Doctors Can Google The Same Subject But Look For Different Things

in STEMGeeks2 months ago

Note: I express my own opinions here and in no way should these be taken as medical advise.

It’s been a recurring joke among colleagues especially those involved in the field of medicine where doctor-patient interaction is a constant thing. In Pathology, 9.5/10 of the time is spent talking to colleagues, histopathology clerk, or medical lab technician. So for clinicians that had to deal with a lot of patient interviews, hearing the joke about their patient’s Googling their disorders has become a common icebreaker.

Call it out of pride for one’s profession but it’s perfectly understandable to be annoyed when someone who isn’t in the same field be ultracrepidarian during clinic visits. Around 4 to 5 years is spent learning basic medical studies as a post grad and another 3 to 6 years is spent depending on how complicated the field one wants to specialize in. That’s a lot of headaches cramming those countless books to make a physician out of you only to be told Google says it’s different.


It's a meme I made back when I was just starting out and got no clue what the hell I'm looking at the microscope. The image is a Serous Carcinoma. My seniors asked how I was doing after seeing I got piled specimens on the lab and this was the response I made on the group chat.

Having experienced life on both sides, I couldn’t help but extend more patience for those that aren’t as informed. You see, if we search for a disease like Breast Cancer, an average person would go looking for links about articles that express signs and symptoms, general treatments, and nonspecific safe answers for their case. While a doctor will search for the same disease in mind but looking for the specific treatment plan suited for the patient’s condition. Non-physicians don't usually go searching for How Tumor Mapping is Done.

There are algorithms to almost everything. If a disease is stage II, then it gets this treatment route but if they are at stage IV then they get this other treatment route or run palliative. The common areas where a doctor Googles the answer are the diagnostic criteria endorse by WHO, their association, and empirical research that backs up the criteria in mind. On the other hand, an average patient may just be contented with clicking on an article from some Hospital’s frontpage with the content and an endorsement to try to seek help on this x institution if they believe they got the signs and symptoms, etc.

So yeah, in a way, we can Google Breast Cancer together but still looking at the problem from a different angle. And this phenomenon isn’t just between doctor-patient relationships as even doctors can have these conversations. When talking to OB-Gyne, Internal Medicine, Pedia, or Surgery residents about the same case, we tend to have our own ways to learning it based on how we are trained.

Let’s say where’ dealing with an Endometrial Carcinoma, from a pathologist perspective, we’d be concerned more on what type of the endometrial carcinoma that is as the treatment and prognostication differs between type 1 and type 2 (worse). We would assess the morphology and whether it fits into our criterion (based on WHO updates, what our association adheres to, and etc.). Once the results are released, the OB-Gyne Oncologist would read the histopath report and stage the patient’s case, decide on how to approach the case (based on WHO and their association’s guidelines) as economic and family matters may affect the decision to continue treatment. None of that stuff is no longer my concern unless they get a second opinion from another Pathologist somewhere and their opinions would differ.

The above are Type 1 Endometrioid Type, Endometrial Carcinoma. Most often occurring among women at the child bearing age group but can still happen on menopausal age groups. Normal tissue is at the bottom part while the bluish parts are the tumor. The more solid/tight it looks the more it spells bad prognosis.

Throughout the process, we tend to share information or inquire how the other field of specialty treats the same case. Same subject but viewed on a different lens. The field of medicine can be as broad to the point that we may work in a single room as an interdependent department but our cubicles prevent us from seeing how the other departments operate in a figurative way of course.

Having acknowledging this to be a common occurrence, it made me feel less bad on asking the medical lab technicians stationed at the histopath often. They know more about processing specimens and same goes for those operating at the Chem lab equipment that I often only get to know more about on the books.

@adamada was here

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What struck me about this excellent post is who things keep being referred back to the WHO. Is there no room for disagreement with their standard practises and what if a doctor were to disagree? What is the path for a reassessment of the guidelines. What would happen if you went against the procedures your 'association aheres to' ?

Is there no room for disagreement with their standard practises and what if a doctor were to disagree?

There is but you have to have a lot of compelling research to back up your claim. The practice of medicine today is more about empirical evidence based practice. If no research supports the algorithm then it's a wobbly way to manage a case. One can put their name on the line but medico-legal instances would lean on to the credible body of consensus.

What is the path for a reassessment of the guidelines. What would happen if you went against the procedures your 'association aheres to' ?

Updates on the guidelines happen yearly some are just minor alterations in how format a report that makes it clear for everyone what you're talking about and it's not just your institution that gets it.

For example, "Endometrial Cancer, Endometrioid Type, x cm widest tumor dimension, FIGO Grade X" would be the current way to declare on the histopath report. While the previous way (just a hypothetical example) "Endometrioid type, endometrial cancer." The old format doesn't mention the tumor dimension and FIGO grading but was added on the new because it had bearing on the outcome, like how big is the tumor would affect the staging and teh FIGO grade is in relevance to how the OB-Gyne Specialists could use that as basis for their treatment plan. These are minor changes but the major ones usually happen around every 2 to 3 years as a lot of stuff has been happening and those include reclassification of Diseases to new categories as revealed by research.

It depends how one is sanctioned by their respective associations, there are several associations for each medical specialty and the laws also include how the international society for that association and local society are weighed. Ours just happens to remove one's name on the member list but they are still free to practice as a physician. They just don't get the perks of being part of the association if they are that bad.

Ahhhh OK, in the UK, we see 'struck off' after a medical mis-practise case but in this case, they most certainly cannot practise medicine in the UK.
There seems to be a lot of bureaucracy which I guess is necessary to a degree but making changes seems to be a very slow and laborious process.
Thank you for the insight and have a great weekend :-)

As much as I hate the bureaucracy of it all, it makes sense and everything is given due process. Likewise, enjoy the weekend too :>

but our cubicles prevent us from seeing how the other departments operate in a figurative way of course.

There have been initiatives at work where one MLS is screen sharing the work to the pharmacists and other internal medicine docs every other week.

This was by the order of our medical director, who is one of the head infectious disease specialists. The idea is to provide context to the process.

Like you have mentioned, there are certain processes the lab folks understand way better than the ordering physicians.

There hasn't been a long term solution to this recurring problem. Departments being out of touch with how the other operates. Initiatives like the ones you mentioned are often met with soft resistance like yeah we know but we're going to forget about it months down the road. Attending inter-department meetings attempt to solve this but it just ends up imposing more rules rather than having an understanding why those rules exist.

It's been a roller coaster on the management side lately. Being short on manpower, our department is being eyed as the human resource they need to man the ER triage because every department has to pitch in with the schedule and we got a free pass due to the nature of our work. The gist of the argument is, while we can man those positions (except for Surgery), our own department's work can't be replaced. IM, Pedia, Family Med, and some of the OB-Gyne work can be delegated to us as we got basic training to man the wards as part of the license.

While the opposite can't be expected if we were to ask them to cover for us when reading slides, cutting up specimens, and etc. It's a multifactorial problem and blaming another department in training is way better than actually putting the spotlight on the admin. Going to make a separate post about how our department is now the most disliked and lazy department just cause we do the background work and not the typical frontliners manning the wards.

Doctors do a lot in saving our life, they go through a lot of angles to define a particular issue because the have to calculate the risk that follows to save life and not hive wrong information about a situation.

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