I kinda hate the Internet.

Warning – somewhat of a vent ahead, again.  Remember this post?  I’m kinda coming back to it.

The last thing I want to do is offend my readers, but this is my blog and I should be allowed to say what I want, when I want to, right?  Now, I know that my being a physician can be a bit tricky.  While I strive not to provide overt medical advice, I can’t help sometimes to want to talk about medical issues from a personal perspective.  Does that make any sense?

So here’s the thing – despite me using the Internet for my own selfish purpose (ie this blog), I am actually kinda hate it.  I am sick watching (ie reading) strangers discussing their medical issues or their children’s medical issues and vilifying the doctors that care for them.  I used to frequent a few message forums, mostly for entertainment purposes, but constantly found myself drawn to the “health/medical” posts.  Most of the time, I can remember shaking my head at my computer, wondering how some people can be so daft, or shocked that someone would ask a message forum for medical advice about whether they thought their kid should see a doctor.  (If you’re asking the question, the answer is probably yes!)  I made the mistake on a few occasions to post a response.  Big mistake!  I’m not actually seen as an expert by these people.  I am just a GP who can’t possibly know everything.  Yet, the “research” the parent has done over the course of a few days or a few weeks, is far more inclusive than anything I’ve learned in my years of training.  Gee, thanks.

I know what you’re thinking – why bother to visit these sites?  My answer – because I want to know what kind of (mis)information is out there, so I’m prepared to fight it in the office.  I have already made leaps and bounds in my knowledge around the “MMR causes Autism” controversy.  Having read books like, “The Panic Virus” and “Autism’s False Prophets“, I am now armed for those parents who refuse the vaccination.  Unfortunately, it doesn’t seem to matter to most of them, which is quite shocking to me actually.  They would rather believe the stories on the Internet than sound scientific results.  They would rather believe the pseudoscience than tried and tested science.   They really don’t seem to care that they are putting other children at risk by not vaccinating their child.  Their reliance on herd immunity is misguided, because in point of fact, herd immunity is waning.

The vaccine debate is just one of hundreds of discussion points, but it’s the one that comes up the most often in my office.  I would say that about 2-3/10 parents are refusing or delaying their child’s vaccination. That frightens me!   Last year, there was news of a pediatrician refusing to care for children whose parents didn’t vaccinate.  I totally get it.  Sure, it’s an extreme reaction on the part of the physician, but this particular physician felt that parents were not trusting in her expert opinion.  How can she care for their child if there is a fundamental lack of trust?

Medicine has come a long way in the last 100 years. Science continues to advance and yes, maybe in 10-15 years, we might learn that A+B does not equal C like we thought it did.  Case in point: hormone replacement therapy once touted as the savior for post-menopausal women was actually found (via the Women’s Health Initiative in 2003) to cause more harm than good.  This is the nature of the scientific method. Develop a hypothesis, design a study to test it and wait for the results.

I’ve never experienced it myself, but I often wonder what it was like for the older doctors whose opinion was respected for what it was.  Paternalism aside, patients and the public looked up to physicians.  There isn’t much of that going on these days.  Patients are showing up for appointments already having diagnosed themselves.  Patients are not afraid to question their diagnoses, and in fact feel quite entitled to do so.  Now, don’t get me wrong, I have no problem with discussing my findings with patients, and explaining to them my rationale behind said diagnosis.   It’s the attitude that I find offensive.  It’s the sense of entitlement from these patients that I have a problem with.   I didn’t spend an extra 12 years in post-secondary education to be put down by someone who thinks they know better because they read about it on the Internet.  It’s insulting.  I wouldn’t dare tell a mechanic how to fix my car.

I’m not a perfect physician – I never claimed to be.  But I would like to be respected for the years I put in to my training and for the continued self-education I engage in on a daily basis.

Is that too much to ask?

The good and bad of family medicine.

Happy New Year!  My apologies to anyone who is actually reading this blog, on my tardiness.  Since the beginning of the new year, it has been very busy, between the office, my home and personal life.

I received a lovely letter today from a colleague in our FHO.  I saw her patient in the after hour’s clinic last fall and followed up with the patient for a few days to ensure she was okay and even sent a note to the family doctor regarding the matter.  In the letter, the physician thanked me for going above and beyond for her patient and told me the patient was doing well and had a speedy recovery thanks to me.  She ended the letter stating that she was glad that our group had a doctor like me.

Well, can I tell you, that just about made my day.

The day to day work of a family doctor can be a thankless job.  I had a patient complain  because it took me two days (2 days!) to fax a referral to the specialist.  I guess patients really don’t think that I have about a million other things to do before I can get to their referral.  It’s rare that I don’t do it the day they ask for it.  I’ve been a bit distracted lately, but I’m human right? I’m entitled to be off my game – so long, of course, that I don’t harm anyone while I’m off.  And really, 2 days to get a referral faxed really isn’t that big a deal.  If I felt she needed to be seen urgently, you can damn well know that that referral would have been faxed the same day.

I sometimes wish I didn’t have almost 1000 patients on my roster list.  It’s really easy to lose track of people, kids especially.  Earlier last month, a father brought in his almost 3 year old son who didn’t have an appointment (the father did).  The father has been under tremendous stress w/ a marriage break up and was concerned about his son.  A family friend thought the child might be autistic.  I checked the child’s chart – the last time he was seen was at his 18 month well- baby visit.  The moment I set eyes on this child, I had the heart-sink moment.  He didn’t engage with me, there was no eye contact and he spent most of the visit talking incoherently and hitting his stuffed animal against the exam-room table.  How could I have missed this at the 18 month visit?  I searched my notes – there was no indication of speech delay at that time, but the parents said he was speaking their ethnic language, and imitating what English he heard on the television.  I felt terrible.  Thankfully, he’s going to be seeing the pediatrician in the next few weeks.  But then I reminded myself that I’m not that child’s parent and it wasn’t my fault he hadn’t been seen in a year and a half.  Small consolation though.

 

 

 

Discussions with patients.

What I love most about family medicine is the conversations I get to have with my patients.  Now that I have children, a lot of those conversations revolve around the kids.  When I tell other moms that my daughter is 3, I get a very sympathetic, knowing smile accompanied by, “Good luck”.  Whoever coined the term “terrible 2’s” obviously didn’t have a 3 year old.  But that’s a subject for another post, another blog actually.

This past week I had a very interesting conversation with a father of two Autistic-spectrum boys.  Yes, two.  What are the chances of that? If there was ever a case for a genetic cause, this would be the family, right?  He introduced me to a book, it’s called “First Idea”.  It was published in 2004 and is written by a child psychiatrist named Stanley Greenspan.  I haven’t read it yet, but it’s on my list for 2012.  My patient firmly believes that his children were born with Autism, it wasn’t something they developed because of mercury in a vaccine, or a particular vaccine his children received.  Rather than believe that his children “changed” overnight, he believes they came out of the womb different.  He described both of their first years; as infants, they never wanted to be held, wouldn’t want to be looked directly in the eye, in fact anything that was super-stimulating (i.e. loud singing toys, brightly coloured books) was very irritating to his sons.  His amateur take on Autism is this:  his children’s brains are wired differently.  Their brains are super sensitive to excessive stimuli.  So rather than constantly berate such a brain with ongoing stimuli, he’s learned through various child psychiatrists that scaling back is best for his kids.  One-on-one therapeutic play in particular has been a god-send for his children.  They are doing remarkably well and he believes they’ll lead productive lives.  A far cry from the image of a child wearing a helmet and banging his head against a desk.

Another conversation I had with a patient this week revolved around vaccines.  She’s a mother to two school-age children.  She reminded me that she needed her Tetanus booster as it’s been more than 10 years.  Then she told me about a child at her boy’s school who was diagnosed with bacterial meningitis due to Haemophilus influzena type B. http://www.cdc.gov/vaccines/pubs/vis/downloads/vis-hib.pdf   This child has permanent hearing loss. This child wasn’t vaccinated as an infant.  It boggles the mind.  As a parent, I  understand the drive to protect your children which is why I can’t imagine what it must feel like to knowingly decline a vaccine that has proven to reduce morbidity and mortality, then have your child exposed to an illness that was vaccine-preventable. How does a parent live with themselves?