self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
I'm a transhumanist doctor. In a better world, I wouldn't need to add that as a qualifier to plain old "doctor". It would be taken as granted for someone in the profession of saving lives.
At any rate, I intend to live forever or die trying. See you at Heat Death!
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User ID: 454
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
18hr ago
I'll take a look, thanks for the rec!
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
18hr ago
India is a big country, with many Indians (citation available on request). I genuinely don't think that you can uniquely identify anyone I've ever written about, barring myself. A schizophrenic man from Bangladesh? A young kid with behavioral issues? Victims of polypharmacy? Good luck narrowing that down to less than a thousand people.
A classic question like "do I report the alcoholic school bus driver" is fraught as hell and younger generations have basically been taught not to engage with the question and to report to risk management.
Interestingly enough, this scenario is pretty explicitly addressed when it comes to the ethics curriculum and guidance for British doctors. I would be expected to warn the patient to desist from dangerous drinking, and if they disclosed drunkenness on duty or continued to drive, I would be legally obligated to report them to the DVLA so that their license gets yanked. This applies doubly so for bus and truck drivers (I refuse to call them lorries).
There is a lot of bloviating about ethics here. UK medicine is obsessed with the topic. It was half the grade on the exam that gatekeeps most postgraduate training.
There exists a massive top-down push to reinforce the image of doctors as a noble, duty-bound cadre of esteemed professionals. That self-conception is gradually fraying in the younger generation, because we sure as hell aren't paid or treated like we're special.
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
18hr ago
I had a similar question on my SSC post, so I'll reproduce my response:
Interesting, is that a point for the Sapir–Whorf hypothesis?
Not necessarily! Psychosomatic complaints are all too common even in developed, English speaking countries. It's not like many patients in India won't express their feelings in terms that directly match with standard (English) psychiatric nomenclature. Plenty of people will use the closest equivalent for "low mood, apathy, agitation etc etc" even if the language lacks a specific term for depression. After all, I'm sure people got depressed well before it was recognized as a clinical syndrome, or had ADHD and autism before the modern taxa evolved.
Of course, cultural idiosyncracies do matter, and some diseases genuinely are culture bound or spread by social contagion (see Scott's posts about the latter, especially anorexia).
It's also not necessarily the case that our diagnosis of a psychosomatic cause is perfectly accurate. Optimistically, one can say that my peers were exercising clinical judgment. Pessimistically, they were quick to pattern match and put people in buckets. There's no law of medicine that says you can't have depression and actual gastric reflux or peripheral neuropathy. The lonely old lady with backpain might well have arthritis, and we do try and check. We just have very little time to do that checking.
I'd say that in the absence of a widespread understanding of "depression" as a clinical condition, most of these patients are coming to see a doctor because of their perceived bodily ailments. They do not envision themselves as depressed, but will still acknowledge sadness, anhedonia etc. But what they claim to seek is relief from physical suffering, and said suffering often but not always comes from psychiatric intervention. I am genuinely unsure if they understand the link, but people do seem to know that the psychiatry department deals with the mind and that they didn't just pick the wrong door.
At some point, someone made the judgment call that the underlying issue was psychiatric, so they ended up in the outpatient clinic. On the other hand, when I was an intern in the medicine department, we had plenty of patients my seniors deemed to be psychosomatic who were treated the same way, but ended up there by some sorting mechanism I'm not familiar with.
I’m wondering if this could be an explanation of the part of the rise in depression/anxiety/mental health conditions in modern societies, or even the mental health gap between liberal and conservatives. Previous generations/less developed countries don’t have better mental health (in fact, from stories I heard from older family members, it might have been far worse in the past), but they’re just unaware of their own mental scape, and lack even the words to describe the concepts we take for granted.
I read a very convincing article arguing that the gap is an artifact (I think it claimed that when specific terminology was adjusted, the purported mental health gap vanished), but I'm afraid I don't have a link handy. If I remember who said it, I'll share. It might even have been Scott.
I think, on a empirical basis, that this effect is insignificant. Med influencers make significant amounts of money and acquire fame by attracting patients using case reviews, and I don't think Scott has ever suffered for it.
Would be ranked very low here in the UK. The best answer would be to try and warn him to cut down on drinking (if he just happens to be an alcoholic but doesn't disclose driving while drunk) first, and then if he persists or outright admits to drunk driving, the doctor is to inform him that he's duty bound to report to the DVLA.
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