Thursday Thoughts: Doctors

It's Thursday, so you know what that means...

Thursday Thoughts

If you are new to my blog, or just missed the past few Thursdays, this is a segment where I post my thoughts about various nutrition and health related topics, or maybe even something else if it is really an intriguing topic.  Most of my current views and opinions come from experience working as a dietitian and as college instructor in nutrition courses.  Most of that learning is science based or observational from the clinical setting.  In general, I hate overgeneralizations, so for many of the things I post, I expect there is one or two exceptions because broad sweeping generalizations are always bound to miss out on something. 

This is an interesting topic that I come across frequently when I am teaching nutrition courses.  While I may not be a medical doctor, I have worked in a hospital, know many doctors, and even did a grad program with a few.  I think it is important for people to understand the role of the doctor, and not the image that is created through the media of an all knowing figure that can fix everything.  

So, here are my thoughts about medical doctors.

1) Many students will comment in my classes that "my doctor never told me that" or "why did my doctor miss that drug interaction" and other similar comments.  I have found that I frequently need to remind them of the role of their doctor.  While a doctor goes to school for quite some time, they are not an expert on every single little condition out there.  I feel bad sometimes when people complain that their doctor missed something or didn't tell them something.  There may be something out there that is uncommon that the doctor does not know, and so by them referring you to someone else, it is not because they are a bad doctor, it is just that they know there is someone better for the job.  Actually, that is the sign of a good doctor.  When they can admit they do not know and instead send you to someone who may better know, this is a good sign and means they are not pretending to care for you when they know they can't help you.  Sadly, insurance and billing can get in the way of this being an effective method of care.

2) When it comes to medications, your PCP is not the expert.  They only know what they learn in school and in some cases this was a long time ago, and then what the drug reps tell them and they read in articles.  They are by no means a walking encyclopedia of medications and know what interacts with what.  But, there is a doctor and/or professional out there that can help, and this is the PharmD or pharmacist, and even a pharmacy tech.  Someone with a doctoral degree in pharmacy is then the expert in that specialty of medicine, just the same as a cardiologist is the trained expert in heart conditions.  Never assume your doctor knows all of the possible interactions and side effects, food interactions or directions for taking a medication.  Always check with pharmacy.  In my opinion, it is not the medical doctors job to be the expert in chemistry and mechanisms of drug metabolism in the body.

3) Speaking of being an expert, the doctor should be an expert in their area of expertise.  This means the area that they have done extra training in.  Once they move into a specialty, they may not longer be the go to person for all conditions.  Do not assume that a nephrologist (kidney specialist) has any idea about an unrelated heart condition or even plastic surgery.  The basics are the same, and everyone gets that base education, but then the doctor may choose to pick a specialty and focus there.  If you have a condition that would require the care of a specialist, don't assume your PCP can provide you with the same level of care and management.  Since I am a dietitian, I will also mention nutrition.  Doctors often pick up advice from the same unreliable sources that are out there in the media.  I have heard doctors tell patients to buy a diet book at the store and see if it works.  Doctors get little training in nutrition in school.  That is why they are not the expert in nutrition.  If they were, they would be a dietitian or other qualified nutrition professional, not a doctor.  Not all doctors are created and/or trained equally.

4) Also along those lines, the PCP should be someone who is there to diagnose a condition based on symptoms.  In order to do this, they need to rule things out.  Some conditions have 5+ symptoms in common meaning testing needs to be done to show that a condition can be eliminated, or possibly confirmed.  Honestly, many times the elimination will go on for a bit so multiple conditions are ruled out and they can confirm a diagnosis.  This does not mean your doctor has no clue what is going on and he or she is just guessing in the dark.  It means they are eliminating other conditions that seem similar to each other and need to be ruled out to get a clear, single diagnosis.  I hear often that someone feels like their doctor just wanted their money so they ran test after test after test.  Sometimes these extra tests are necessary because they let the professional know that you do not have something and then can confirm when you do have something.  Symptoms alone can't make a diagnosis.

5) After they can make an appropriate diagnosis, they are there to help with treatment and intervention.  The doctor is not there to cure you.  Many things do not have a cure, but they can be treated.  A doctor will then determine the appropriate treatment and monitor the patient for improved health.  I have heard people also complain about this aspect.  It is not unusual nor is it wrong for a doctor to change medications based on new information they receive or more recent tests.  It is also not their job to enforce and watch over all of the treatment.  It is 100% the responsibility of everyone involved in the care team, and that includes the patient.  Ultimately, a doctor can tell a patient what to do and how to do it, but the end result is up to the patient.  Diabetes is a great example.  This requires that the patient be fully responsible for their medical care every day of the week.  The doctor is just the person overseeing the care.  The patient becomes their own health care provider, in the sense that they are providing their own care at home.  The doctor can't be with all patients all the time.  When I hear people complain about this or that when it comes to something the doctor did or did not do I get upset that this person had no idea they are in charge of themselves.

In the end, I think people place to much responsibility on doctors, which in turn leads to negative feelings about the medical profession.  I honestly think people expect to much from their PCP and then when the doctor takes too long or doe snot have the answer ready to go, then they inappropriately place blame on the physician.  The doctor is a great resource and should be utilized in the correct way.  I think a lot of this has to do with the media portrayal of the doctor, the current medical system, and perceptions over the years about the doctor.  My best advice is to understand the role of the doctor and how they diagnose and treat based on the information they have available to them, not that they provide cures, fast fixes, and know what is wrong without testing.

QUESTIONS: What are your thoughts on this topic?  Have you ever felt like your doctor was not doing a good job?  Do you understand the role of the doctor?


Lori said...

You bring up great points. I'm fortunate to have a friend that is a PharmD and at that point I learned that those are the folks to trust with med information. I know great doctors, but just as with any profession, some I completely disagree with. My husband just recently visited one who told him he likes to put people on statins because it makes them live longer. Um, what?

I once had a nurse who, when I told her that I took calcium supplements only occasionally (at the time, I don't take any now), made a smart comment under her breath - well, that's a start. I ignored it, but even though its completely cocky I wanted to say - um, did you study nutrition for 7 years? Because I did. I get my calcium through food, not pills. I'm not just going to take a pill because a doctor or nurse tells me to. :)

Jessie said...

Great Thursday Thoughts this week, Melinda. I think these are great points, especially the idea that doctors are NOT experts in everything related to your body, even though many people think they do. And I think the real danger comes when doctors think they know everything about meds and nutrition, too (fortunately, haven't met too many of those). Yes, doctors are highly-trained, but they don't know all the secrets of the human body - that's why there are so many specialties and other health related fields, like nutrition.

I hear you about the insurance problem - a friend of mine was working with a patient lately who had esophageal strictures (corkscrew) and the physician wanted to use a scope to view them from underneath while he was placing a PEG (he couldn't go through the top because the strictures were so bad), but insurance said: "No way, too expensive". So meanwhile, this poor woman is suffering tremendously, and her condition is quite bad! Grr...

Biz said...

I think it depends on the doctor. I once had a pediatrician for my daughter prescribe a medication that hadn't been used in 10 years!

I love my diabetes doctor I have now though! :D

Special K said...

As a doctor, I agree with most of your thoughts. Too often, people mistake CONFIDENCE for KNOWLEDGE. Actually, the most ACCURATE doctors are ones who remain inquisitive and continue learning in their area of expertise. Not just "how many of these operations have you done?" but "what is the last time you received updated training in this?" that is really important. Doctors job is not to be responsible for your health, but give you access to your options for improving your health.

Gina; The Candid RD said...

This is something that everyone walking the streets NEEDS to read!!! Seriously, I get so angry when people tell me their doctor told them something about nutrition (or anything else..) that I completely disagree with (and this happens often). PEople will always listen to their doctor over their RD!! So sad. I often hear people tell me that their doctor recommended the Adkins Diet, or NO SUGAR AT ALL, once they were diagnosed with diabetes. That's awful!!

Emily said...

Most drs don't even receive ANY nutrition training, so it really bugs me that they feel the need to give nutrition advice to patients. Why don't they let the dietitian, who has studied for 5 years use her expertise?! That said, there are some drs who have studied and do know more than the average physician, but I think they should still see the dietitian as the nutrition expert.

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