Update: What does clinical evidence really mean?

Discussion in 'Fibromyalgia Main Forum' started by lenasvn, Aug 27, 2006.

  1. lenasvn

    lenasvn New Member

    The reason I ask is because a few months ago my GP would not give me apiece of paper to DSHS to relieve me from work activities thru their cash assistance program. He said there was no clinical evidence that I was sick (labs, I guess, just my word and me coming in looking like a virus bacteria magnified). I had to stop recieving the cash assistance this spring because of this. He does not want to diagnose, and expect my upcoming Rheumy visit to be the thing.

    Now I started to think. What does clinical evidence mean? I understand as the rest of us that an MRI for a MS patient usually is the clinical evidence, for example.

    But then- how do a psychiatrist diagnose someone with depression or bipolar? Clinical evidence? I mean, the clinical evidence would be behavior, appearance, history.

    Wouldn't patient history, recurrent complaints, labs pointing to possibilities, etc- be clinical evidence?

    Please, if you have any idea or input, PLEASE RESPOND! I have some major difficulties because of this.

    Many, many thanks!!
    [This Message was Edited on 08/28/2006]
  2. Pianowoman

    Pianowoman New Member

    You do make a good point here. Generally, I believe clinical evidence would mean some abnormality on physical examination or some abnormality that would show up on blood work, x-rays, scans etc.
    That does leave the question of psychiatric evidence. There are clear criteria for psych diagnoses so I guess their definition would be different.
    I have never thought of it this way and it does beg the question'why?" Some doctors who believe in mind-body medicine would likely look on your case a little differently.

    Just my opinion
  3. lenasvn

    lenasvn New Member

    I am asking for my medical record from my doc to see what he have written so far. When it comes to DSHS, they say he doesn't have to do much more than write a note saying "diagnosis in process, please put a hold on work activities", and then sign it.

    He's excuse that there is no clinical evidence doesn't matter then (seems like) but he is not pleasant to argue with, as a matter of fact- I have avoided to see him because I sense he thinks I'm a malingerer.

    I've been thinking about a journal for a long time, but my brainfog have helped me not getting it done once the children went to bed,,,,I'm hopeless. Thanks so much for great advice, Hayley, I really appreciate it.

    Maybe the rheumy will be my best bet when it comes to a diagnosis so I can finally apply for SSDI and then I don't need DSHS anyway.

  4. suzetal

    suzetal New Member

    If I was you .I would find another doctor.Who can tell when you are sick by just looking at you.

    The minute my new GP saw me she knew I was not well at all.She has supported me 100% .So have the doctors (specialist) she has sent me to.

    I keep a copy of all my medical records.Even ex-ray explanations that I have them write out in detail.Blood test MRI Cat Scan bone density and bone scans.Everything.Even records of ER visits I have had.

    I am paying and want everything in black and white and written so I understand it.I have had no problems with anyone accepting my wishes.If one does I ditch em.

    You are sick and you need a doctor that will support this whether its in there text book or not.

  5. lenasvn

    lenasvn New Member

    he have not sent me to a neuro to evaluate my neuropathy or brainfog and vertigo and dizziness, or to a cardiologist with my postural tachycardia and inability to walk long distances or tolerate heat (MS has to be excluded if someone shows vertigo, neurological problems, heat intolerance, inability to move legs when walking daily for extended time, etc). He have not done everything he should have done as I see it, and I went to him in January, that's 7 months without help except for the rheumy referral.
    [This Message was Edited on 08/27/2006]
  6. lenasvn

    lenasvn New Member

    I appreciate your replies. As for having any tests done, I,ve had none done, it is unbelievable. 2 years and no test from MD's besides a couple of x-rays and standard labs.
  7. Loveyame

    Loveyame New Member

    I had a very old doctor when I started having major symptoms of this dd and his comment was that he did not have the time to check out each and every symptom I was having. BUT HE DID LISTEN!! I researched my symptoms and told him what tests I wanted ran. I told him the test and what the reason was for it. I ruled out lupse, ms, lyme disease by having the tests done. So in a long winded way I am trying to tell you.....Tell your doctor what tests you want done, and why. If he won't schdeule the tests for you then you need to find a doctor that will!
    The secret to the diary is to keep a pencil and piece of paper with you and jot down how you feel when you feel it-then write it in a journal later when you have time. Remember to date and time each jot. Also state your pain level from 0 (no pain) to 10+ (if the pain is so bad you can't function) this way the doctors can medicate your pain. Hope this helps
  8. lenasvn

    lenasvn New Member

    I am very weak and foggy this morning, but you guys are so helpful! I will ask for some tests. Especially a nerve conduction test so I can get the nerve pain/neuropathy diagnosed for future disability app. There are other things that needs to be diagnosed, but this will be the first thing since I used my hands in previous professions and lost them because of it.

    I'll get back to you during the day, I'm accually seeing my doc today for eye ball pain that I get every summer where only my Imitrex for migraines work. I found out some time ago he never documented my eye complaint. That's another pitfall, docs who doesn't document symptoms.
  9. Cromwell

    Cromwell New Member

    First thanks for the heads up on the new movie. I did not respond on your other post as people were getting mean. I really appreciate you keeping us informed.

    Clinical evidence. Yes. I have to tell you I carted a friend round the doctors and ER rooms last year and they kept telling us "There was no clinical evidence to support her claims of pain". She had a leg broken in several places that was not healing properly BTW. as well as having FM/CFS.

    Well she died in hospital, being ignored due to that "lack of evidence" aged 46.

    So I too, am bewildered by what this actually means. Just read a RD article re all the mistakes in labs and how to insist on rechecks and to ask what the tests are, and what they are for and what they are needed for.

    Love Anne
  10. lenasvn

    lenasvn New Member

    Thank you, I thought of removing that post, but thought my purpose was mainly to inform the ones who mentioned it previously so I kept it up.

    Your story about this friend of yours is a wake up call. My doc have already attempted mental diagnosis which my psychiatrist warded off, I have been apprehensive to go see him, but I need to bring him "back down" and let him know that any mental evaluations will be done by my good'ol psyk.

    He have not contacted him or my counselor during the time I've seen him, but instead attemted an "amateur diagnosis" to put me on SSRI's. I have severe reactions to them and refuse. My doc get mad, well, you can imagine the story.

    It will be interesting to see his reaction today, this means that he has to explain my symtoms on something else than "all in my head".
  11. mme_curie68

    mme_curie68 New Member

    Hi Lena -

    This used to throw me in school all the time but here is the medical definition:

    Signs - physical events that can be observed, measured, monitored: heart rate, blood pressure, pulse, body temperature

    Symptoms - what a patient describes to you as their complaint - chest pain, shortness of breath, insomnia, pain.

    Certain diseases can be diagnosed by symptoms only. Psychiatric diseases would be one category, fibro. would be another, in the absence of Lyme, RA that have signs for dx.

    BUT the problem with many autoimmune diseases is that they can be "active" symptomatically for many years before the physical, measurable signs are present. Which stinks. Royally.

    Madame curie
  12. lenasvn

    lenasvn New Member

    So fibro can by defenition be the diagnosis right now because of the consistent presentation, and many other things besides family history, etc. He could-if he wanted to, he just won't. I bet he never had to choose beween macaronies and noodles for dinner either.

    Added afterwards: or he could say "possible FM".
    [This Message was Edited on 08/28/2006]
  13. lenasvn

    lenasvn New Member

    today, and told him I cannot handle SSRI's. He seemed fine. I also told him I went to my psyk. to double check that I had no other marbles ratteling besides my PTSD. He seemed happy with that too, so he removed a row in my patient file about what he previously "suspected".

    He adviced me to try St John's Worth which is fine with me. He admitted that he is waiting to see what the rheumy will say since he can't diagnose, only suspect. he gave me a referal to an eye doc for my eye pain, finally.

    It worked out pretty good, and I have less pain in the summer and let him know that. I told him the basic pattern in my health (thru the year) he wrote down everything.

    I had to laugh, he wrote St John's Wart in the journal (I can see everything since he want you to sit close). I didn't have the heart to tell him about the spelling,,,LOL, LOL!
  14. Cromwell

    Cromwell New Member

    So nice to see you replying too. How are you? I have been meanoing to post looking for you of late. You are so smart and wise. Thanks for that definition.

    Love Anne

    Oh and Lena, please keep on pursuing following your gut feelings, I got a little stymied trying to help my friend as her family did not believe her either, had she been single I could have pushed more.
  15. lenasvn

    lenasvn New Member

    I will keep pushing.

    When you wrote to MME Curie I thought for a moment that you were talking to me. I thought "boy, she doesn't know me",,,LOL! Then of course my pooped brain connected the dots that it was for MME Curie.

    And my doc just asked about my brainfog today,,,
  16. mme_curie68

    mme_curie68 New Member

    Good for you!

    I'm glad you finally got that referral for the eye pain. Eyes are not an area of the body to be fooled around with.

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