Comments on: Continuing today’s theme

By: Jill-Unnecesarean

Jill-Unnecesarean — Wed, 11 Mar 2009 17:37:19 +0000

Nowhere is this more apparent than in obstetrics. Add to it the philosophy that pregnancy and birth do not need to be pathologized in the first place and that the practice of medicine is best reserved for when it is actually needed and you get a century old struggle of responsibility between woman and doctor. http://tinyurl.com/c7e2a5

Great post and I loved your subsequent post on advice for patients.

By: dx

dx — Wed, 11 Mar 2009 14:29:41 +0000

@stargirl65: For all the comments I’ve gotten here (and elsewhere) about it, I admit that maybe I need to learn more about the antibiotics issue. But let me point out that jerks and idiots get sick, too, and nothing is going to keep them from being jerks and idiots. That said, I think most people don’t want to be jerks and idiots, and I can’t help thinking that at least some of the unrealistic expectations your patients bring in were taught to them by the medical system. So I applaud you for sticking to your guns, but I don’t think you can win it all by yourself. Patients need to learn not to look to doctors for easy solutions to all their problems. Doctors can help teach this, but it needs to be part of a process of patient empowerment. Unfortunately, a lot of doctors resist this because they fear it will diminish them, either in status or salary. I think there’s room for healthy compromise.

By: stargirl65

stargirl65 — Wed, 11 Mar 2009 13:55:22 +0000

You seem to be reasonable and informed. I agree with most of what you have said above. BUT I have patients that have a sore throat for one hour without fever that want antibiotics. Patients that state, “I have a cold and need antibiotics.” I explain to them why they do NOT need antibiotics. They then call me daily for the next 7-10 days begging for antibiotics until they finally are better. I do not cave in. Many patients have left my practice because I stick to my guns. Many have given me poor ratings on websites too. Luckily I own my own practice so I can do as I wish. Many employed doctors are pressured by their administrators to make the patient happy, even at the expense of good medical care. The other day a patient insisted on an MRI for their back pain of 3 days. I refused. They went to the ER. No MRI done there either, but what a waste. You seem to understand the bigger picture of health care. Most of my patients want it all and they want it now. They also want it for free. I have patients that refuse to take cholesterol medicines for high cholesterol because it is too expensive, but will pop about 12 vitamins a day.

Many of my patients medical problems would resolve with weight loss, exercise, a healthy diet, drinking in moderation, restructuring their stressful lives, and quitting smoking. I counsel this all day (even though insurance pays nothing for that kind of service). Insurance pays for me to order tests and give them drugs. No one wants to work to maintain their own health.

By: dx

dx — Wed, 11 Mar 2009 13:22:24 +0000

@anon305: Yes, doctors are superior – that’s kinda my point. Doctors are granted a lot of privileges and latitude within the medical system, at the expense of patients – yet Dr. Mintz seems to be arguing that patients should give up even more. But health care reform won’t work if it’s all about strengthening doctor’s position against patients. I think we’re starting to see quite clearly that the practice of medicine alone is not enough to keep Americans healthy; one of the the ways we can fix that is to stop treating doctors like they are the solution to the problem of illness. You wonder why patients don’t like bad news from doctors: because we’ve been trained by the medical system to think that doctors have a solution for everything (usually a pill). And where are these doctors who have an hour to spend talking at patients? Is it so much to ask them to spend some of that time listening?

By: anon305

anon305 — Wed, 11 Mar 2009 03:19:04 +0000

Uhhh… I hate to break this to you, but doctors ARE superior to patients when it comes to the practice of medicine. If I have belly pain, i have no clue whether its autoimmune hepatitis, appendicitis, perforated colon, or gastritis. I need the doctor to diagnose me and tell me about treatments.

Also you overestimate the willingness of patients to listen to their doctors when they get news they dont like. If you are convinced you need narcotic pain meds, then the doctor could spend an hour telling you why narcotics are a bad idea but you arent going to listen, you are just going to “doctor-shop” until you find one that agrees with you.

Same thing with antibiotics. People dont want to hear that they might have to wait a couple of weeks for a virus to run its course. They want INSTANT relief, and if you dont offer an instant relief, they will keep going to urgent care clinics until they find a doctor who will give them what they want.

By: dx

dx — Tue, 10 Mar 2009 17:24:29 +0000

@Reality: Welcome, and thanks. Yes, I am very much aware of my anomaly-ness, in part because I know my particular circumstances are rather unusual; but I do think my perspective puts me in a position to help other patients be more proactive and responsible in their own care. I agree that we need to reintroduce the “art of conversation” into medicine, and I respect the difficulties faced by many doctors (including yourself) in their practice. I guess the question is, how do we address those difficulties in a way that is not punitive towards patients?

By: Reality Rounds

Reality Rounds — Tue, 10 Mar 2009 15:45:24 +0000

I came across your website from Kevin MD’s blog. First off, very well written. Secondly, I rarely come across patients as well informed as you. You realize you are an anomaly? Because the majority of patients I see are scared, sick, tired ,in pain etc, they are often not doing cost comparisons for their care. It is the doctors and nurses responsibility to teach their patients, and to prescribe the appropriate treatments. Patients may “demand” a drug they see on TV for example. It is up to the doctors and nurse practitioners to patiently explain why it is not right for them. The art of conversation has been lost in medicine. Some doctors and nurses are afraid to converse with their patients because of time constraints or because they do not know the answers to their questions. As far as the every present malpractice threat, patients who respect and have a good relationship with their doctors, rarely sue.

By: Doctor vs. Patient: Nobody Wins

Doctor vs. Patient: Nobody Wins — Fri, 06 Mar 2009 08:30:30 +0000

[...] antibiotics, MRI scans, and the kitchen sink as the main culprits and needed to change their ways. Duncan Cross clearly believes this line of argument is ridiculous and offensive, equivalent to [...]