david_h wrote: EpicanicusStrikes wrote:
J Thomas wrote:What this tells MDs is to ignore rare diseases.
Mindsets like this are lethal.
I hope you won't take offence, and I'm sorry for your losses and the circumstances surrounding them, but to say this mindset is lethal seems to me to be a generalisation along the same lines as "cars are lethal" or declaring the justice system irretrievably useless based on a handful of mistrials. Isn't this (by which I mean the use of Bayesian statistics to guide decision-making in general, not
your personal experiences about which I know nothing) just being practical?
Maybe, but more practical would be actually doing some research on the conditions being presented. When a doctor tried to diagnose my sinus polyps as TMJ Disorder, I walked away and found someone willing to actualy scan my head because I knew he was wrong. He just refused to admit it.
Once it became obvious that the debridement was only spreading my mother's condition over a period of months, until half her upper body had been eaten down to the ribcage, alternative solutions needed to be sought out. But they refused to change their tactics. Even their head of the infectious diseases department refused to listen to my suggestions that it might be USA 300, because he apparently doesn't read the CDC's EID Journal and had no clue that it was being tracked across the state.
He just wanted to push patients through his hyperbaric chamber like it was a some panacea drive-through. The surgeon in charge had never even heard of PVL toxins. Of course, it turned out I was wrong, but at least I knew the proper treatment was not to just keep ripping pieces off of her until she either got better or she died.
By the time PG was actually tested for, found to be postive and a treatment of immunosuppressants was started, her health was trashed to the point where she lived another year-and-a-half in constant agony.
Plus there was the constant vancomycin resistant MRSA bacteremia she had to deal with. Every time she tested positive, they went straight for the stuff that she claimed never worked on it, her charts claimed never worked on it and I claimed never worked on it. But of course they wouldn't deviate from dictation until, duh, it ended up not working.
Or the fractured back she eventually developed which they didn't find until an x-ray just happened to spot it, despite her constant claims that something serious was wrong. One step further, the persistant bacteremia produced a cyst in the fracture. But, again, they just thought she was being whiny about the pain and wouldn't listen or investigate further until she refused to attend any further therapy sessions.
So what's my point? Well, go ahead and start with the basics. That makes most sense. But for god's sake, change your damn mind when continued evidence shows that you are wrong. Listen to your patients. Listen to their family. Read their charts. The facts are there. Don't wait until someone is coughing up blood (like my father), or crapping out blood (like my uncle), before you consider that a new diagnoses may be in order. And when the necrotizing fasciitis you're spreading throughout a patient eats an entire pectoral muscle group, consider that you are not dealing with capillary damage from radiation therapy that was well documented to be within safe guidelines.
Blindly following the most likely scenario and being trained to ignore darkhorse diagnoses is a bad thing.