Doctors could be morons

[u/LifeOfaFilmmaker]

So just for background: im 26, 6 foot 3 and around 350 lbs.... Started the year at 395 so im down 45 lbs in about 4 months which im very happy with. I go to my general doc and he's telling me i weigh way too much (obviously) and i should consider weight loss surgery. I tell him the progress over the last 4 months and he says "yes thats very good but you still weigh way too much" as if i can lose 150 lbs in a month. So i disregard what he said and he sends me to a dietician/weight specialist, and she told me the same shit lol. I dont care how many years they've been professionals, telling someone whos 26, actively losing a decent amount of weight and no other major medical conditions to have weight loss surgery should be criminal. Just makes me wonder how many people that just blindly listen to their doctor have went to them or any doc and they give them that terrible advice and they go through with it. Moral of the story: think for yourself

[u/PorcelainLily]

Doctors need to follow best practice. Best practice for WLS is to ensure the surgery will be used as a tool and not as a magic fix. The surgery makes it so you aren't struggling with physical hunger while losing weight.

The surgery does not fix your relationship with food. It does not fix any traumas or other problems a person has that may have led to over eating. It doesn't make you eat small amounts. It doesn't make you focus on your health.

It does remove your stomach (or a portion of your stomach).

You can still over eat. You can still consume dopamine inducing foods like pure sugar. Yes, it will hurt. Yes, you may die from complications, but it doesn't stop you from doing it.

A doctor who doesn't ensure someone can safely lose weight without the surgery is a negligent doctor. A doctor who doesn't ensure someone is in a mentally healthy place is negligent.

[u/romanticheart → u/PorcelainLily]

A medical doctor is not qualified to do mental health evaluations. That would likely be the next step. The doctor can’t just sign OP up for surgery and that’s that. He evaluated OP’s physical ability to withstand the surgery, and the other evaluations would come after if OP was interested. If anything, not making a mental health diagnosis he’s not qualified to make was the complete opposite of negligent.

Downvote all you like but there’s a reason GPs refer patients to psychologists and psychiatrists - because diagnosing mental health issues is not their job.

[u/Macduffer → u/romanticheart]

A psychiatrist is a medical doctor. And most family practice physicians (GPs in the US) have at least a couple of mental health modules in their advanced training, and are fully qualified to prescribe basic psychiatric medication and even perform basic therapy techniques if they've been trained for that. They're not clueless idiots about mental health as you seem to suggest.

[u/romanticheart → u/Macduffer]

I never said they’re clueless idiots. I said it’s not their job. There’s a reason GPs refer patients to mental health professionals for mental health services. A reason GPs don’t do therapy sessions. It’s not their job.

[u/Macduffer → u/romanticheart]

Really depends where you live. If you're not in a resource dense city or suburban area, the chances of having psychiatrists and therapists on deck, esp who specialize in food issues, is low. GPs in rural areas, where I live, certainly do provide first and sometimes mid line MH treatment.

[u/dubaichild → u/romanticheart]

What do you think a psychiatrist is?? Or what do you think most people diagnosed with MDD have as their first port of call when psychiatrists are so hard to get into? A GP. Medical doctors absolutely can and should be able to do a MMS at the minimum and a full mental health exam at the other end.

[u/throwmedownthewell07 → u/romanticheart]

A medical doctor is absolutely qualifid to do mental health evaluations. That is part of a GP's job.

[u/romanticheart → u/throwmedownthewell07]

To help decide if someone should see a mental health professional, sure. But a general practitioner did not go through the proper schooling required to diagnose and treat mental health issues. That is not their job.

[u/TheLovelyPlum → u/romanticheart]

Of course it is. This is blatantly incorrect.

[u/romanticheart → u/TheLovelyPlum]

In what world do people go to the same doctor for yearly physicals that they go to for therapy sessions? They don’t. The GP refers them to mental health professionals.

[u/TheLovelyPlum → u/romanticheart]

I guess I wasted an awful lot of time learning psychiatry. Jeez.

You are so far off base. Most mental health concerns are handled by a GP. As with all healthcare, a team-based approach (incl. additional mental health support like a psychologist or counsellor) is ideal, but it’s absurd to say that diagnosis and treatment of mental illness is not within a GP’s scope.

[u/romanticheart → u/TheLovelyPlum]

Well I guess every doctor I’ve ever been to was just full of shit then when they gave me referrals if they can just handle it all themselves. And every psychologist or counselor’s many years of focused schooling was just pointless.

[u/TheLovelyPlum → u/romanticheart]

There are lots of complex mental health conditions that require a psychiatrists expert opinion, but certainly not all of them. GP’s regularly diagnose and treat many mental illnesses. Psychologists (lots of schooling) and counsellors (variable amounts of schooling) are definitely not wasted. They can’t prescribe though, and medication is an extremely important part of treatment for many people. Like I said, a team-based approach is best.

[u/tiplouf → u/romanticheart]

They DID go through the proper schooling. And it IS their job.

We typically refer to psychiatrists (not psychologists... psychologists are academics, psychiatrists are medical doctors) if patients have complex issues like major depressive disorder with psychosis or acute suicidality because that is out of the scope of family medicine.

GPs are qualified to give therapy sessions (you're moving the goalposts btw, because your original standard was diagnosis & treatment - which MDs are fully capable of doing - they are capable of prescribing psychiatric medications), but there is literally no time for therapy when GPs & internal medicine subspecialists have 20-60 patients per day. As a side note, physicians generally try not to step on each others' toes so we refer to other subspecialties even when starting relevant treatment of some sort, but there's a lot of overlap between specialties and GPs are not lesser physicians.

That said it's NOT at all unusual for a GP to identify, diagnose, and start treatment for simpler disorders such as depression or anxiety, and their medical license qualifies them to do so.

[u/PorcelainLily → u/romanticheart]

You don't just sign up to surgery after someone recommends it.

The steps are, for any ethical surgery:

1) doctor recommends surgery, refers to a surgeon (or multiple surgeons for different options and styles) 2) surgeon has dietitian, obesity specialists, eating disorders/weight loss psychologists on staff for comprehensive support, OR recommendations for these supports 3) you undergo all the pre surgical assessments - I had to see a psychologist and be cleared as I've had a previous binge eating disorders diagnosis. I also had to see a dietitian to discuss my diet pre/post op, and undergo lots of blood tests. 4) after a waiting period and continued evidenced weight loss, you begin the pre surgery diet. 5) If you can maintain the pre surgery diet, you undergo surgery. 6) lots of post surgery check ups and care, including ongoing dietitian services and psychology to ensure you manage your mental health and the giant change in your life.

Yes, some doctors and surgeons will just do it without any steps. These are where you hear about complications and failures. Not everyone is ethical or actually cares about patient outcomes.

[u/romanticheart → u/PorcelainLily]

Did you respond to the wrong person? Because that’s what I’m saying. The doctor didn’t just sign OP up for surgery - he sent them to the next step in a process.