2013-07-05, 11:53 | Link #141 |
Komrades of Kitamura Kou
Join Date: Jul 2004
Age: 39
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There is a stark difference considering some of us practice in poor countries where not everyone can afford a CT scan on the fly.
Theres is such a thing as excessive and pointless testing when even the basic exams have enough specificity and sensitivity to make the correct diagnosis majority of the time without subjecting the patient to diagnostics that are not only expensive but also have side effects (pain radiation etc.). Its called medical economics.
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2013-07-05, 16:58 | Link #143 |
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Join Date: Aug 2011
Location: Philippines
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The problem is CT and MRI are additional charges to the patient especially if he/she doesn't need it. IF the patient requests for them to be done and is willing to spend, then of course, we as doctors give in because it is the right of the patient. But it's another story if the doctor recommends the imaging when the patient doesn't need it. A good history and physical exam can already detect a stroke. A CT scan / MRI help you localize where exactly in the brain the cause of the stroke is.
Doctors should refuse to run too many scans unless it's necessary. For example, if a patient has headache, does it mean he/she should have an MRI or CT scan right away? No. Depending on other symptoms, that headache could have been a migraine which is most definitely nothing compared to a stroke. It still boils down the the history they take and the physical exam they do. If the patient is just too worried and requests for a CT scan, it's natural for doctors to discourage the idea, but of course, the patient would have the final say.
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2013-07-05, 19:28 | Link #144 |
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You know guys we got a patient who has severe abdominal pain and jaundice with positive choleliathiasis on ultrasound and our doctor still insist to have a CT-scan first before surgery and orders tons of "branded" pain meds and supplements, She says she just want to be sure... I just scratch my head and look at disappointment.... She decides to discharge the patient ( in that condition?!) but the SO insist of a transfer to a public hospital.....
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2013-07-05, 20:22 | Link #145 | |
Komrades of Kitamura Kou
Join Date: Jul 2004
Age: 39
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Real life isn't House MD where everyone is stuck into an MRI and poof diagnosis made. Not everyone has some mystery illness that requires all sorts of exams just to discover. If this were the case then there would be long lines in front of the CT scan. But if you really want that scan go ahead and do it, even when your doctors think it is ultimately a waste of money. Just remember that not everyone needs it, and even more so not everyone can afford it.
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2013-07-05, 21:02 | Link #146 | ||
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Join Date: Aug 2011
Location: Philippines
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It all boils down to "defensive medicine" apparently. My dad (a senior surgeon) talked to me about this. Doctors overuse tests because of fear for being sued.
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2013-07-05, 22:58 | Link #147 |
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That's in America... I think some doctor's do it to make more reason to "why they should be given higher pay"....
Anyway.. Is asking for P300,000 as "personal PF" by a surgeon reasonable? I mean for that surgery only, excluding the equipment and his service all throughout the patients stay in the hospital? and oh he's a neurologist |
2013-07-06, 09:57 | Link #148 |
Senior Member
Join Date: Jul 2013
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Okay I'm a registered nurse..So I guess I can help you with your problem.. The thing is, it's difficult to diagnose your problem as we need to do tests done.. Note that it's not always the same cyst that will occur.. The worst is if it's cancerous.. You should know that cancers may have same symptoms during earlier stage with some other benign tumors such as cyst, so all I can say is that.. Please do consult an ophthalmologist regarding that problem.. I hope you do understand your situation right now, and that needs immediate attention especially that you already have had the same symptoms before.. reoccuring cyst are not good..
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2013-07-06, 18:43 | Link #149 | |
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Cyst on the breast and ovary are pretty not to be ignored whether its benign or malignant (what more if its malignant LOls) |
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2013-07-06, 19:42 | Link #150 | |
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Join Date: Mar 2003
Location: Northeast USA
Age: 38
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How do you know if a CT or MRI is unnecessary until you run it? Strokes aside, what if the patient has a brain tumor, infection, trauma, aneurysm, multiple sclerosis (less common in the Philippines, I know), and so on? If you don't order them and the patient goes on their way, only to have it discovered later, you could be on the receiving end of a lawsuit for negligence. Sure, your history and physical will correctly indicate that it is unnecessary the majority of the time, but there will be some cases that slip through that would otherwise be caught by the imaging. Should we image 100 people if only two really would have benefitted from it, driving up the costs for everyone? Most people would probably say yes, if it means that their chances of experiencing a missed diagnosis is decreased. The hospital would probably say yes, because an unused imaging machine is wasted space and investment for them. As a result there is little incentive not to order the test, aside from your own conscience. Even then, I wonder what will happen when you miss something that imaging could have caught. It's true that we're ordering a lot of unnecessary tests in America, and there are more reasons than just defensive medicine. I won't deny that laziness may very well be a part of it. Order enough tests and the differential becomes clearer to you without having to do too much thinking. I agree that we should be more careful about the tests that we choose to run, but those lawsuits are tricky.
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2013-07-06, 20:33 | Link #151 | |
Komrades of Kitamura Kou
Join Date: Jul 2004
Age: 39
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This doesn't apply in third world countries like the Philippines, where 50% of the population can't even pay the rough equivalent of $5 monthly to be covered by the most basic health insurance (PhilHealth), much less pay for a CBC (~$4) or a chest xray ($5-$6 ish). It's not so much to me defensive medicine as it is the fact that you can make a very good diagnosis assuming you were trained properly, while knowing that most of your patients will struggle to find payment for the tests they need, even more so unnecessary ones. I would gladly cut or waive my PF if it came down to it.
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2013-07-06, 21:39 | Link #152 | |
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Join Date: Jan 2012
Location: London, England
Age: 37
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It was a very unfortunate case and it can be argued that this is a relatively rare occurrence but the point remains that tests can be dangerous. The point my dad wanted to highlight in this story is doctors must take great care when they consider administrating any test on patients. Often there are financial and health costs to consider when performing these tests. |
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2013-07-07, 06:33 | Link #153 | |
This is my title.
Join Date: Aug 2011
Location: Philippines
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It just irritates me when I see other doctors order ct and mri left and right without first considering the history and PE properly...
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2013-07-07, 11:13 | Link #154 | |
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Join Date: Mar 2003
Location: Northeast USA
Age: 38
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There is another element that might be different between the US and the Philippines. It partly has to do with litigation as well: we document everything. Compared with the way that medicine used to be in the "olden days" an increase in documentation was needed, but we have reached ridiculous levels such that physicians spend more time charting than they do working with patients. And that's really all that it is; few physicians have the time to read through much of what is written in the chart, instead looking for particular highlights and updates. Getting a thorough history takes time. Talking through things with the patient takes time, getting to know the patient and earn their trust takes even more time. Plenty of patients are unreliable historians, too. It's more time-efficient to get a brief history, schedule the patient for imaging and labs, and then move on to the next patient. It isn't right or ideal, but it's a limitation that we have to work with.
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2013-07-07, 11:22 | Link #155 |
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Join Date: Sep 2008
Age: 38
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So, I'd like some opinions on this. Lately, I've noticed my left eye's had this weird twitching/pulsing feeling under the eye. Closing the eye usually makes the feeling go away, as does putting my finger under the eye (as if I were to wipe a tear from the inner duct without touching the eye itself).
For a while, while it worried me, I thought it was just a feeling and not something actually happening. Then a week or two ago, it started happening while I was in the bathroom, so I decided to check the mirror and noticed there was actually a visible pulse going on under the eye (think those cliche anime pulsing veins). This sort of freaked me out. I checked online and it looked like the three main causes are inadequate sleep (I do have some degree of insomnia, usually takes 30-60 minutes to fall asleep and the past couple of weeks I'd only gotten about 6 hours a night on average at best), stress (definitely been getting that at work), and eye strain. The last one is the one that I'm most curious about, as I do work with computers all day, but I also got new lenses in my glasses in May. I cannot recall when this twitch started happening, but I at least know it wasn't happening before January. Anyone ever have something like this happen? It's getting more frequent, so not sure if I should consult an optometrist, check to make sure they didn't screw up my left lens, or if this is an issue for a general practitioner. |
2013-07-07, 11:57 | Link #156 | |
Love Yourself
Join Date: Mar 2003
Location: Northeast USA
Age: 38
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There's always the possibility that it's eye strain but I doubt that it's the case here. How many hours per day do you wear your glasses? If they were a source of eye strain then my guess is that you would have noticed within a week of the lens change (both that your eyes felt fatigued and that the spasms were present).
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2013-07-07, 13:05 | Link #158 | |
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Join Date: Jul 2013
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2013-07-08, 02:12 | Link #159 | |
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