Posted by Larry Hoover on July 23, 2004, at 16:51:35
In reply to Re: apples oranges Lar and fires, posted by AuntieMel on July 23, 2004, at 15:38:42
> It's good to have you back, Lar.
Thanks. Feeling stronger as time goes on.
> I could be way, way off on this, and confused. It *is* friday.
>
> It seems that we have an apple/oranges problem here. Or you are trying to say the same thing in different ways.I think we're saying something different entirely.
> Ulcers and MI are things that can be tested for and diagnosed, notwithstanding false negatives. The theory of the *cause* of ulcers was found to be erroneous, but ulcers themselves could be diagnosed.
Chronic pain can be diagnosed, too, but pain can't be measured. There are many different kinds of assumptions in medicine. Diagnosis is often "proven" by the success of treatments suggested by the tentative diagnosis.
> Somatoform Disorder, and others, are convenient labels that get applied when all other tests fail to show anything.I would never call them "convenient", although they can be prematurely applied by some clinicians. Med school and residency are lengthy for good reason. But 50% of each graduating class was in the bottom half.
> There is a good chance that new technology will find, or help narrow down the diagnosis even further.
The average time to get an accurate diagnosis of Chronic Fatigue Syndrome is greater than 6 years (and takes 11 doctors). It also doesn't help that's it's called the Yuppie Flu. There will always be these "shadow diagnoses", where objective evidence and diagnostic specificity just can't (yet) be found.
> But the biggest point here, in my opinion, was that fires was diagnosed with it, without his (or is it her? please tell) knowledge.
There is a school of thought that believes it is deleterious to inform some patients of their diagnoses, based on a judgment of the individual's character traits.
> And that the diagnosis was done by a shrink, and without any testing to rule out other things first. That seems to me to be a HUGE assumption.
If I recall, the diagnosis was by a psych resident. That means that *all* cases would be supervised by senior staff. It wouldn't be just this one doctor's opinion.
> And putting it on a chart as if it was based in science seems totally irresponsible.
Why is it irresponsible? Any newer physician would take that under advisement, but perform new diagnostic tests of their own. It would be malpractise to do otherwise. Doctors themselves are just as aware of the subjective quality of such a diagnosis. The uncertainty is not lost on doctors.
> Fires set the record straight, and for that should be commended.Set what record straight? I'm confused by that statement.
Lar
poster:Larry Hoover
thread:366835
URL: http://www.dr-bob.org/babble/psycho/20040723/msgs/369618.html