Thursday, September 6, 2012

Rebuttal

In late July I re-ran my "Dr. Worthless" post, about the (alleged) migraine specialist who didn't do shit for one of my patients.

On August 28, nearly a month after I put it up, the following comment was posted:

"Dr Worthless: Pretty much every neurologist in my metropolitan area. I am sick and tired of managing issues that fall into the realm of neurology because of the laziness of your specialty. I really miss the days when a neurologist could actually make a diagnosis without an MRI."

Here is my rebuttal:

Dear Dr. Whoever You Are:

Thank you for kindly painting all neurologists with the same brush.

I'm sorry some in your area aren't up to your personal standards in work ethics. By a similar definition I know some "lazy" internists who seem to feel that I should be treating bladder infections, sinus problems, or foot ulcers simply on the grounds that the patients also have a neurological disorder, and therefore tell them to call me for their general medicine needs. So I suppose I could say I'm sick and tired of managing issues that fall into the realm of general medicine because of the laziness of your specialty.

But I won't do that. To make generalizations based on 1 or 2 people is what leads to idiotic stereotypes. I'm sorry you feel that way based on the few neurologists you've encountered. So stop referring to them and find others.

Please try to keep in mind that medicine is a team sport. When you view other doctors (or nurses, or whatever) as the opposition, the only person who really loses is the patient.

Diagnosing people without an MRI is fairly easy. I (and many other hard-working neurologists) do it every day. Bear in mind that many neurological conditions (migraines, Parkinson's disease, epilepsy, Bell's palsy, and Alzheimer's disease, to name a few) are clinical diagnoses. This means they're based on what the doctor thinks after taking a history and doing an exam. The purpose of MRI's (which, I admit, are often overused) is usually to exclude other causes, rather than confirm the diagnosis.

MRI's, like all forms of technology, are like genies. You can't put them back in the bottle. If you don't like it, perhaps you should consider going back to the days when an internist could actually make a diagnosis without a CBC. Or CMP. Or stethoscope (after all, in 1840 the flexible binaural stethoscope was cutting edge). MRI's may be overused, but I find them to be more effective at excluding/confirming serious neurological disorders than sacrificing chickens over the patient and dancing naked under the moon.

I'm going to guess that you've never been sued (I have). Nowadays you can get legally reamed out for NOT ordering tests, regardless of any guidelines that say it's fine not to do them. You can tell me that I'm practicing defensive medicine, and guess what? I don't care. If doing everything I can to protect my family and my livelihood is being lazy, than so be it.

Ordering a test often has more to do with CYA than diagnostics in ANY branch of medicine. If you have some magic power that exempts you from legal action and allows you to make 100% accurate diagnoses without using that newfangled stuff, than you have my respect for being a better physician than little old me.

Yours truly,

Ibee Grumpy, M.D.




20 comments:

jimbo26 said...

Nice one , I'll vote for you . ;-)

Jennifer McDonald said...

Dear Dr. Whoever You Are:

Do as Wil Wheaton says, and don't be a dick. It must be nice to be as special as you are, and as perfect as you are, and have everyone else around you be a worthless POS, but that doesn't mean you get to be a douchebag about it.

Love,
The World

...does that about sum it up?

Anonymous said...

Amen!

Packer said...

A good rant does cleanseth the soul and bespeaks of the nobility of man.

Phrase for the first day of school:

High dudgeon.

thethingspatientssay said...

I'm just glad you still take call at the hospital on weekends, unlike our neuros, who push TPA in the ER, then dump them on us while they leave for a three-day weekend.

Anonymous said...

Me thinks the shoe was just the right size for dr Whoever You Are's foot. Perfect fit! Feel free to wear it, Dr W-Y-A.

brent said...

Have you ever done any double blind studies comparing results of sacrificing chickens over the patient and dancing naked under the moon against "traditional" therapies? Are you anti-altnerative medicine or what???

Anonymous said...

Well, Grumpy you getting upset over this also speaks for your insecurity. I think all of us being in this profession understand in a few weeks time:take everything client says with the grain of salt. Their family doctor did not advise to call you about bladder infection. They decided to do it and blame family doctor just for defence. How many times we all have seen clients who come with chronic symptoms of many years, and claim that 10-20 other MD's told them nothing, did nothing, and diagnosed nothing. As a PCP I understand frustrations caused by unhelpful consult. But be sure it does not attack you personally.

Anonymous said...

Agree with anonymous 12.52 PM

A frequent one we get is the Friday afternoon "called my neurologist for a refil on my Painbegone and they never called me back."

When we check with the neuro, they tell us that they told the patient two months ago that they couldn't get any more refills without an office visit.

Keep a big salt shaker on your desk.

Toni Atkins said...

Since 2008, I've been to over 21 specialists and there are lazy doctors in every subgroup. I think my worst was a rheumatologist. At the end of the HUGE work-up his parting words were "Well, if it was Lymphoma you'd be dead already." Awesome!

As for the notion that all neurologists are solely dependent on MRIs, HA! I've been trying to find a neurologist to do an upright MRI on me for months.

Ms. Donna said...

Dancing naked and and sacrificing chickens? Where is that on YouTube or in Merck?

Steeny Lou said...

Did you actually send this letter, Dr. Grumpy, or was it something you wrote as a vent? I would have loved to have been the one who got that report in my queue to transcribe!

By the way, I found a typo in your report. :)

Anonymous said...

Of course you should treat bladder infections. You're a urologist, aren't you?

Oh. Never mind.

Alien Outwit said...

What annoys me the most is that everyone who is quick to go "Neurologists/Surgeons/whoever suck and are lazy and don't do their jobs" knows ten people in their own damn specialty that they would never send their family members, in-laws, or even pet turtles to for treatment. Sop, stop crappin on one another, people!

Oh, and OB/GYNs suck!

Steph said...

There actually seems to be a difference between oldschool neurologists and younger ones who seem to be more dependent on technical devices.
Many younger neurologist don't seem to trust in their own clinical judgement that much.
I remember an old guy at ER telling me that he would be sending me down for an MRI even though he knew exactly what they will be finding there based on his exam. He was dead right. You need that imaging stuff as it is included in diagnostic criteria for many neuro issues.

Aeris said...

@Toni Atkins ........ "upright MRI"? I'm not aware of any that exist? Also we have good reasons NOT to do a scan. And those are the consequences of dealing with the results of the scan. Say, we find an aneurysm, most likely incidental.... Then what?

Toni Atkins said...

@Aeris.... In my case, there is a reason to do the upright MRI (which does exist). I promise I don't just enjoy them, or have nothing better to do with my time. My neuro originally thought I had a Chiari Malformation, as I have all the classic symptoms including stabbing headaches triggered by Valsalva maneuvers. In his words, he only ordered an MRI to "confirm". But when the supine MRI came back clear, he said I did not have a CM1 and we decided to wait it out and see if my neuro symptoms progressed. A month or so after that I was diagnosed with Ehlers-Danlos Syndrome, a connective tissue disorder caused by a genetic defect. When one has a heritable connective tissue disorder, like EDS, there are changes in the brain structure in gravity-bearing positions, like sitting or standing. Which coincides with my clinical presentation, as I am symptomatic when sitting or standing. Thus I may still have a Chiari Malformation that would be visible on an upright MRI, especially given my history or neck issue and CCI. I do understand why it's hard to find a neurologist that knows anything about connective tissue disorders, especially Ehlers-Danlos Syndrome, but it's still frustrating.

As for incidental aneurysms, most neuros know how to judge when and if intervention is needed in those cases. Personally, in my case there'd be no such thing as an incidental aneurysm. The vascular form of EDS (type IV) is fatal because we're so prone to aneurysms and dissections, that's why we tend to die around 48.

Anonymous said...

Standing ovation!

PharmacyJim

Anonymous said...

Dancing under the full moon with naked chickens sacrifices? Sign me up. Whens the next full moon?

cliffintokyo said...

@Anon:
Absolutely. Sacrificing chickens and dancing naked is so much more FUN!

 
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