with a stethoscope. Requesting an abdominal CT to diagnose appendicitis is almost an admission of failure to interpret clinical signs. Medical exams are still in the form of "long cases": one hour in a room with a patient to come up with differentials, a list of investigations and a management plan. <br />There is still a lot of value in traditional Western medicine. Maybe one of the reasons why people start to gravitate towards Eastern philosophies is that they feel that our methods are becoming less and less personal. All the more reasons to maintain those skills.<br />AnastasiaAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-3045634714760830992.post-76719217656329591902011-06-22T08:08:35.172-04:002011-06-22T08:08:35.172-04:00I've read something about changed personalitie...I've read something about changed personalities after larger transplants – changes in both feelings (love, temper) and carvings/food preferences. People talk about having to re-learn to love their spouse.<br /><br />I don't think my feelings literally origins from my heart muscle... But I also seriously doubt that they only exist in my brain.<br /><br />Food for thought. ;)Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-3045634714760830992.post-80828949084778639852011-06-22T01:29:29.272-04:002011-06-22T01:29:29.272-04:00Pfizer only wishes they can come up with something...<a href="http://www.pbs.org/wgbh/nova/body/leeches.html" rel="nofollow">Pfizer only wishes they can come up with something that works as well as leeches...</a>js290https://www.blogger.com/profile/08157385596237909630noreply@blogger.comtag:blogger.com,1999:blog-3045634714760830992.post-59007046547160033832011-06-21T22:27:10.723-04:002011-06-21T22:27:10.723-04:00Descartes is a personal favorite of mine because o...Descartes is a personal favorite of mine because of his stance on thinking and the mind. Nice post!johnhttps://www.blogger.com/profile/11126132841611727249noreply@blogger.com