As with the Drive podcasts, I listen to this guy primarily for the guests and the insight they provide on stuff that I think I know…so I can reach the point where I realise that just ain’t so (worth thinking about in itself )
Full disclosure…and thanks to the imprinted timeline for the topics…I skipped to the section on continuous read glucose monitors. I was toying with the idea of one of these before I asked my primary care doc if maybe, perhaps, peut etre a fasting insulin measurement could be added to the Usual Suspects along with the Apo-b and Lp(a) ).
Doctors have to be very careful about lifestyle. It is not what they know. It is what they say.
Patients blame others for their lifestyle problems.
Doctors or anyone can only be so intrusive into anyone else’s life. Many people do not want to deal with any discussions of most things. Unlike their ability to post endlessly on social media.
VeeEnn have you noticed that most people in public will never admit they are wrong? That is in private thoughts as well. If someone is never wrong…where does that leave things?
Well, in matters of personal decision making, I don’t give a rodent’s wrecked 'em about most people (beyond how their decision making affects me, myself, I…and family and friends)
In fact, I look specifically for where I might be/might’ve been wrong …the better to stop doing Wrong Things in the future. I’ve written about it extensively in the context of ASCVD and my piecemeal search for what I might be doing wrong to achieve that “moderately elevated” LDL-C. I was wrong to accept my physicians’ reassurances…and, come to think about it, my new PCP admitted that she had thought my worries were unfounded and now realises she was wrong.
Mind you, I shouldn’t be too judgemental about folk who do the wrong things and don’t change in spite of evidence/education. A dentist married to a transplant hepatologist…that’d be a bit rich.
You posted on medical training. Had little to do with you personally.
Doctors get 10 minutes maybe 15 to see the patient. It can not boil down to a discussion of who is to blame for anything. If it does that is wasting the time.
Anyone can decide what to eat, smoke, or drink…and in any combination. The discussion is not productive in the doctor’s office.
That said what is not brought up at all in doctor’s discussions and exams is scary.
A good friend of the family’s dad we all thought had Alzheimer’s. The friend now age 87 told me differently a few days ago. The friend was a doctor in the Hartford area. He also became a lawyer.
His father had stomach ulcers. He went in for surgery to have 3/4 of his stomach removed. There had been leaking of the stomach fluid up against the pancreas.
The father went to his doctors and none of them measured his vit B12. He went into a dementia. Destroyed his life.
The friend never admitted it at the time. He probably took it personally as a failure not to follow up on his dad’s care. Kidding around he said the other day the only thing he should have done is sue the doctor. I think he meant the GP for ignoring the surgery.
That is medical stuff not lifestyle. That is more than a full time job in a 15 minute appointment.
What is said? Yes the questions are asked. The paperwork is filed.
But what is the evidence? Meaning my dad a doctor has smoked from age 17 to 85 with no problem.
What do doctors do when the lifestyle is none of their business and does no harm? He does cough but he is an athlete.
There is not solid evidence that in many cases things matter at all. Just because 19 to 25% of people, whatever this decade’s stat is, die of cancer does not mean 75% of the population needs a tirade in the PCP’s office.
There are a handful of reasons to see such discussions as unprofessional.
I doubt any of them have much merit in the context of health and well-being for both the individual and society as a whole.
See, once a patient has made the voluntary decision to walk into and occupy a limited amount of time in a doctor’s office there becomes an ethical…and I might add, a medico-legal…obligation to address prevention with someone whose choices are obviously creating the problem that may have brought them along in the first place. Or, if it’s “just” an annual physical with no perception of a problem, addressing the appropriate way to keep that perception of a reality moving forward.
Examples of survivor bias in aged physicians notwithstanding.
Out of interest, I got to wondering whether a psychiatrist could rightly claim that patients’ smoking habits are “none of their business”. So, I did some research…as in took to Google to see if there’s any recognised stance on the psychiatric field’s take on smoking and mental health.
Well, it seems that some feel that smoking cessation education is part of a psychiatrist’s scope of practice.
Across a practice what is productive varies in time. Psychologists sit down with people over many sessions. Smoking should arise as a concern. Good luck getting people to change. If you smoke, it is not the foremost topic to be addressed.
The number of dishonest shrinks is amazing. Many of them do not know the issues. Instead, they pander.
As far as citing smoking cessation for mental health that is correct but it is down the road in care. It is not generally primary. Pathology is.
Pathology is why there are ethical concerns. No one should change who another person is or attempt to change anyone. Care is about helping with insight or therapy towards alleviating problems. This is done over a lot of time. A PCP would insult people by attacking such topics.
General suggestions by the PCP, drink less, eat less, stop smoking. Here is where to get help if asked.
Yes, well if you read the document, it’s a common mistake that smokers make…not so much the starting in the first place but the rationale for continuing.
On a certain level getting her to realize that was getting her to pander. It makes no difference at this point and ongoing discussion is a waste of time for the doctor.
I call that pandering. Just shaking her head and agreeing. Can we just please move on now?
You might be right but get it out of the way because you have limited time with the current doctor. It does not matter if you are right or wrong.
Point taken for current treatments. Probably made little difference to a different approach by a different doctor. You are only seeing the current doctor for a different approach. At the very least you lost all faith in a prior doctor and won’t deal with that doctor, you want someone better to approach the problem.
You can call it whatever you like…and I’m sure you have reasons that you find satisfactory for doing so. I call it a reminder to someone who’s basically in a role of leaned advisor to individual patients that patients are in fact individuals. Specifically, that just because the majority of patients with a mixed dyslipidemia are fat, sedentary smokers, hidden behind that smokescreen…and getting less attention because of it…are the handful of Good Custodians of their bodies who are the very folk who are more likely to gain benefit from medical interventions appropriately timed.
Interestingly, in the next newsletter put out by the practice was a little article on the clinical significance and value of a Coronary Artery Calcium scan as a useful tool in triaging patients with unfavorable lipid panels (ok…the marketing person called it “high cholesterol” I guess there’s no stopping that) and an aid in decision making when deciding for or against lipid lowering medication.
It all is what it is. I am sorry you are having problems with your health.
We keep swinging from discussing you to medical practices. There is a difference. By no means do I think doctors have to be mean or tough to be honest. Some pandering is necessary. Time is wasted otherwise.
