Kickas.org Forums Ankylosing Spondylitis General Discussion #1 AS Web Support Group GP's Oblivious to AS

Hi Cindy,
The problem is...
I live in a place where there are not too many Rheumys to even choose from, unfortunately.

When I first went to him he was only one of two in the capitol city where I lived.

I would have went to that other Rhuemy, but his waiting list for new patients would have made me wait six months before even seeing him.

I needed immediate help.

Since then, I have even moved an hour away from where my Rhuemy has his office, and still I will be going to him, coz I've been told by my husbands GP that I should keep the one I have because there aren't any good Rheumy's in this/my present area either.

I live in West Virginia if that explains anything.


Sunshine Hugs

Scotty,
I'm afraid in my experience with GP's that's not uncommon, sometimes it's a case of re-educating the professionals. To be honest I've also had good GP's in the past, that are also prepared to listen.

The worst I have come across, as I went to him because I a was in total agony, his reply was:- can't do anymore for you, your just going to have to get on with it. Well that went down like a lead balloon & I never went back to see him again.

Fortunately things are better for me now, have a decent GP & Rheumy.

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Over the years, I have asked several Doctors this same question, How much time did you spend in the subject of "ankylosing spondylitis" during med school? The usual answer was an average of 13 minutes.

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You raise a good point as usual George.

I don't think that many people have an understanding of what attending medical school is really like. Here's what my medical school experience broke down into...

The degree is 4 years in total, with the first two years dedicated to 'book learning' and the last two years are for clinical experience. As for the 'book learning' forget any misconceptions people may have of it being like an undergraduate degree, with 15 hours of lectures a week plus some labs (depending on discipline). In med school we are scheduled from Monday to Friday from 9 am to 5 pm for approximtely 42 weeks of the year. That time could be any of the following: lectures, small group tutorials, anatomy labs, clinical skills sessions, patient encounters. Each year was broken down into 3 'blocks', and at the end of each block there was an examination process that lasted 2 full days, with additional opportunity for evaluation throughout.

The block which covered rheumatology came in the middle of my second year. This block included all aspects of neurology, all aspects of musculoskeletal system (including rheumatology), all aspects of opthamology, and some topics which were consistent throughout each block - medical humanities and clinical skills.

Rheumatology was taught to us in about 6 lectures over the course of a week with approximately 35 hours of other topics in one hour blocks. The lecture which included ankylosing spondylitis was about spondyloarthropathies and included: AS, reactive arthritis, psoriatic arthritis, enteropathic arthritis, and undifferentiated spondyloarthropathy.

This and every lecture in medical school is given by a specialist in that particular field, which means that someone who spends their whole career in one specialised area comes and talks to the newbies about it. Sometimes you luck out and find a gem of a doc who can remember what it was like getting pelted with information for 8-9 hours a day with only the beginning of knowledge base, but for the most part we get specialists who speak as if they're presenting a paper at a conference.

Sidenote - rheumatology was really well taught at my uni by newer docs who kept the information simple. Which leads me to another point - if we're learning a new disease at (literally) 15 minute intervals, you're going to (for lack of a better word) stereotype that disease. This means that AS happens to men who are in their 20s-30s who are HLA-B27 +ve and have back pain. With such an onslaught of information, it's difficult to remember that things predominantly happen to one sex or another (for example), but this is not an absolute universal truth. (And by predominance I mean anything greater than a 50-50 split of an ailment between the sexes.)

The next two years are, as I said before, clinically based. At my university med students rotated through different disciplines every 6 weeks, while doing 1 in 4 call, and wrote exams at the end of each 6 week period. Call means going to the hospital at some point between 6 - 8 am on a given morning (depending on the specialty - surgeons are notorious for starting very early), working your usual day, and then being the go-to person for your team that evening/night/early morning, AND THEN, you have to stay around to give all that information over to your team before you go home. For example on internal medicine I was at the hospital from 730 am on one day until at least 12 pm the next (you're supposed to go home at noon, but it rarely happens, 1:30 is a more realistic estimate).

While it would be great to rotate through all the disciplines, there just isn't enough time in two years to do it, so we do things like 'general medicine' or 'general surgery' but obviously don't have the opportunity to do all the specialties that exist. This is what my two years looked like: surgery (oncologic, thoracic, urology), emergency, anesthesia, community health, pediatrics, family medicine, psychiatry, internal medicine, oncology, more family medicine (x 2 ), palliatve care (x 2 ), radiology, aboriginal health. I also spent additional time inbetween 1st and 2nd year doing a rheumatology rotation and time inbetween 2nd and 3rd year doing a palliative care rotation.

I'm sure you know George that this isn't directed at you, but hopefully give people a better understanding of what medical school is like, and how with such vast amounts of information it's hard to take it all in. More often than not the ailments that stay with you the most are the ones that you see in your clinical years, but this is very much luck of the draw, and dependent on the incident/prevelance of each disease.

You (or someone else) made a great point about what the real role of a family doc/GP. They are access points to a greater (more detailed) system. The know a lot about a little, and are able to direct people to specialists as need be. They also overlook everything that is happening for that patient, as many specialists have tunnel vision about their discipline, and may not recognise that the patient has other health concerns other than the issue they deal with personally. In a fee-for-service system like Canada, where doctors are paid for the tasks they do (and things like couselling and good ol' fashion histories and physicals are paid peanuts) GPs are (relative to other professions) horrendously underpaid and undervalued. Why have I chosen such a thankless job for my future profession? It's because you get to have long lasting relationships with patients, and you help them navigate a complex medical system, you manage the whole person and not a disease entity within it. I find it personally rewarding, if not financially.

Thanks to you and other George who stick up for docs in this and other threads. Like any profession, there are good and bad, and I've seen my share of bad (even learned along side some of them). But honest to goodness, there's a lot of people out there that do it because they simply like helping people, and couldn't imagine their lives' work to be anything but.

Hugs,
Jeanna

hi Jeanna, how's it going? I don't get to come here as much these days so may have missed any progress reports - any more exams on the horizon?

Hope all is going well, sorry your first Winter has been so long lived, although i guess you're used to that!

I just posted about this in the womens forum.


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My GP told me that my back pain is just the normal aging process when I came to see him in terrible pain at the age of 22. I found a new one right away. Which is not that easy with a husband of course. But I remember being sooooooo mad! He obviously didnt consider AS a disease. When I was in the spa in a half year from this, I wrote him a long letter about how ignorant he was etc. I was of course polite. I never sent it to him. Maybe I should find it and send it now.

Jeanna, thank you for that. It's so hard for those of us who are trying to work our ways around the healthcare system to truly understand why docs don't know everything. Your post illustrated very well why that is.

As someone who's seen the system from both sides, how would you suggest we get the word out to the medical community about a specific disease?

Many hugs,

Thanks for posting this Jeanna, especially at a time when we have so many new members who "know so much more" about AS than their GP's do. Your explanation of the roles of Family Doctors and their relationships to Specialists is important for all of us to read and hopefully understand the role of a GP.

I haven't told you this before but, I have had two of my GP's, one of my Specialists and a Doctor from a walk-in Clinic, all spending some of their free time in tuning in to KickAS to see what people are talking about and find out what the latest horror shows with AS are. They are all fascinated about the NSD and baffled by the amount of medications some ASKickers are taking without first stopping the medications previously prescribed.

I am going to keep watching this thread for sure.

Thanks for clearing up some of the mis-information and beliefs that are passing around here.

Hugs,
George

Hi Scotty,

Take a look at the post by Strutsy down the page a bit. It will answer some of your questions and concerns and as well, give you a better understanding of the relationship of a GP and a Specialist.

While a Specialist would understand why your presentation of the disease is different than the previous patient who just left his/her office, a GP is limited to thinking of AS in a much different way as he or she may only have two or three AS patients and they all have a different presentation of their disease.

When I first saw my GP as a patient, he knew enough about AS to understand what it was all about even though he wasn't aware of the hundreds of different symptoms that his future patients with AS may present. But now, he has several patients with AS and he has learned a lot more and on my regular visits, we share AS information and learn from each other.

Give these GP's a break. Maybe they don't yet know every detail of Scotty's AS foot problems but do know the details of OldGeorge's AS and connections to his other problems. A GP doesn't want to be a specialist, they just want to get you to a Doctor who is a Specialist in AS.

I've told my GP a lot of things about AS but I don't gloat over it and think I would be a better Doctor than him. Knowing more about miscellaneous symptoms of AS than your Doctor is interesting but so what? Just tell your Doctor what they are and it may help him to decide what the best course for treating you will be. I work with my Doctor, I don't compete with him. And he does one hell of a good job in treating me though I have to admit that my Farabloc belt did boggle him but he now accepts it as another method of getting pain relief that works for me.

George

George,

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I haven't told you this before but, I have had two of my GP's, one of my Specialists and a Doctor from a walk-in Clinic, all spending some of their free time in tuning in to KickAS to see what people are talking about and find out what the latest horror shows with AS are. They are all fascinated about the NSD and baffled by the amount of medications some ASKickers are taking without first stopping the medications previously prescribed.

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That is nice to know because my GP and my Spine Surgeon also come to kickas.org to learn more about us and how to help us with AS more.

John

You may be having a problem similar to what is happening to my right leg for the last few years. In the area L4/L5 was where I had my "straighten the spine" surgery several years ago and for the last few years, the nerves in the surgical area are being covered and compressed by calcification and are now acting in a strange way.

And to add yet another problem, I have developed cysts along the spinal cord which were also found to be affecting the nerves in the spine and these may have to be removed soon.

See if you can get some nerve conductivity testing done to locate the origin of this problem. I am going to get this done again soon for my problems.

Hope they find out what is happening to you.

George