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[IPk] Medical Conservatism (was medical ignorance)

Am I right in thinking that - sociologically - academic research and
medicine are the two most hidebound and traditional professional areas of

Meaning in terms of learning new things and insisting that the profession
itself is the fount of all knowledge; having a strong "not invented here"
syndrome. That gives a strong scepticism to anything from outside the
profession, and a (possibly) blinkered faith in anything from inside.

I picked this up when I read in a book by Dr Andrew Walker
(sociologist/theologian at Kings) that these two areas still maintained the
medieval "apprenticeship" system for learning "how to do it" - you have to
be supervised by an existing professional for a number of years in your

Bit of a tangent, but I'd be interested to hear any views.


> -----Original Message-----
> From: Nanette Chana Freedman [mailto:email @ redacted]
> Sent: 30 October 2001 08:57
> To: email @ redacted
> Subject: Re: [IPk] was Sliding scale vs. pumps, now medical ignorance!
> Date: Sat, 27 Oct 2001 22:41:15 +0100
> From: "Tony O'Sullivan" <email @ redacted>
> Subject: Re: [IPk] Sliding scale vs. pumps
> >It is frightening how little many hospital staff know about 
> diabetes, 
> >say on surgical units and the like.
> I second that.  It has been my experience too when talking with almost
> all physicians other than those who really are specialists in 
> diabetes.
>  Watching the proliferation of medical literature (for which the 
> pressure to 'publish or perish' in the scientific/medical community is
> responsible) it is really not suprising that drs cannot keep up with
> the literature outside their specialty.  What is suprising and
> upsetting is the arrogance of those physicians who will not admit that
> their knowledge of diabetes was acquired n years ago in medical school
> and since they are human, this knowledge is a) only hazily remembered
> unless they use it regularly, and b) out of date.
> I have worked in hospitals for many years (as a Medical Physicist in
> Nuclear Medicine), and it was only when I started reading all about
> diabetes when I developed type 1 nearly 4 years ago, that I realized
> first how dangerous was the little list of blanket 
> recommendations in a
> recent highly reputable textbook on cardiac imaging about giving
> glucose and insulin to diabetic patients who come for certain cardiac
> scans for which they should be 'glucose loaded'.  It amazed me that
> none of my medical colleagues had ever questioned it - I shocked them
> by telling them that if anyone treated me according to those
> guidelines, I would for sure be out cold - I have been educating them
> ever since on this and other issues relating to diabetes and relevant
> to ensuring that diabetic patients are in an optimal state for various
> scans.  
> Some of them still thought they knew it all, but after an unpleasant
> incident where they had 'guessed' how much insulin to give a patient
> and sent him badly hypo (though since they were monitoring him closely
> and had an iv line in place to give glucose just in case, the incident
> was quickly dealt with), they decided to listen to me.
> I then found that I was being asked to take a major role in patient
> management decisions every time a patient showed up for a scan with
> high blood glucose, and aware that I am not a dr, and feeling the
> responsibility was too much and inappropriate, I arranged, with their
> enthusiastic agreement, for an endocrinologist to come and talk to the
> department, and he discussed with us the issues involved in 
> determining
> the optimal physiological state for scanning, and gave us some simple
> guidelines (way more intelligent and flexible than the textbook) and
> agreed to act as a consultant any time we cannot easily 
> decide together
> with the patient what to do (a lot of diabetics have very little real
> understanding of their condition and their treatment, regretfully -
> presumably due to a combination of doctors not educating them and
> patients themselves who do not really want to know, just want to be
> told what to do and not to have to think about it - I used to think
> this was a myth, that it was all the doctors' fault, but now believe
> otherwise).
> From the relatively few papers published on this subject (several by a
> very serious group in Finland where rate of type 1 diabetes is I think
> highest in the world), I guess that in most Nuclear Medicine
> departments, this issue is not taken seriously, and that as a result
> diabetic patients (assuming they escape the worse scenario of
> well-meaning but ignorant physicians sending them hypo) may get less
> than optimal images when they come for FDG scans (FDG is a radioactive
> tracer which is a glucose analogue - you see why it could be a problem
> area? - and is very useful for scans in cardiology and oncology).  We
> are trying to put something together for a paper on this subject, with
> the noble aim of educating the wider nuclear medicine community, but
> there is a lot of careful work required to do that, and it 
> won't happen
> any time soon - maybe someone else will get there first, and in spite
> of my need too to 'publish or perish', I would be delighted in this
> case if they do.
> This is of course only one example, relating to my specialty, but I'm
> sure one can point to numerous other examples.
> Nanette
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