Diagnosis is a mix of economics, the medical system, culture, and a shitload of other variables I am leaving out. For any condition mentioned above, diagnosis rates that vary could be due to one country overdiagnosing, another country underdiagnosing, cultural variation in how the condition is percieved, or the medical system.
For example, my British father in law has rosacea. Undiagnosed, but I have it, too, and have done tons of reading. He has it. However, his British doctor has not diagnosed him. Why not? I don’t know, but my guess is that it has to do with socialized medicine, which has a higher threshold for treating things that are not fatal. If you have a limited pool of money, it has to go to more serious conditions. Rosacea is not serious, therefore no treatment. It could be, however, that rosacea is seen culturally as not a big deal–what is a little redness and a bumpy nose?
And some allergies that start out as nuisances can turn into ones that are life threatening. That’s why when you have a mild allergic reaction to something – let’s say you eat some peanuts and your throat gets scratchy and you get some skin irritation – you’re advised to avoid peanuts so the reaction doesn’t escalate the next time you eat a Snickers bar.
I didn’t think my seafood allergy was so bad at first – I got a scratchy throat, my lips tingled and my ears hurt, whatever. I could deal with that in exchange for snow crab legs and shrimp scampi. Then I ate some crab rangoons at lunch one day, and that evening I had big hives all over my face and chest. Not fun! Anaphylactic shock is even less fun, so no more crab rangoons for me.
You, too? So do I. I didn’t even know that it is a local curse. Does it have to do with those gazillion blackbirds?
I don’t know where you get your information, but it it incorrect. Being less than completely happy is a normal state. Dysthymia is chronic low grade depression. You don’t even have to be “depressed” to have dysthymia. The worst symptoms that I have are an inability to concentrate, a lack of interest in anything, and a lack of energy. It also interfers with normal sleeping patterns. With some other people it affects appetite and leaves you with poor judgment and an inability to make decisions. Some people feel a sense of hopelessness. And still others feel nothing. Just nothing.
And for people with dysthymia, it goes on and on for years. And they can develop full blown episodes of deep depression too.
Dysthymia can be a terminal illness. Please don’t perpetuate ignorance about it.
I very much doubt that the doctor is avoiding making a diagnosis in order to save money. That’s simply not how the system works. I think you might be closer with the possibility of cultural differences in the perception of the condition (one which I’d never heard of until now).
But you know the general point is true. With socialized medicine, you have to make hard decisions about how to use the available funds. Here? If you have insurance (and that is not a given, which of course is the problem with our system), and you need a hip replacement, schedule the surgery. Someone will be happy to do it. UK? Sign up for the waiting list, we will get to you when we can.
I am not saying either system is better, but I don’t think it makes sense to deny the flaws of socialized medicine, and this is one of them.
It’s subtly different from this. Some GPs will urge treatment for their working patients above others, some will recommend their whiniest patients for treatment first. There really isn’t just one big queue you have to join the back of!
The luckiest of us get a referral and have a race between NHS and (work based) private insurance. It’s no contest.
I read a paper some time ago that theorized that the reading of logographic languages would not be affected in the same way by dyslexia. The idea was that the speech centre is used differently for reading the different types of written languages, and therefore dyslexia has different effects when reading, for example, Chinese and English.
They dragged their feet on birth control pills for thirty years {!} because the medical profession, which has a shitload of political clout, was making a shitload of money out of abortions, and didn’t want to, uh, terminate the goose that was laying the golden eggs.
I just read in “The Language Instinct” by Steven Pinker that dyslexia is “often related to a difficulty in mentally snipping syllables into their phonemes”, which is obviously not going to be a problem in a language like Chinese where each letter represents a word. I’m not sure where Japanese fits into that, though.
Nope, just stories from every British person and British ex-pat I have met–and since my husband is British, I have met a few. Anecdotes aren’t evidence, but funny how the anecdotes match up.
A few more:
I don’t know any Americans under the age of 30 who have had teeth pulled and have not gotten some sort of bridge or replacment. Both my sister-in-law and my husband have had teeth pulled in the UK and were just left with gaps in their teeth. When my husband moved here, it took several thousand dollars to fix his teeth.
A British ex-pat friend of ours had a bad back. In the UK, he was refused surgery and had years of chronic pain. Here, he had surgery and is pain-free. His mother needs knee surgery, but is over 80 and has been refused. My mom is over 80 and had the surgery 6 months ago.
Look, I am not saying the UK systerm is bad. Under socialized medicine, everyone gets treated, which is wonderful. I wish we did that. The price, however, is that the treatment is rationed–it has to be. We ration by ability to pay (or having insurance), but if you can pay, things don’t get ignored. That leads to my real point, which is this: If you ration care, it is going to change how you diagnose and treat. Non-fatal illnesses will (and probably should) recieve less attention.
Just a comment on this, I don’t know of anybody under the age of 30 in the UK who has had teeth removed with no sort of replacement. How old are your brother and sister-in-law?
Just an anecdote from my side, my bottom front teeth are a little crooked (small bottom jaw pushed them together a little…nothing major) and when I was a kid I remember my dentist looking at the way they had come through and asking me to smile. Since I don’t show my bottom teeth when I smile he decided there wasn’t any point in putting braces on my bottom teeth to straighten them out (my top teeth are perfectly straight). Would this rationalisation have happened in the US or would the dentist just have slapped some braces on straightaway?
This could be that cultural thing, though, couldn’t it? Sparkling white (really, when did we start worrying that our clean healthy teeth weren’t white enough?) perfectly straight teeth with no cracks or holes in them are really important to a large segment of Americans.* Not so much for the British, as I understand it.
*It’s also your confirmation bias. I know plenty of under-30 Americans in rural areas with missing teeth and no desire to replace them. Again, culturally, it’s not a priority to fix. I also know plenty of poor under-30’s in urban areas without the money to get their teeth fixed. It’s only among the affluent that teeth are crowned or bridged instead of pulled and left gaping.
grey_ideas Both were under 30 when thier teeth were pulled. Sister in Law is 33 now, my husband is 31. This wasn’t years and years ago.
WhyNot, That is what is interesting. My husband and his sister are not from a poor family at all. Their father owns a business that is doing well, and they grew up in a 5 bedroom house that is huge for England. They travel extensively. I think that is what surprised me the most. Of course I have encountered poor people with missing teeth, and I should have said that. But these aren’t poor people, and with the US standard of dentistry, they would have replacements. Another dentristy example…my FIL wants his teeth whitened, but his dentist refuses because he smokes. Would that happen here? No, because the dentist would be happy for the business.
grey_ideas, Yep, you would have be subjected to the horror of braces.
Again, my point is this: In the US, doctors and dentists are rewarded financially for finding more wrong with you–it means you come back, and it means you are more satisfied with them, since they fixed what is wrong. In the UK, there is not that reward and resources have to be rationed. Those economic forces affect diagnosis and treatment. How can they not?
