Comments on: Sort out vs rule out http://www.medrants.com/archives/2567 Internal medicine, American health care, and especially medical education Sat, 11 Feb 2012 15:15:48 +0000 hourly 1 http://wordpress.org/?v=3.3.1 By: lymph nodes http://www.medrants.com/archives/2567/comment-page-1#comment-520370 lymph nodes Tue, 18 Mar 2008 14:46:59 +0000 http://medrants.com/?p=2567#comment-520370 It cannot be ignored, that nearly all Breast Cancer Tumors occur in the upper outer quadrant of the breast area, this is where the Lymph Nodes are located.. It cannot be ignored, that nearly all Breast Cancer Tumors occur in the upper outer quadrant of the breast area, this is where the Lymph Nodes are located..

]]> By: matte http://www.medrants.com/archives/2567/comment-page-1#comment-86853 matte Wed, 09 Nov 2005 07:52:39 +0000 http://medrants.com/?p=2567#comment-86853 Diagnsotic skills all require careful attention and time to interview, examine, test and rexamine. low Reimbursements unfortunately discourage this. as for diagnostic skills offerred by a MD/DO or NP ? some MD's/DO's are great, some are terrible. some NP's are great, some are terrible. New England journal of medicine recently had an article showing that Pt's hospitalized late in the week had increased risk of having a bad outcome. This indicates the fact that people do get fatigued and fatigue can influence the quality of health care. no surpise here...but this does highlight how other influences other than professional degree affect outcomes. Tina , good luck with your search for a good provider. Diagnsotic skills all require careful attention and time to interview, examine, test and rexamine. low Reimbursements unfortunately discourage this.

as for diagnostic skills offerred by a MD/DO or NP ?
some MD’s/DO’s are great, some are terrible.
some NP’s are great, some are terrible.

New England journal of medicine recently had an article showing that Pt’s hospitalized late in the week had increased risk of having a bad outcome. This indicates the fact that people do get fatigued and fatigue can influence the quality of health care.

no surpise here…but this does highlight how other influences other than professional degree affect outcomes.

Tina , good luck with your search for a good provider.

]]> By: tina http://www.medrants.com/archives/2567/comment-page-1#comment-86603 tina Tue, 08 Nov 2005 19:08:18 +0000 http://medrants.com/?p=2567#comment-86603 Hi Dr.Bob, I went to the PCP the other day with all the lymph nodes on the left side of my head swelled up, a fever, and weakness on the left half of my body. She told me it was TMJ and I had no infection, told me the lymph nodes weren't swollen. Rather odd as I live in this body every day and I don't normally have painful puffy lumps where my lymph nodes are. TMJ is some crazy stuff. I have to say that previous interactions with NPs have been better than with MDs. They have more time to listen and are willing to say "I have no idea". Time is the factor. The PCP was so busy not listening that she gave me an answer that makes no sense. Every visit is about getting me out the door quickly with as many meds as possible. I didn't need meds the other day. I needed to make sure I didn't have menengitus or something else really odd that I would be unaware of. Now other people in the office are feeling sick so it seems my TMJ is contagious. I am actually looking for an NP or something along those lines as I need to in the care of someone who can stop and think for a minute and listen to me without questioning everything I say. My experience with endos confirms the above ruling out phenomena. When Dr. Satan ruled out the endocrine system as the root of the problem she was at a loss. She sent me to a cardiologist and then wanted me to go to a neurologist. She had no ability to think in a global way. The cardiologist could only tell me "it's not your heart-its something endocrine". Did these guys miss out on the rest of med school or something? Hi Dr.Bob,

I went to the PCP the other day with all the lymph nodes on the left side of my head swelled up, a fever, and weakness on the left half of my body. She told me it was TMJ and I had no infection, told me the lymph nodes weren’t swollen. Rather odd as I live in this body every day and I don’t normally have painful puffy lumps where my lymph nodes are. TMJ is some crazy stuff.

I have to say that previous interactions with NPs have been better than with MDs. They have more time to listen and are willing to say “I have no idea”. Time is the factor. The PCP was so busy not listening that she gave me an answer that makes no sense. Every visit is about getting me out the door quickly with as many meds as possible. I didn’t need meds the other day. I needed to make sure I didn’t have menengitus or something else really odd that I would be unaware of.

Now other people in the office are feeling sick so it seems my TMJ is contagious.

I am actually looking for an NP or something along those lines as I need to in the care of someone who can stop and think for a minute and listen to me without questioning everything I say.

My experience with endos confirms the above ruling out phenomena. When Dr. Satan ruled out the endocrine system as the root of the problem she was at a loss. She sent me to a cardiologist and then wanted me to go to a neurologist. She had no ability to think in a global way. The cardiologist could only tell me “it’s not your heart-its something endocrine”. Did these guys miss out on the rest of med school or something?

]]> By: Dr. Bob http://www.medrants.com/archives/2567/comment-page-1#comment-85640 Dr. Bob Sun, 06 Nov 2005 23:40:05 +0000 http://medrants.com/?p=2567#comment-85640 I think this is also what seperates out the physicians from the midlevel providers. Some nurse practicioners claim they can do as good a job as primary care docs. I think they can make some claims in this area when the diagnosis is certain and there are well designed clinical protocols for management. The mistakes I see them making though are when the diagnosis has not been made yet, when the disease has an unusual presentation, or when there are complications or unexpected response to treatment. The length of their training doesn't expose them to enought variation and amount of pathology. As the old saying goes - "you can't diagnosis it if you've never heard of it". I think this is one of the areas where primary care physicians shine. I think this is also what seperates out the physicians from the midlevel providers. Some nurse practicioners claim they can do as good a job as primary care docs. I think they can make some claims in this area when the diagnosis is certain and there are well designed clinical protocols for management. The mistakes I see them making though are when the diagnosis has not been made yet, when the disease has an unusual presentation, or when there are complications or unexpected response to treatment. The length of their training doesn’t expose them to enought variation and amount of pathology. As the old saying goes – “you can’t diagnosis it if you’ve never heard of it”. I think this is one of the areas where primary care physicians shine.

]]> By: matthew md http://www.medrants.com/archives/2567/comment-page-1#comment-84740 matthew md Sat, 05 Nov 2005 00:44:09 +0000 http://medrants.com/?p=2567#comment-84740 Not only general internists, but also general surgeons follow the "sorting out" criteria. I agree that not enough credit is given to these potential diagnostic dilemmas. Nonoperative determinations are just as thought provoking (and angst-producing) as "taking a patient to surgery" and yet the reimbursement does not adequately consider the cognitive process involved by the surgeon. Not only general internists, but also general surgeons follow the “sorting out” criteria. I agree that not enough credit is given to these potential diagnostic dilemmas. Nonoperative determinations are just as thought provoking (and angst-producing) as “taking a patient to surgery” and yet the reimbursement does not adequately consider the cognitive process involved by the surgeon.

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