Doctors that don't really listen to patients reporting symptoms

 This is a response to "In reporting symptoms, do patients know best?", a piece in the New York Times April 13, 2010.

Note: Of course, I don't even discuss the fact that "symptoms", as opposed to "signs" are by definition the subjective experiences of the patients, regardless what factual or biomedical basis they have. 

My comments

The two most egregious incidents I can recall were these. (1)  my wife and I,  after several years of being very healthy, got Swine Flu shots in 1976.   We both got violently ill, but when we reported this to the doctor, his reply was "That's never been reported as an effect, it must be a coincidence."   We asked, then, was he going to report our case?  No, of course not, because... it's not a reported effect.  

Once, my wife, a field biologist and excellent observer, went to see the doctor of the day at our health system, and reported that "this is what I experience..." and described her symptoms.  The doctor's dismissive response was "No you don't."

That said, and anecdotes aside,  solid data show that doctors report an abysmally low fraction of diseases they are required by law to report,  so it's not too surprising that they report few of ones they are not required to report.

The reasons, as described in so many posts are many, ranging from abusive arrogance to lack of motivation to a rational decision not  to do something that detracts from time with the next patient,   etc.   Some are good reasons, some not so good.

The kernel of truth that matters is that doctors in the US "health" system, by and large,  are simply not a good detection mechanism for mindful detection and reporting of issues that seem minor locally, but statistically, in an broad overview,  have serious public health consequences.  It's not one's "fault", it's how that "system" functions, and will continue to function.

Drug companies have little motivation to encourage a change in the system.   Hospitals are not motivated to detect downstream problems in patients that have been treated and released.

All of this presents a very serious risk, not only to individual patients, but to the length of time it takes "Homeland Security" to detect a silent attack with biomedical consequences.     While DHS is spending billions of dollars, literally, to create high-tech biosensors to put on rooftops in all major cities,   they are spending, um,  zero? dollars on figuring out how to simply ASK people to report unexpected conditions into some national database, bypassing hospitals, doctors, etc., and figuring out how to make sense of the result flood of noisy data, including those who intentionally try to "game the system" or use it to create its own panic.

Still,  if you want to know what safety issues are with doctors in hospitals,  it would make sense to simply ask the nurses.   You think they don't know?

Similarly,  if you really want to know that the actual side-effects are of medications and procedures,  ask the patients.    Individual anecdotes will appear as variable as UFO reports, but collectively,  patterns will emerge to solid statistical analysis that will find problems long, long before they are found by our current "don't ask, don't tell" patient safety "system".