A 23-yearh old medical student

[Dino]

I think the main idea is that the testers give us too little information to make an educated choice. It may refer to something they discussed in class.

 

Can't identify a picture by seeing only a few pixels.

[apache]

no, there's lot's of people with "aspd" who break the law and are cool with it, and we label them with disorder, because they break our laws... but laws and social norms vary from country to country, culture to culture, if you want to treat the question like a logic puzzle then sure, you have an operational definition, with criterion that are axioms, and after qualifying the diagnoses in such a fashion, you can check off the capriciously criterion, and the whimsical percentage of criterion you have to meet, unless you meet some criterion that is both necessary and sufficient (the criterions are so arbitrary that during the writing of the dsm 3 in 1980 spitzer's (the guy who chaired the dsm 3 committee) wife said that one trait of a personality disorder sounded stupid so they took it out as one of the criterion, lol), but the more objective the criterion become, the less generalizable, and vice verca, and either way you have a subjective interpreter interpreting the objective statements, even if they weren't baseless axioms, so where is the real diagnostic utility? besides having a billing code handy...

 

Accidentally deleted my last post so here are the criteria for OC personality disorder. Maybe he doesn't meet the right number of criteria so he might not have the disorder, only traits.

 

Muse: I 'm not sure that being egodystonic is necessary in order to have a personality disorder.

[thatonekid]

...a bunch of links...

Thanks for the LOLs.

[Dino]

Thanks for the LOLs.

 

......Ditto!.......

[thebouque]

I know that psychiatrists don't follow the DSM4 criterion by criterion but they look more at the general picture, biopsychosocial factors, longitudinal history and response to treatment AND the rely on the dsm criteria.

However, the DSM 4 and psychiatry isn't the only subjective thing in medicine. Medicine isn't as evidence based as we'd like it to be. How about chest X ray interpretation and otitis dx in kids?

I think that the DSM offers a guide, something that helps people to come up with a diagnosis. Of course psychiatry is culturally based, but so is behaviour, and psych is a behavioural science.

Muse what approach would you recommend to diagnose mental conditions? A different diseases classification altogether? How about things like differentiating between normal grieving and major depressive disorder?

[Femto]

I don't know about others who have yet to begin med school, but recently I have actually become concerned about the intellectual demands of medicine, in as much as it seems like the day-to-day work involves little understanding of the physiological mechanisms. Especially because I get pretty frustrated when I have a question and the best answer is "that is the way it is". For those in med school, do you encounter this "answer" a lot?

 

I know this is tangentially relevant at best...

 

 

I know that psychiatrists don't follow the DSM4 criterion by criterion but they look more at the general picture, biopsychosocial factors, longitudinal history and response to treatment AND the rely on the dsm criteria.

However, the DSM 4 and psychiatry isn't the only subjective thing in medicine. Medicine isn't as evidence based as we'd like it to be. How about chest X ray interpretation and otitis dx in kids?

I think that the DSM offers a guide, something that helps people to come up with a diagnosis. Of course psychiatry is culturally based, but so is behaviour, and psych is a behavioural science.

Muse what approach would you recommend to diagnose mental conditions? A different diseases classification altogether? How about things like differentiating between normal grieving and major depressive disorder?

[thebouque]

I don't know about others who have yet to begin med school, but recently I have actually become concerned about the intellectual demands of medicine, in as much as it seems like the day-to-day work involves little understanding of the physiological mechanisms. Especially because I get pretty frustrated when I have a question and the best answer is "that is the way it is". For those in med school, do you encounter this "answer" a lot?

 

I know this is tangentially relevant at best...

 

In ''broad spectrum'' clinical medicine such as family medicine or ER, forget about in depth knowledge of physiology/pathophysiology. All you need to know are the basics. Does that mean that it's not intellectually challenging? no. Clinical medicine in itself is very intellectually demanding even if you don't constantly think about the exact mechanisms all the time. Also, in undergraduate medical education in Canada, less and less time is devoted to the basic sciences.

 

However, the more specialized you become, the deeper your knowledge of the mechanisms is. For eg, an internist will have a sound understanding of the pathophysiology of most systems, but a cardiologist will have an extremely good understanding of heart physiology/pathophysiology.

 

Bottomline:

- In day to day practice, the more specialized you become, the more you know about underlying mechanisms (of your area of expertise).

- It's not because someone doesn't have a deep knowledge of pathophysiology that his job is not intellectually challenging.

 

As for your question about ''that's the way it is'', you mean when I ask my preceptor a question about why this drug has this effect? Most of the time the answer is look it up (whether they know it or not).

 

Peace

[thebouque]

PS: you still do learn quite a bit of physiology/pathophysiology in the preclinical years but most people forget most of it.

[aaronjw]

PS: you still do learn quite a bit of physiology/pathophysiology in the preclinical years but most people forget most of it.

 

Thats encouraging lol

[apache]

medicine isn't as evidence based as we'd like it to be

psychiatry isn't the only subjective thing

but we have a guide, something that offers diagnoses

 

diagnostics are useless in psychiatry... have you ever read any of my posts in the monetary value of conveying "expertise"? well, that's what a diagnoses does, it gives you social power too... sort of like the priests, who were the only one's that could read the bible in the old days... imagine some of these arcane diagnoses coming into play in court at a custody hearing, oh, dependent personality... well, interpreting those traits are subjective and have low clinical inter-rater reliability... and have huge consequences in the real world... no just medicine

 

there's no systemic way to become a good psychiatrist, that's my point, it's well known that patient response is completely independent of years of practice, accolades of the psychiatrist, grades in med school etc. but are very highly dependent on the shrinks personality variables... but that would sort of threaten the monetary value of their "expertise" now wouldn't it, so we give people 3 months of psych, let them off at 3 pm, and tell them to hush hush, and not to laugh too loud because there's really no explanation why all dr. x's patients do way better than dr. y's, even if they have the exact same training, use the same cbt, even write the same scipts... shoot, i guess it's back to shamanism, or at least an open market...

 

I know that psychiatrists don't follow the DSM4 criterion by criterion but they look more at the general picture, biopsychosocial factors, longitudinal history and response to treatment AND the rely on the dsm criteria.

However, the DSM 4 and psychiatry isn't the only subjective thing in medicine. Medicine isn't as evidence based as we'd like it to be. How about chest X ray interpretation and otitis dx in kids?

I think that the DSM offers a guide, something that helps people to come up with a diagnosis. Of course psychiatry is culturally based, but so is behaviour, and psych is a behavioural science.

Muse what approach would you recommend to diagnose mental conditions? A different diseases classification altogether? How about things like differentiating between normal grieving and major depressive disorder?

[Femto]

In ''broad spectrum'' clinical medicine such as family medicine or ER, forget about in depth knowledge of physiology/pathophysiology. All you need to know are the basics. Does that mean that it's not intellectually challenging? no. Clinical medicine in itself is very intellectually demanding even if you don't constantly think about the exact mechanisms all the time. Also, in undergraduate medical education in Canada, less and less time is devoted to the basic sciences.

 

However, the more specialized you become, the deeper your knowledge of the mechanisms is. For eg, an internist will have a sound understanding of the pathophysiology of most systems, but a cardiologist will have an extremely good understanding of heart physiology/pathophysiology.

 

Bottomline:

- In day to day practice, the more specialized you become, the more you know about underlying mechanisms (of your area of expertise).

- It's not because someone doesn't have a deep knowledge of pathophysiology that his job is not intellectually challenging.

 

As for your question about ''that's the way it is'', you mean when I ask my preceptor a question about why this drug has this effect? Most of the time the answer is look it up (whether they know it or not).

 

Peace

 

Okay, that makes sense. I guess clinical practice is not necessarily demanding of your knowledge of science per se, but other intellectually demanding skills, correct?

 

The answer "that's the way it is" was just a general characterization of a common frustration I am finding...as I slog through my last year of undergrad. If I ever have a question about how something works, I am finding that the answer most often describes a correlation, and not a causative mechanism. For ex, when a kid asks how a car is able to go down the street, an "answer" may be "well, the driver puts his foot on the accelerator". Which isn't really an answer.

 

I think in first and second year I just assumed that a response that outlined a correlation was sufficient...but now I recognize those are not complete answers, and my thought was this may be a common theme in the study of medicine, not just the practice of it, but hopefully I am wrong.

[NLengr]

Medicine is to basic medical science what engineering is to basic engineering science.

 

For example, an engineer may not know the exact materials science behind why cast iron has a higher melting point than aluminum, but they do know that if you are building a desiel engine, aluminum has a melting point that's lower than the burn temp of desiel, and therefore shouldn't be used as an engine block of a deseil.

 

In a similar manner, I can't tell you the exact mechanism of how troponin i is made by cardiac tissue, but I can tell you that given the correct picture of increased troponin i + chest pain + EKG changes that you are having a heart attack and need X, Y, and Z treatments.

 

Medicine is about applying science to acheive an end goal, not so much the science itself. If you want pure science, you want bench research. Medicine's challenge is applying incomplete and sometimes conflicting real world information to achieve your goal of patient care.

[thebouque]

Medicine is to basic medical science what engineering is to basic engineering science.

 

For example, an engineer may not know the exact materials science behind why cast iron has a higher melting point than aluminum, but they do know that if you are building a desiel engine, aluminum has a melting point that's lower than the burn temp of desiel, and therefore shouldn't be used as an engine block of a deseil.

 

In a similar manner, I can't tell you the exact mechanism of how troponin i is made by cardiac tissue, but I can tell you that given the correct picture of increased troponin i + chest pain + EKG changes that you are having a heart attack and need X, Y, treatments.

 

Medicine is about applying science to acheive an end goal, not so much the science itself. If you want pure science, you want bench research. Medicine's challenge is applying incomplete and sometimes conflicting real world information to achieve your goal of patient care.

 

Excellent post, I thinks it sums it up pretty well and I like the analogy with engineering.

 

On a side note, there are disciplines that are between clinical and basic sciences, ie anatomical pathology, medical biochemistry, medical microbio, medical genetics and heme (to name the most common ones).

[xkittens]

Medicine is to basic medical science what engineering is to basic engineering science.

 

For example, an engineer may not know the exact materials science behind why cast iron has a higher melting point than aluminum, but they do know that if you are building a desiel engine, aluminum has a melting point that's lower than the burn temp of desiel, and therefore shouldn't be used as an engine block of a deseil.

 

In a similar manner, I can't tell you the exact mechanism of how troponin i is made by cardiac tissue, but I can tell you that given the correct picture of increased troponin i + chest pain + EKG changes that you are having a heart attack and need X, Y, and Z treatments.

 

Medicine is about applying science to acheive an end goal, not so much the science itself. If you want pure science, you want bench research. Medicine's challenge is applying incomplete and sometimes conflicting real world information to achieve your goal of patient care.

 

damn!! I need to know why!

[m30wc0w]

no, there's lot's of people with "aspd" who break the law and are cool with it, and we label them with disorder, because they break our laws... but laws and social norms vary from country to country, culture to culture, if you want to treat the question like a logic puzzle then sure, you have an operational definition, with criterion that are axioms, and after qualifying the diagnoses in such a fashion, you can check off the capriciously criterion, and the whimsical percentage of criterion you have to meet, unless you meet some criterion that is both necessary and sufficient (the criterions are so arbitrary that during the writing of the dsm 3 in 1980 spitzer's (the guy who chaired the dsm 3 committee) wife said that one trait of a personality disorder sounded stupid so they took it out as one of the criterion, lol), but the more objective the criterion become, the less generalizable, and vice verca, and either way you have a subjective interpreter interpreting the objective statements, even if they weren't baseless axioms, so where is the real diagnostic utility? besides having a billing code handy...

i sort of disagree with you...

there is clinical relevance to a lot of personality disorders, because they influence the pathology of Axis I disorders. furthermore, they're very often comorbid with Axis I disorders. and just because different cultures have different values, doesn't mean that nothing is right; the extermination of jews in Nazi Germany was seen by many to be a moral good, yet everyone agrees that the systematic destruction of a people is wrong. furthermore, if you disagree with the notion of cross-cultural objectivity, then you're not just acting in the present sense, but the temporal sense too... which calls the notion of social progress into question. most (if not, all) people would say that, morally, western society has improved over the past 100 years; black people in the States are treated (for the most part) as equals and we care a lot more about the rest of the globe than we ever did (though we abuse it as much as ever).

i mean sure, different cultures DO have different laws... but understanding social conventions is, typically, what we view as something that's necessary for a human to survive. that's why, intuitively, we feel aversion towards people who are black sheep. of course, it be argued that we're just enforcing the tyranny of the majority, but the truth remains that having an internalized idea of values is important to surviving in society and, when someone violates those values, we feel that they are acting neither for the good of themself (because by violating the social contract they're jeopardizing their own interest) or the good of society.