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[quote=Anonymous][quote=Anonymous][quote=Anonymous][quote=Anonymous][quote=Anonymous][quote=Anonymous][quote=Anonymous][quote=Anonymous][quote=Anonymous][quote=Anonymous][quote=Anonymous][quote=Anonymous]Cut back to 24hr a week now that med school loans are paid off. Enjoying having a life again. I’d work 40 hours if patients weren’t so miserable and management didn’t try to cram my schedule way past full.[/quote]

What makes the patients miserable? I mean, specifics in terms of behavior thet shouldn't be doing. [/quote]

Just angry about wait times in the office (that I can’t control), having a lot of things that they “insist “ on being tested for despite it not being relevant for their symptoms - and some tests will yield a lot of false positives if you test everyone for them. It sounds wrong- like, “if I test positive, and the test is 99% accurate, then it’s a real positive!” but google the Bayes Theorum and you’ll see that’s actually wrong. But patients INSIST on testing for things. And it muddies the waters and makes my job harder and doesn’t make their symptoms go away because now they’re convinced they have, for example, chronic Lyme disease and they won’t consider that their fatigue is actually probably from sleep apnea or depression. Anyways I’m ranting. [/quote]

None of that sounds miserable to me. It sounds human. It sounds like humans who are struggling and are asking doctors to help them feel better. [/quote]

Yes, people are trying to self advocate because care has become so abbreviated and disjointed[/quote]

But without any nuanced understanding of the tests they insist on! Did you know that if chances are really low that you have a disorder (and you don’t meet criteria for testing for it), but you test for it anyways , and get a positive result, if that test is 99% accurate, it means that there is only a 1 in 10 chance your positive result is real? #mathdoesntlie[/quote]

This article detailing how often doctors miss life threatening pulmonary embolisms is terrifying:
https://www.sciencedirect.com/science/article/pii/S2772632022000113[/quote]

And what do you think the morbidity and mortality would be if every patient who might, on a very off chance, have a PE is given a pulmonary angiogram which is the gold standard for diagnosis?

Or even “just” a chest CT?

I’m not talking about cost, even. Or availability of practitioners and machines to run all these tests on every single patient with some  shortness of breath. I’m talking about harm to patients that results from doing the test. [/quote]

What harm?   Ignoring the problems is the true harm. [/quote]

Ok,
I’ll play. A pulmonary angiogram is an invasive procedure which can lead to disability or death. 
A chest CT has so much radiation that the risk of it CAUSING cancer has to be weighed against any possible benefit of using it. [/quote]

How about a D-dimer blood test?[/quote]

How sensitive and specific is that test for a pulmonary embolism? If it’s elevated, does that patient automatically get a pulmonary angiogram? What’s the next step? (Think of this as a learning activity)[/quote]

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