this post was submitted on 08 Jul 2024
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Do you trust the doctors with your life?
Remember what they call the person who graduated in last place from medical school: Doctor.
They aren't all bad, but many are overworked, too busy to focus, and perhaps burnt out. They also might need a full history over time to make a diagnosis. By way of example, during an annual physical, my doctor noticed my weight gain, and said there was no way I could gain that much weight in a year without something wrong. He ordered blood work and found a thyroid disorder. That also explained why I had no energy to do anything more than the bare minimum to survive.
Looking just at thyroid disorders, a doctor might just check TSH (thyroid stimulating hormone). The "normal range" is 0.5 - 5.0. So your TSH could be 4.9, and your doctor would say it's normal. However, I know a bunch of people with thyroid issues, and everyone I know feels "normal" when their TSH is close to 1.0.
If your doctor orders a thyroid antibodies test, they could discover Hashimotos Thyroiditis (which happens to be my diagnosis, as well as my wife's and my three children). Basically that means your immune system is attacking and destroying your thyroid gland. When she was first diagnosed, my daughter's TSH was normal, but the antibodies test was positive, so they knew it was just a matter of time.
How do you make sure every possibility is covered though?
I don’t really go to a doctor regularly.
Do you think I should? And try to find a doctor which seems competent? But how do you evaluate this? And how regularly should you visit a doctor?
Usually when I finally get to a doctor, most of my symptoms are already over. When feeling bad, I typically won’t make an appointment because I feel mentally incapable. Unable to make an appointment, get there, and then manage to explain what is wrong.
That sounds almost impossible to me.
You should go to the doctor at least once a year. They can check you out in a physical, and order blood work, and see how things change over time. It's also easier for them to deal with other routine illness when you've been seeing them regularly, and they can make sure you're getting your routine vaccinations. It doesn't matter if the symptoms have passed. You can still describe them to the doctor and they should still consider them.
Regarding how to know if the doctor you're seeing is competent, a lot of that is how you feel when you're with them. How do they treat you? Do they remember what you told them last time? Have they been thinking about it, reading about your symptoms, looking up possible causes?
Regarding a psych referral, it depends on how that was brought up. If they mentioned that some of your problems sounded like depression, then they might be suggesting that there's something there for you to deal with. However, if you think there's a medical problem, and the psych referral feels to you like they're not trying, that's a bad sign.
"To a hammer, everything looks like a nail"
A medical doctor should be looking for medical causes for symptoms. The way they come to a diagnosis is by identifying possible causes and ruling them out one by one. If they jumped to psychological causes without ruling out medical causes, I'd be concerned that they aren't really trying.
When I started seeing my current doctor, I already had two issues that had been diagnosed: Hashimotos Thyroiditis, and gout. When I came to him, I wanted to avoid taking meds for the gout, so he recommended drinking coffee to prevent flare-ups. In that first visit he also gave me a referral to see a sleep specialist because he thought I had sleep apnea.
I ended up having a sleep study and got a CPAP machine. That allowed me to have actually restful sleep for the first time in years.
Each time I returned, he had done more research into what my issues were and he had new things to try. He also has my family medical history, so he's watching out for issues that I might be prone to because of genetics.
I'm on medicine to reduce uric acid for the gout now because he had done additional reading and in one of my appointments he explained that new research showed that the high uric acid that causes gout flare-ups could also cause other issues due to causing general inflammation. Even though the coffee was preventing severe flare-ups, he convinced me to try allopurinol to reduce the uric acid.
He's also been concerned about the weight I gained due to the thyroid issues, so he's been working with me to help me lose weight.
What I'm saying is, after every visit, I leave feeling like my concerns have been addressed. He listens to what I'm telling him, and responds to what I say.
If you're not happy with the doctor you've seen, you should seek out someone who you feel comfortable with. My current doctor isn't the first doctor I've seen. There were probably five or six doctors I've seen over the years that were underwhelming before I found him. One good way to find a doctor is to talk to friends, family, or coworkers and find out if they have a doctor they like.