Thanks Mac, I'm sorry, but I haven't got the expert knowledge of Illich, as you have.
And I must admit. I'm more interested in the future than history, which, I can't always asess the accuracy of.
There is certainly a good point to be made that there is unnecessary medication (and to a lesser extent surgery) going on.
I'm not too sure about this statement, I'm a keen advocate of evidence based medicine (and surgery), but still I see victims of procedures which could have been prevented, maybe more in the surgical world than the medical one. (Tonsillectomies are a good starting point.)
Clinical iatrogenesis is the injury done to patients by ineffective, toxic, and unsafe treatments."
couldn't agree more, but, thankfully, us, (health care professionals), are becoming more adept at sifting out the wheat from the chaff.
Social iatrogenesis results from the medicalisation of life. More and more of life’s problems are seen as amenable to medical intervention."
although it makes every nerve and bone in my body quiver, I must confess Mac, I agree. Although, I've just had a rather splendid bottle of Chablais, and a very good lamb vindaloo, is it up to you to deny me a large dose of a Proton Pump Inhibitor to ease my morning symptoms?
Incidentally, many "alternative" treatments are either ineffective (e.g. Zuma's garlic, beetroot and potato for HIV/AIDs) or toxic and unsafe (e.g. Virodene and Laetrile).
Dead right- we as "professionals" dish out enough unevidenced snake water, why replace it with even more rubbish?
Simple anxiety and depression (I'm not talking about major depressive illnesses) are no longer seen as normal variations in the spectrum of experience but bad things to be medicated away.
Oh dear, agreeing again, is it time to get back to the speed camera thread on jet blast ? Yes, unfortunately primary care clinicians have probably over medicated their stressed and anxious population with various drugs (SSRI's in the main). Can you help me differentiate between the two? Can you chaps in secondary care tell the difference- if so, let me know, I'll spread the secret!We've probably not had the guts , previously, to suggest other (credible) measures such as pumping up their exercise regime
. Our quango's (NSF's/NICE) have provided some back-up.
Personally I believe that a modicum of suffering (in the larger sense) is needed for us to be wholly human, but that severe or unrelieved suffering impoverishes rather than enriching. Only sadists think it is good for you.
well lets hope that ALL our attitudes, values and beliefs are reflected by this statement.
Once upon a time in 1890 (or 1940) a child was feverish and coughing. Someone went to get the GP and he eventually came round in his gig or his motor and was ushered into the normally unused parlour. The child was produced and he gravely examined the child, percussing and auscultating the chest. A few nostrums were prescribed (there was nothing else) and advice about diet and warmth given before he left. The next day he came to see the child again. High fever, tachycardia and tachpnea - a real pneumonia. That evening no improvement. The next morning worse, the fever is spiking at 104F - the doctors shakes his head, "It's touch and go now I'm afraid Mr Brown, I'll be back later". That evening the child is delirious, nothing will persuade her to drink. "I think I'd better stay for a while Mrs Brown", and the doctor, wrapped in his old ulster, settles down by the cot with a teaspoon and some cold sweet tea. At 3am the fever is 105F, the child is burning up, the crisis. At 4am the child is suddenly soaked with sweat and the temperature is 99F - is this the lysis or just another hope? At 6am the temperature is still down and the child is awake and asking for her mum. "I think she'll be alright now Mrs Brown", he says and sets off for his morning surgery.
it's a great story, but did the doctor make a difference, and was that the best use of his time ?
well, I wonder what planet you're living on!
Earth, more specifically somewhere between Liverpool&Manchester, and you're more than welcome anytime:-)
Which doctor gets the most satisfaction? Which doctor gets the love and respect?
Is it all about respect for the doctor? Shouldn't we be respecting our patients? Power to the elbow of the doc who stayed up all night, but is that the best use of his/her time?
Antibiotics work and we know how and why
Beta-blockers work and we know how and why
Analgesics work and we know how and why for most of 'em
Proton pump inhibitors work and we know how and why
Antihistamines work and we know how and why
Steroids work and we know how and why
Antihypertensives work and we know how and why
Chemotherapy often works (ask the guys in the Hodgkins thread) and we know how
NSAIDS work and we know how and why
Anaesthetics work, but we still aren't quite sure how! Forgo them if you're a purist.
Antiarrhymics work and we mostly know how
Antiepileptics work (mostly) and we know some of how
Well Mac, we could deconstruct these arguments all night, (antibiotics and the rise of resistant strains, the latest guidelines on not starting hypertensive patients on beta blockers, how some compound analgesics are worse than useless, PPI's and the delay in the diagnosis of gastric cancer (not sure about this one !!), Anihistamines and rebound effect, Steroids- have saved many lives, but why is the useage in France five times that of in th UK?, Chemotherapy- again ,why the different regimes around the world?- surely joined up thinking between radiotherapists/surgeons/physicians/nurses etc would make more of a difference? NSAID's - are we killing more than curing?
Anaesthetics? can only speak anecdotally- wonderfull stuff- and I must apologise to the rather buxom dental nurse!l
Its a nice list of things you think make a difference, but I note that you haven't included such greats as tar inhallations, cox II inhibitors, HRT and that wonder of ante-natal morning sickness, thallidomide.
Don't be terirbly sad, I'm making a difference in my own bit of bush
To be a doctor and a surgeon is for me the most thrilling and exciting thing in the world. In exchange for this one assumes grave duties and arduous responsibilities. To be worthy of the trust that patients place in one demands self-discipline, continued study and moral rigour.
We all feel the same:-) but it's not the preserve of doctors and surgeons.
Take care. :-)