If you spend anytime with the medical industry you soon realize the issue.
I helped launched (the now deadpooled) Theil backed MetaMed a few years -- essentially a private research team for medicine, and what the founders taught me was astounding.
That things like amputating the wrong limbs, doctors not washing their hands and killing you by infection and a horror of other preventable errors are shocking common.
This didn't even take into consideration that things discovered in labs that might cure you take at least 30 years to reach the doctors who might implement them, if they ever do.
The distortion of hubris from doctors, economic incentives and other systemic issues results in a "health care system" that doesn't realily seem to do what it sets out to do -- we spend 10x what some developing countries do per year per person with no better outcomes.
Accute care seems to be reasonably good, fixing a broken arm, etc. (assuming they don't accidentally remove it); but chronic care is often just a pipeline for the recurring revenue model of big pharma (at best).
The examples are never ending but for fun, take a google to discover how many pap smears are performed annually on women who have already had their uterus removed - then consider the cost to insurance and tax payers.
I often think that the medical industry enjoys (or suffers) from some sort of a given god complex. They can do what they want as soon as they reach a certain threshold of saving. Nobody will debate them (most of us don't have the articulate knowledge anyway) and will morally and existentially satisfy from still being alive.
I just went through 4 doctors (gen. and specs.) about deep yet diffuse cardio vascular problems (life altering if not threatening). Their diagnosis was "nothing to see you are depressed". Since my problems started I can't sleep on my right side (causes heart race, pain and suffocation), and have now back pain; in order to sleep without pain I tried on my stomach. This configuration changed something, I felt stings around my heart, and a sudden relaxation, warm blood reaching my fingers and feets (something I didn't feel for a year). Stings moved along, hurting at finger and toe tips. I felt sweetly alive, jumped out of my bed (because now I can). Even cleand my browser tabs. So much for depression.
I tried discussing with doctors calmly. Accepting the data, their knowledge. Yet not backing down if I felt they weren't really solving my problems. But it's impossible. One doctor even dared me to reproduce transient symptoms with an annoyed tone. You start considering being hypercondriac, a crybaby.
Deep down all I want is a way to monitor myself deeply so I can take care of myself but I'm facing this paywall.
I'd do a few things. First, keep a journal for 30 days. pick a few criteria up front, what you eat, physical activity, amount of sleep, and the events you're having seems like a good base.
Second, talk to a psychologist. Follow up that diagnosis. Maybe you are depressed, but maybe the cause of the depression is the pain you're in. Maybe you're not depressed at all. Having that diagnosis will cut off that set of probabilities, and force your doctor to move down the list to less likely possibilities.
Third, maybe get a heart rate monitor, and track that for a few nights. If your heart rate does shoot up to 150 while you're lying down (sometimes) you'd want your doctor to come up with a good explanation for that.
Fourth, perhaps most important, try going to a teaching hospital. It's much much better to have several residents with something to prove thinking real hard about your problem. Get several eyes on your case at the same time.
Think like a scientist. Accept you don't know what's going on, talk with your doctor about what the possibilities are - ask your doctor to assign probabilities to those possibilities. Come up with a plan to work through the list from most likely to least likely. Accept that maybe it is depression, rule that out so you can work further down the list.
Your doctor is just a person, maybe they're having a bad day or a bad year. That's fine, but you still need their expertise to get an answer. Don't contradict, but ask why they think X is most likely, and what's the best way to resolve or rule out X. They may not want to work with you, but you can certainly work with them.
At the end of the day, you want to feel better. I hope you can find someone that'll help solve that problem.
Interesting methodology. Obvious too, but when these kinds of thing happen your mind goes astray and it's hard to keep being organized.
I didn't log anything but I was quite precise and trying to isolate things. Went on a clean diet right away. Tried to find what activity would get me in stable condition, since failing cardio is a vicious circle, I wanted to find a minimum amount of things to keep the machine active without further injury.
Someone suggested your 4th idea. By the time he talked me about it I was a bit lost. I even tried to talk to a hospital cardiologist, the secretary looked at me like I deserved to be in a mental institute.
I tried all I could to ensure discussion, but all the time, they look at me like a poor thing that needs a mood pill, because after all my BP is fine, and I could walk to him so why am I worrying. It's so difficult to find someone that looks at your problems. And to go back to the original topic, medicine is slow to evolve (as expected) and still too invasive. To investigate one told me I'd need a coronarography which is not a trivial exam. There's no in between for them, even though some have access to more recent tools (ultrasonic artery check, instead of echocardiogram, which doesn't take coronaries in account).
ps: at the 4th doctor, I did cave in and accepted anti depressant. It did relaxe muscles for a few days, leading to smoother blood flow. It didn't cure me of my problems, it just made me suffer less for them. The last night event had more impact on my health and mood than 6 months of visits and treatments. Medicine is hard, it's complex, people are human, these guy makes an important and difficult job dealing with pain and problems all day long, I don't deny that. That said, medicine needs to evolve, and I feel they're too satisfied [1] with their result to really reach the best.
[1] surely other factors are responsible for sub par health. Economy, politics, sociology, education... I'm not ignoring this too.
I'm not a doctor, you should follow your doctor's advice. I do have a couple more things to consider.
First, contact a psychologist, like talk therapy. They'll be able to back up or reject a depression diagnosis. Sure, it's possible it's all imaginary, but stuff like imaginary pain usually happens with amputees. Something happening that's a big deal. They'll also be able to provide some support in dealing with this whole mess. It's nice to have someone say, yah, you're not crazy, you're in a crazy situation and that would frustrate anyone.
Second, lots of anti-depressants have to build up to work. it takes weeks for them to have any sort of effect, and you should taper off of them. Read the details about how the one they gave you is supposed to work. It's not really surprising you felt better for a couple of days, you felt like you were making progress. Perhaps you were a little willing to overlook things that would worry you.
Maybe go back to doctor four after talking to a head shrinker. A therapist can help you express what you need from doctor 4. "I feel like i'm following your advice, but my other doctor and i think my depression (if you're even depressed, which seems like it hasn't been nailed down yet!) comes from the feeling that i'm not being taken seriously and current treatment doesn't seem to work very well." I'm trying X but X doesn't seem to be a complete solution, what else can we do?
In any case, things suck for you right now. You are not powerless, and i'm sure you'll find a way to make things better. You're on a tough road right now, i'm sure you have friends and family that care about you, and will support you through this struggle. If nothing else, there's a random internet stranger that is rooting for you.
Don't give up! I was told the same thing you are depressed. Doc even wanted to push meds on me. Took months of seeing specialists but ended up getting a real diagnosis which required a major surgery. Now I'm finally better but you have to work within the system which means finding a good doctor.
Sleeping on your stomach often helps problems with sleep apnea, which is often something that isn't something patients know they have.
If you stop breathing in your sleep, it can make your body enter a "flight or fight" state that makes your heart race and adrenaline rush through your system. It also decreases o2 saturation and the poor sleep quality negatively impacts daytime mood and concentration.
Consider getting a sleep study, at least to rule that out as the root cause
It's worth noting that many developed world's medical systems have a problem with the acute-chronic gap. Remember that pretty much all systems grew out of acute care - as a result, nearly all of them are quite good at it. But one of the problems with increasingly good acute care, as well as general increase in public health is the rise of chronic care issues.
The sheer inefficiency and ineffectiveness of America's chronic care is not alone. Here in Canada, it's pretty clear that our system strains when put up against chronic care.
There's certainly a lot to fix, but as you've pointed out, doctors are a huge component in the current system that has the change. This points to the fact that somehow we need to engage and get buy in from them.
One of the things that I'm always wary about when reports like this come out is that while they present a wonderful opening into engaging with current stakeholders, it's also very easy to put current stakeholders on the defensive, and have them quickly adopt a us-vs-them mentality, something that certainly is not conducive to change.
> There were 15.892m total hospital admissions in 2014/15, 31 per cent more than a decade earlier (12.102m).
(Not all of those will be surgeries)
and:
> In 2015, across Hospital and Community Healthcare Services (HCHS) and GP practices, the NHS employed 149,808 doctors, 314,966 qualified nursing staff and health visitors (HCHS), 25,418 midwives, 23,066 GP practice nurses, 146,792 qualified scientific, therapeutic and technical staff, 18,862 qualified ambulance staff and 30,952 managers.
tl;dr - The US has similar "sentinel events" that are decided upon by a not for profit Joint Commission organization that accredits health facilities across the US. Failure to "respond" to a sentinel event and make meaningful attempts to prevent future occurrences can jeopardize a hospital's accreditation. Hospitals voluntarily report "most" sentinel events to the Joint Commission so their data is explicitly not usable for frequency/trending over time.
To add additional info on the subject, the US employs a similar concept (and name) to "sentinel events." Relevant to surgery, this includes:
"Invasive procedure, including surgery, on the wrong patient, at the wrong site, or that is the wrong (unintended) procedure"
"Unintended retention of a foreign object in a patient after an invasive procedure, including surgery"
More broadly, sentinel events are generally defined as:
"a patient safety event...[that] results in any of the following:
Death
Permanent harm
Severe temporary harm" (1)
Outside of surgery, there are around a dozen additional, specific events that are always deemed to be "sentinel events." This includes forms of assault, abduction, unauthorized departure (i.e. the medical team has not yet discharged the patient) leading to patient death/harm, and specific, highly avoidable outcomes due to standardized procedures such as blood transfusions, too much bilirubin in newborns, and prolonged radiation. (1)
These sentinel events policies are guided by the Joint Commission in the US, a not for profit organization that guides many patient safety initiatives and accredits health facilities in the US. At least for hospitals, site visits are unannounced around every 3 years. (2) Failure to gain/maintain accreditation, among many outcomes, threatens a hospital's ability to participate in Medicare/Medicaid as the Centers for Medicare & Medicaid Services (CMS) considers the Joint Commission a national accrediting organization. (3) Revenues from Medicare + Medicaid are generally essential for the solvency of a high majority of hospitals in the US - in 2013, the national average was ~58% of hospital revenues (4).
Hospitals are "strongly encouraged" to report sentinel events to the Joint Commission but it remains voluntarily. Thus, the Joint Commission's data is available but explicitly not "an epidemiologic data set and no conclusions should be drawn about the actual relative frequency of events or trends in events over time" (5)
However, hospitals are "required" to respond to a sentinel event through a comprehensive analysis and planning to prevent future occurrences. If the Joint Commission becomes aware of an event during a site review or other means that was not addressed in compliance with the lengthy review policy required, then the facility will risk its accreditation status. (1)
(Post often references "hospitals" but applies to many health facility types.)
> "health care system" that doesn't readily seem to do what it sets out to do -- we spend 10x what some developing countries do per year per person with no better outcomes.
It's a for-profit healthcare system. It does exactly what it sets out to do. Spending 10x more without having to deliver better outcomes is a success. If it could get 20x more cost for half as good outcomes that would be even more of a success.
Healthcare can never really be a consumer market without an acceptable, nearly-free-at-point-of-use baseline alternative or very heavy government intervention in its operation.
(The NHS is arguably at the other end of the scale, since it manages demand with triage and queuing. If your condition is merely uncomfortable and not life-threatening you'll have a long wait. It is, however, very cheap.)
Healthcare could easily get costs controlled precisely by being a consumer market. If we wrote the checks for our health care ourselves, and if there weren't laws against publishing prices for procedures, and insurance companies could operate in all states, then there would be tremendous lowering of costs in a very short time.
Pro tip: if you're going to have surgery, especially to have part of your body removed, use an indelible marker to write clearly on the operating site as well as the opposite side. Something like "remove this kidney" and "do NOT remove this kidney".
I helped launched (the now deadpooled) Theil backed MetaMed a few years -- essentially a private research team for medicine, and what the founders taught me was astounding.
That things like amputating the wrong limbs, doctors not washing their hands and killing you by infection and a horror of other preventable errors are shocking common.
This didn't even take into consideration that things discovered in labs that might cure you take at least 30 years to reach the doctors who might implement them, if they ever do.
The distortion of hubris from doctors, economic incentives and other systemic issues results in a "health care system" that doesn't realily seem to do what it sets out to do -- we spend 10x what some developing countries do per year per person with no better outcomes.
Accute care seems to be reasonably good, fixing a broken arm, etc. (assuming they don't accidentally remove it); but chronic care is often just a pipeline for the recurring revenue model of big pharma (at best).
The examples are never ending but for fun, take a google to discover how many pap smears are performed annually on women who have already had their uterus removed - then consider the cost to insurance and tax payers.