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Meeting the Doctors

I always found going to the doctors a bit scary. What is very weird! When I’m feeling bad and there is someone who could potentially help me, I should happily and gratefully be jumping into this person’s arms. However, whenever I’m with a doctor I feel a little bit as if it’s my fault that I’m sick, and that I have to rush through things to not bother him or her too much because there are really sick people out there needing attention.

Since I did homeopathy school I gained a bit of medical background. Actually this school is all about medicine. The students need to learn basic medicine in order to determine when a natural treatment would not be appropriate and a referral to the medical doctors must be done. And from that I learned that doctors have a different view on illnesses than we normal people think they have. And that can lead to misunderstandings which can make the doctor/patient sessions so uncomfortable.

Doctors - A Matter of Status

OK, there is this status thing going on as well: The doctor is the expert and you are the patient. That’s the distribution of roles and you can’t just ruffle those up.  So don’t barge into surgery and deliver a diagnosis of our own. Just don’t do that: They hate it! Even if you know what you have because you had it thousand times before. Don’t! I have some experience with cystitis there. I learned the hard way to shut up. At the beginning let the doctor do the talking and asking questions. It’s a bit like school – you are there to answer.

But back to how a doctor has to think to find the right diagnosis!

A View on a Matter – How Doctors See It

I always thought that if somebody is sick, then the doctor collects all the evidence – called symptoms – and a picture forms what disease that is. We get some medication and of we go.

What actually happens is something entirely different and much more complicated. Because the body is a very versatile thing and because we are so different from each other diseases don’t always look the same, while at the same time there are a lot of different diseases showing very similar symptoms. Some look almost the same at the beginning and only later different and new symptoms show up.

This means that just collecting the evidence won’t do, because sometimes the absence of a symptom is important as well. What doctors do is the following: They collect the main evidence. That is what you tell them when you go for a consultation, like let’s say ‘a runny nose’. Then, in their mind they create a list of all the diseases which have the runny nose in common and rank them according to how common a disease is, if you are the right age, if you have a family history, if a certain disease goes round at the moment and so on.

During this first phase they are starting to ask questions. From those answers they eliminate all the diseases from the list which don’t fit the bill anymore. If there are still a lot of entries left on the list and to confirm the ‘question phase’ they usually do a manual examination. From that they reduce the list again. If they are still not satisfied with the result the next step would be more invasive tests like blood test.

It is an iron rule always to go from the least invasive examination to the more invasive ones, because you firstly don’t want to put an unnecessary risk on the patient and secondly you don’t want to stress a sick body more than necessary, and of course: the more invasive the more expensive.

So doctors don’t jump to a conclusion by looking of what they see in front of them, but they are eliminating all the other possibilities. This is called ‘differential diagnose’. And all this thinking and the decisions on how far to go in the examination process has to happen while they are talking to you and within 7 minutes or so, because that is the allocated time for a basic consultation which is the NHS is paying for.

Becoming an Informed Patient

This strategy sounds rather straight forward if you are looking at the sniffles. But there are worse things called syndromes (accumulations of symptoms) out there, where the word already indicates that nobody really knows what it is because otherwise it would have a real name. Like: ‘Irritable Bowl Syndrome’? Has to do with the bowl which is somehow irritated and that apparently shows in many ways as it is called a syndrome, what indicates that it has many reasons. What is rather confusing!

Actually it makes one wonder how doctors manage to help people at all.

So, what do we learn from this? Firstly not to panic! Doctors actually do know a lot and they are trained to not just know how the body works, but to concentrate in consultations and to lead the patient into the right direction with their questions. You can support them, though!

You have to become an informed patient!

This is not about finding the diagnose yourself. This is very much about having the answers ready when the doctor asks the question.

Find out of what causes and at which age you ancestors died, and what kind of diseases are running in your family.

Learn to observe your body and your actions. A lot of symptoms have to do with timing and a lot of symptoms appear delayed.

Simplest example is a tummy ache after having eaten too many dried fruit without drinking enough. Dried fruits soaks in all the fluid from and around the stomach and makes you dehydrated. And there they sit, not very well digested due to lack of fluid and starting to bloat before they had time to leave the stomach. Ever had a lot of gas in the upper tummy – oh well, don’t try that! That can feel like a heart attack (try to make a differential diagnosis there). But of course that doesn’t happen immediately after you had the prunes.

Some of the things you should learn about yourself are: what makes you bloat, how is your digestion altogether – how often/regular do you go to the loo, how long do you need, what is the consistency, in which situations do you get headaches, how regular/heavy is your menstruation, when was the last one, how well/long do you sleep, what makes you nervous, ...?

If you have an acute problem: try to remember everything you did in the past few days. Infections have incubation times. That means you caught it, then it incubates in your body without you noticing and only after a while you see the symptoms. This duration of not showing a symptom is characteristic to an infectious disease and it helps to find out what it is.

Sometimes it’s just a simple tiny thing. I all of a sudden had an itch on my foot, thought of everything from athletes foot to allergies to insect bite. It only was a bit red, nothing was visible and after a while the itch turned into a pin prick pain. Told you: I do love experiments. So I got the magnifying glass, a pin and some antiseptic spray and had a closer look. It turned out that two days ago I had been dry shaving and a rather short bright hair had pricked itself into the thick skin. From walking on it, it worked itself deeper and then hit tissue with nerves in it. Such a little bugger can cause such a pain. So be vigilant and remember what you did the past days. BTW: I’m always shaving on a towel now which I avoid stepping on. Not with me anymore!

If you have a recurring problem: write a diary. If it has to do with pain, then give your pain a quality like hitting, humming, punching, pricking, … and a strength from 1-10. Write down when you feel changes in quality and strength and what you did at that time. If it has to do with digestion, write a food diary. If you don’t know what might be related then note down everything that jumps into your head, especially at times when something changes. Sometimes the writing down will become a part of the therapy itself.

It is all about starting to care about yourself. Every doctor is happy to have a patient who has the observation needed and who is willing to work on the problem. Doctors don’t work in the same way like beauticians do, where you just put your head down and enjoy the ride. They need your participation as an informed patient. And this is for your own benefit.

At the same time insist on being treated as such. Insist in getting things explained in a simple way and without all the Latin. Some things are so evident for doctors that they sometimes forget that their patients don’t know about these things. Make them realise that only if you understand the treatment you will be able to be part of the doctor/patient team – and that you actually might be bothering them less if you would know how to deal with certain things yourself.

Gesundheit! Bless you!

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Copyright 2007
Author: Rika