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that eludes critical evaluation? In response I propose that it might be
unconscious feelings, making part of the diagnostic process that elude
such critical evaluation. In 1989 the Dutch neurologist Jos Snoek
published the thesis entitled: “Het denken van de neuroloog” (The thinking
of the neurologist). He had studied the the cognitive processes and
diagnostic strategies of a series experienced and inexperienced
neurologists. Snoek described that the diagnostic problem solving process
could be divided in two types: an analytic type and an intuition-based non
-analytic type. Experienced doctors have learned to rely on their feeling
that the pattern they recognize leads to a right choice one although they
have no complete argumentation for their choice. This type of feeling-
based clinical thinking will largely elude critical evaluation. Pattern
recognition is especially important for this intuition-based strategy.
Intuition is a combination of knowledge, intellectual abilities and
pattern recognition. Inexperienced doctors having not yet developed the
abilities of an expert miss the feeling that they can rely on the results
of their much more analytic way of problem solving. Thus, the diagnostic
strategy in routine consultations seems to consist of two forms of
clinical thinking: an “automatic”, quick, intuitive, non-analytic form and
a much slower, analytic form of clinical reasoning that is used to solve
difficult or unusual problems Ref.2 ========================================================================= No I am not a diabetes expert, I am a senior clinical study synthesizer Doc2doc posted at 31/7/2011 (in response to a message posted by doc2doc moderator Sabreena)
No Sabreena, I am not a diabetes expert and if I were I would not know what it means: to be a diabetes expert. You write that you are looking for a senior doctor with diabetes expertise and probably you mean: with expertise in type 2 late onset diabetes mellitus. I feel sorry but I am not the man you are looking for: I am a Dutch senior doctor in neurology who developed only in the last few years scientific clinical interest in diabetes mellitus. I became interested when I discovered that type 2 sugar disease (= type 2 diabetes mellitus) and type 2 free-copper disease (= "type 2 Wilson's disease" = “free-copper -Alzheimer's disease”) have much more in common than I had realized before. Just imagine: type 2 diabetes mellitus and free-copper Alzheimer's disease seemed to have in common: not only extracellular amyloid plaques but also a disturbance in copper metabolism leading to increase of free-copper. Just imagine: free-copper toxicosis might play a causal role in degeneration of island cells in type 2 diabetes!.
No Sabreena I think that I do not fit your bill, the more so because you are looking for someone who could fancy being the diabetes mellitus clinical champion for a year. Such a fancy is completely out of order for me. If you were looking for someone with expertise in helping young clinicians to learn how to synthesize evidence to improve clinical decision making in the treatment of patients with type 2 diabetes mellitus I would probably consider such a request.
As long as I do not recieve such a request I go on fancying that BMJ-Chief-Editor Fiona Godlee will invite me to write a paper in the BMJ on critical thinking on cause and treatment of type 2 diabetes mellitus.Ref.3========================================================================= In Response to moderator Luisad: Do doctors take vitamin (or other) supplements? . (BMJ doc2doc Hoogenraad / 9-8-11)
Luisad (doc2doc moderator) wrote that there is no evidence that supplements work and some evidence that they do harm and that in the latest Cochrane review was written that antioxidants may cause harm. She wrote that lots of intelligent people take them and she asked if any doctors we know take them.
Well I know a doctor who takes every day antioxidatve zinc supplements. He takes 50 mg zinc/day in the form of zinc gluconate tablets. He is convinced that oral zinc is the best antioxidative supplement for prevention of Alzheimer's disease (see: bmj rapid response tjaard hoogenraad 3 aug 2011). He takes the dose of 50 mg elementary zinc because, in a placebo controlled clinical trial of zinc for age related macular degeneration, this relatively low dose was sufficient to induce a significant improvement of the vision. The supplement did work and did no harm!
Luisad is right to warn for messing around with mixtures of various vitamines and antioxidants but she should not throw out the child with the bathwater. Anti-oxidatve zinc supplements should be evaluated just like any other medicine, that is by randomized clinical trials.
Tjaard Hoogenraad, retired neurologist, UMC Utrecht; Neterlands ; see: youtube: video: Alzheimer zinc; go to: www.alzheimer-copper.com; Ref.4=========================================================================
Breakthrough: Oral zinc for free copper toxicosis in Alzheimer's disease
3 August 2011By Alzheimer's disease I mean: Late onset type 2 free copper dementia
and by Wilson's disease I mean juvenile type 1 free copper disease. My message: Synthesis of the best available clinical evidence leads to the
hypotheses: 1. Free copper toxicosis is a causal factor in Alzheimer's disease2. Oral zinc is an effective and very safe treatment of free copper
toxicosis3. Evidence based clinical decision: early signs of Alzheimer's
disease: 50 mg elementary zinc/dayThis is the message I planned to present at occasion of the Alzheimer
Association International Conference on Alzheimer Disease in Paris on July
19th,2011. I did not succeed to realize these plans. Therefore I placed an
abstract of my paper on my website www.alzheimer-copper.com and I placed a
short video on youtube: Zinc for Alzheimer.