The reason why foreign residency programs aren't considered valid in the US is quality control, from both competency and medico-legal standpoints. If you were CEO of a private practice or hospital in New York City, who would you hire? A grad straight out of a US residency or one out of Swedish residency? The safer bet is the one straight out of US residency for numerous reasons: you can more easily trust and call his references, he has already likely taken the US medical licensing exams, you don't have to give him an English comprehension test, familiar with the mess that is US medical system, etc...
As a CEO of a hospital that wants to make money I would hire the Swedish grad for less and give him a 4 month US legal medical mess class for a lot less in cost that wouldn't involve a doctor. Since I'm known as a hospital that accepts non-us residency people, I can save a lot of money until the market resolves this inefficiency.
Also there are the other 5 anglo countries, which will have no problems with english. Many of these UK, german, etc grads could also be people from the US originally, so there wont be english competency problems there. Many europeans also have excellent english on average, like germans and scandianvians. It would be miles ahead of the average non-west euro immigrant software engineer that is very common in the USA.
QC and skills wise, I don't have much worries from these top tier countries medical practices. Do you freak out if you have to go to a hospital in Sweden because the doctors may be bad!?
Doctors are people like you and I. They are imperfect and make mistakes. There are plenty of brilliant doctors out there and not-so-good doctors out there. It takes responsibility on the patients' part to advocate for themselves, do some research, and find the right fit for them.
To add to this, I used to be very critical of doctors but having had various metabolic challenges and going off and learning all that stuff, medicine is a difficult confusing mess.
If you disagree, read this (about 2/3 of which is relevant to me):
There are thousands of diseases and not that many different symptoms. Most serious diseases have numbers of mild conditions that look very similar.
This is not to say there are not major issues with the way medicine is researched and practised. And that being a doctor does tend to encourage people to be arrogant and overconfident. And that the medical basically selects people who are good at memorizing stuff.
Make sure your physician is evaluating and treating your Lyme. Lyme is relatively uncommon in the Southeast US compared to the Northeast US so physicians here are not as experienced in treating it.
I would also seek a second opinion from a neurologist if you have not already. If you feel that you have cognitive impairment now, then the neurologist may feel that a brain MRI is indicated. This may not affect management, but may provide you with prognostic information.
While having a good memory is important for cognition, it is just as important to be able to forget memories. There are probably limits to how efficiently our brains can scan memories for information relevant to a given situation and having more memories decreases the efficiency of this process. Also, when you can find almost all knowledge about anything on Google in just a heartbeat, it's inefficient to try to memorize most things. As Einstein said, "Never memorize what you can look up in books."
It's not an uncommon strategy for clinicians to use questions like that to get parents or patients, who are dealing with an inordinate amount of stress, to let down their defenses with the intention of directing them to self-assess their resolve. The author may be able to take care of her child now, but how about when he's 18 years old, when his outbursts may start to hurt others. There are some families who are capable of overcoming the challenges of raising a developmentally disabled child to adulthood (such as this family) and there are some who can't. I've had patients break down and cry when asked pointedly challenging questions like this, however ultimately, this can be a helpful process for the parties involved when applied correctly.
I suspect that the author and others here have missed the true, veiled purpose behind the question, however that does not detract from the overall aims of her article or the clinician. In the end, the clinician's prodding has led to a led to a deeper raison d'être for both the author and the reader.
