Hi Alan
Your message struck a chord with me, as I also still need to get out my
Christmas cards (but my excuse is that I sometimes wait till after New Years
so that I can reply to all the cards I get!).
Your comments about the medical profession are important. It takes awhile
after being out in medical practice to realize that we don't know everything,
and that we are not always right. I think that one of the most important
parts of maturing as a doctor is to learn to live with this uncertainty,
since when we start practice we have the expectation that we will know
everything, and that we will always be right, and also the expectation that
our patients will think that as well. Doctors have a high suicide and drug
abuse rate, and I think that having to live with uncertainty leads to a lot
of this.
Looking after patients with diseases like Parkinson's Disease teaches us a
lot. There is uncertainty in everything we know about this disease, and
everything we do to try to control it without making people worse. It helps
everyone (your doctor, the person with Parkinsons, their caregivers, their
other family and friends) to develop an alliance so that there is good
communication. Most doctors would rather have this type of relationship than
the althernatives. However, it does make more work for us (we have to keep up
to try to know at least the same amount as patients!), and its hard to admit
that you might be wrong about something (people do react differently to
things, and just because something is very unlikely to happen, doesn't mean
that it won't). I would like to think that most doctors are open to the
information that their patients provide, and if they don't know about the
information directly, will find out what the basis of the information is. The
word misinformation means various things to various people. To a scientist
working in a research centre, if you can't prove "it" with a double blind
crossover study, or if "it" hasn't been proven, then "It" can't be trusted.
To someone working directly with PD patients, if "it" works better than the
harm it may be doing, "it" is worth using unless most "experts" are pretty
sure its snake oil (something likely innocuous the sale of which is giving
someone exorbitant amounts of money). For someone selling some substance or
service for PD, there is always some bias towards profit, no matter what they
may profess, and subjective claims that are made should always be evaluated
with that in mind. For PD patients, like my father, and their caregivers,
like my mother, if "it" seems to work who cares what the cost is and lets
hope that it doesn't have any short or long term side effects. It helps me to
remember these various viewpoints when I tell someone that they've been
misinformed, or when someone tells me that I'm misinformed. In the end, it
always comes down to us as individuals (no matter what our previous education
or experience) to try to be as educated about things as we can, to filter and
weigh all this information, and to decide for ourselves wheth information is
"right" or "wrong", or useful to us or not likely to be useful. Doctors give
advice, but it is up to each person to decide for themselves what to do with
that advice. There are however some people who have a lot of anxiety, and
have great difficulty living with uncertainty, who need their doctors to play
the God role, who don't wish to learn for themselves, and feel better with
someone else doing it for them. Again I think it is a matter of experience
for doctors to be able to interact with people according to the person's
personality and needs, and not the doctor's own. Experience is a great
teacher, and that's why I find this list so helpful, and I think that most
doctors will also.People shouldn't  be afraid to talk to their doctor about
their expectations, and about their knowledge. You can always find another
doctor if the relationship doesn't work out, but there of course won't be
another person quite like you!
The other problem for the doctor is time, how to find the time that each
patient or care giver needs or wants. Again good communication and knowledge
helps to use time in an efficient manner.
Anyway, enough rambling at the end of the year. Hope you and yours have a
happy healthy new year!
Brian Symonds B.Sc. M.Sc. M.D.        <[log in to unmask]>