Comments on: Domhnall MacAuley on a dead certainty http://blogs.bmj.com/bmj/2009/07/10/domhnall-macauley-on-a-dead-certainty/ Just another blogs.bmj.com weblog Tue, 24 Nov 2009 05:59:59 +0000 http://wordpress.org/?v=2.5.1 By: Geoff Mitchell http://blogs.bmj.com/bmj/2009/07/10/domhnall-macauley-on-a-dead-certainty/#comment-4540 Geoff Mitchell Sun, 19 Jul 2009 10:49:55 +0000 http://blogs.bmj.com/bmj/?p=747#comment-4540 Thanks Domnhall for an enlightening article. To Claire, diagnosis of any medical condition requires working out the probability diagnosis, but not discounting the less likely. I'm glad someone took a good history, but am prepared to bet that when you walked (or were wheeled) in, MI was not the first thing on the doctor's list of probabilities. Something you said or the way you looked made the doctor notice that your presentation was sufficiently different to other 30-something year old people with chest pain that they looked further afield. Thank goodness. That doesn't stop doctors looking at the chip-eating obese amongst us and thinking they are a heart attack waiting to happen. You are right and so are they. Thanks Domnhall for an enlightening article. To Claire, diagnosis of any medical condition requires working out the probability diagnosis, but not discounting the less likely. I’m glad someone took a good history, but am prepared to bet that when you walked (or were wheeled) in, MI was not the first thing on the doctor’s list of probabilities. Something you said or the way you looked made the doctor notice that your presentation was sufficiently different to other 30-something year old people with chest pain that they looked further afield. Thank goodness.

That doesn’t stop doctors looking at the chip-eating obese amongst us and thinking they are a heart attack waiting to happen. You are right and so are they.

]]> By: Claire Jackson-Prior http://blogs.bmj.com/bmj/2009/07/10/domhnall-macauley-on-a-dead-certainty/#comment-4511 Claire Jackson-Prior Mon, 13 Jul 2009 16:04:03 +0000 http://blogs.bmj.com/bmj/?p=747#comment-4511 This line in the first paragraph makes me shake with rage. "With heart disease, our classic picture is of an overweight hypertensive smoker, living between the pub and the chip shop." It is the idea that anyone can spot illness this way could have cost me my life. I am a 36 year old heart attack survivor who was 8 stone at the time of my MI and had given up smoking, drinking and junk food 6 years previously. I think that far from finding a "likely candidate" for any disease, a much better way would be to listen properly to what patients are telling you, and not dismiss possible causes for their symptoms because they don't fit your preconceived ideas. This line in the first paragraph makes me shake with rage.
“With heart disease, our classic picture is of an overweight hypertensive smoker, living between the pub and the chip shop.” It is the idea that anyone can spot illness this way could have cost me my life. I am a 36 year old heart attack survivor who was 8 stone at the time of my MI and had given up smoking, drinking and junk food 6 years previously.
I think that far from finding a “likely candidate” for any disease, a much better way would be to listen properly to what patients are telling you, and not dismiss possible causes for their symptoms because they don’t fit your preconceived ideas.

]]> By: Ohad Oren http://blogs.bmj.com/bmj/2009/07/10/domhnall-macauley-on-a-dead-certainty/#comment-4503 Ohad Oren Sat, 11 Jul 2009 19:33:50 +0000 http://blogs.bmj.com/bmj/?p=747#comment-4503 Thanks for the enlightening article, Domhnall. What could it possibly be that makes 'cancer' such a latent beast, theoretically so hard for experts to decipher, and no less easily retrospectively comprehended? Could it be that the mutation-to-expression time gap obscures the so-called simple molecular processes from being understood on a phenotypic basis? Or that the unique multistep nature of environmental and genetic influences creates an equation too complex to manipulate? But those should not as much interest us if the clinical profile of the cancer patient you are talking about could somehow be defined. To that aim, someone should recognise how to 'solve' the next question: where does external factors bear more significance - in the induction of cancerous conditions or rather in metabolic/endocrinic/cardiologic diseases per se? One day, maybe, we will have in our textbooks scales of environmental impacts on various groups of diseases... Sounds imaginary.. Thanks, Ohad Thanks for the enlightening article, Domhnall. What could it possibly be that makes ‘cancer’ such a latent beast, theoretically so hard for experts to decipher, and no less easily retrospectively comprehended? Could it be that the mutation-to-expression time gap obscures the so-called simple molecular processes from being understood on a phenotypic basis? Or that the unique multistep nature of environmental and genetic influences creates an equation too complex to manipulate? But those should not as much interest us if the clinical profile of the cancer patient you are talking about could somehow be defined. To that aim, someone should recognise how to ’solve’ the next question: where does external factors bear more significance - in the induction of cancerous conditions or rather in metabolic/endocrinic/cardiologic diseases per se? One day, maybe, we will have in our textbooks scales of environmental impacts on various groups of diseases… Sounds imaginary..

Thanks,

Ohad

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