Yes, this sounds completely right. One unusually good doctor I had told me, “In the right patient, any drug can have any effect.” It took me another four years to solve that particular problem, ten years in total, and I’m still concerned that when I see my new PCP (previous one retired) he might try to change my meds that’ve been working for 5 years.
Most doctors are too cautious, for whatever (often justified) reasons, to just try things. Most really don’t know how to respect what patients know about themselves or to interact with an actually-intelligent patient. I’ve had doctors tell me, “I don’t know what to do with what you’re telling me. Most patients wouldn’t even be able to notice these kinds details and put them together, so none of the research captures them.” And then they usually decline to try anything based on best guesses after first- and nth-line interventions fail.
It’s also true for veterinarians, btw. My cat gets chronic bacterial UTIs. We spent years having vets and specialists tell us, “Nope, unless you spend hundreds of dollars on a cystocentesis every six weeks, we’ll insist the problem is behavioral and stress related and not give antibiotics. No, it doesn’t matter that the $20 course of amoxicillin worked the last 10 times and that if it did again the symptoms would be mostly gone before the cysto results even come back. No, we don’t count it as evidence that you can tell a flare up is coming a few days in advance by the change in urine smell. Your cat just needs to suffer until the culture comes back and you have to deal with her being completely incontinent and dripping blood,” (we diaper her at night and when she’s infected). “Also, you should have us do a cystoscopy even though we probably can’t because they don’t make a scope small enough for a six pound cat but you’d have to pay anyways if we try and can’t, and you should do an MRI that if it shows anything we almost certainly won’t be able to fix it surgically so it won’t give any new treatment options,” (we’ve done ultrasounds and they don’t find anything). Finally our own vet gave us as many bottles as we wanted and said to use them as needed, and everything was fine for a few years. We also cleaned up her diet and found out a big part of the problem was a prescription gastrointestinal health food she’d been on for a previous condition (or at least, the food interacted with a suspected anatomical defect that no one can find because she’s too tiny for tests to show it) (we think she can’t tolerate brewer’s yeast? maybe?). She only had two infections the whole next year. She’s now 13, and just had to switch antibiotics because she started showing signs of resistance to amoxicillin after 5 years, but we honestly hadn’t thought she’d make it even to 10.
They tell doctors, when you hear hoofbeats, think horses, not zebras. But there are also deer, and elk, and antelope, and buffalo, and lots of other hoofed animals. And sometimes there are zebras!
Yes, this sounds completely right. One unusually good doctor I had told me, “In the right patient, any drug can have any effect.” It took me another four years to solve that particular problem, ten years in total, and I’m still concerned that when I see my new PCP (previous one retired) he might try to change my meds that’ve been working for 5 years.
Most doctors are too cautious, for whatever (often justified) reasons, to just try things. Most really don’t know how to respect what patients know about themselves or to interact with an actually-intelligent patient. I’ve had doctors tell me, “I don’t know what to do with what you’re telling me. Most patients wouldn’t even be able to notice these kinds details and put them together, so none of the research captures them.” And then they usually decline to try anything based on best guesses after first- and nth-line interventions fail.
It’s also true for veterinarians, btw. My cat gets chronic bacterial UTIs. We spent years having vets and specialists tell us, “Nope, unless you spend hundreds of dollars on a cystocentesis every six weeks, we’ll insist the problem is behavioral and stress related and not give antibiotics. No, it doesn’t matter that the $20 course of amoxicillin worked the last 10 times and that if it did again the symptoms would be mostly gone before the cysto results even come back. No, we don’t count it as evidence that you can tell a flare up is coming a few days in advance by the change in urine smell. Your cat just needs to suffer until the culture comes back and you have to deal with her being completely incontinent and dripping blood,” (we diaper her at night and when she’s infected). “Also, you should have us do a cystoscopy even though we probably can’t because they don’t make a scope small enough for a six pound cat but you’d have to pay anyways if we try and can’t, and you should do an MRI that if it shows anything we almost certainly won’t be able to fix it surgically so it won’t give any new treatment options,” (we’ve done ultrasounds and they don’t find anything). Finally our own vet gave us as many bottles as we wanted and said to use them as needed, and everything was fine for a few years. We also cleaned up her diet and found out a big part of the problem was a prescription gastrointestinal health food she’d been on for a previous condition (or at least, the food interacted with a suspected anatomical defect that no one can find because she’s too tiny for tests to show it) (we think she can’t tolerate brewer’s yeast? maybe?). She only had two infections the whole next year. She’s now 13, and just had to switch antibiotics because she started showing signs of resistance to amoxicillin after 5 years, but we honestly hadn’t thought she’d make it even to 10.
They tell doctors, when you hear hoofbeats, think horses, not zebras. But there are also deer, and elk, and antelope, and buffalo, and lots of other hoofed animals. And sometimes there are zebras!