Quote:
Originally Posted by AncientMelody
A primary care doctor seeks to know his patients and we ask if this is a good idea? Of course it is a good idea. I think it's a very clumsily written piece, hopefully his patient interactions are a little smoother. But the fact that he shows genuine interest in his patients' lives is at the heart of the primary care relationship. It would be dangerous and unethical yes to try to perform true analytical psychotherapy in this situation yes but I can assure you that a primary care physician is not only trained but indeed obligated to counsel patients on potential risks to both their mental and physical health.
Additionally two symptoms or health history items that may seem unrelated to each other to some may actually be the key to accurate diagnosis and treatment.
I hear so often how people want medical providers to treat them as whole people, not as a list of diagnoses. This doctor does just that.
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From the article linked, it doesn't sound like he's seeking to know his patients or seeing them as whole people--he's just looking for substance abuse everywhere. There's a logical fallacy known as confirmation bias--basically, if you go into a situation with an already-formed assumption, you're going to find evidence that it's true. If you assume every patient in a certain age group is abusing substances, you're going to find evidence that yes, some of them do use substances. But while you're busy finding evidence of that, you're going to miss the concerns of patients who aren't using, or patients who are using but for whom it's not problematic. (Consider that more and more states are passing medical marijuana laws, and there's a growing movement toward legalization of marijuana.)
Also, my experience (as well as the experience of many other people; the New York Times has even run several articles about it) has been that once you're slapped with the label of "substance abuse" or "mental illness," symptoms of genuine physical illness are often written off as all in your head. I nearly died of an autoimmune disease because the intern treating me in the ER was convinced I'd caused the symptoms myself by overdosing, even though my symptoms were totally inconsistent with symptoms of an overdose. But I was a psych patient with self-harm scars all over my body, so she assumed beyond all reason that I couldn't really have been physically ill. It wasn't until my blood pressure crashed to 50/40 and they had a crash cart next to my bed that she decided that maybe I wasn't just crazy.
Too often, doctors' first assumption is that symptoms are drug-induced or psychosomatic, when that should be the assumption of last resort, after all the other possible causes have been eliminated. It often discourages patients from seeking out further health care and contributes to the reason that the life expectancy for people with mental illness is twenty years less than people without mental illness.