The recent discussion of the appropriateness of bringing patients back to the office has really gotten me thinking about my overall philosophy of practice. What are the rules that govern my time in the office with patients? What determines when I see people, what I order, and what I prescribe? What constitutes “good care” in my practice?
So I decided to make some rules that guide what I think a doctor should be doing in the exam room with the patient. They are as much for my patients as they are for me, but I believe that thinking this out will give clarity in the process.
Rule 1: It’s the Patient’s Visit
The visit is for the patient’s health, not the doctor’s income or ego. This means three things:
All medical decisions should be made for what is in their interest, including: when they should come in, what medications they are given, what tests are ordered, and what consults are made.
Patients who request things that are harmful to themselves should be denied. People who ask for addictive drugs or unnecessary tests should not get them. Patients who are doing harmful things to themselves should be warned, but only in a way that is helpful, not judgmental.
All tests done on the patient should be reported to them in a way that they can understand.
Rule 2: Minimize
Many doctors and patients have a “more is better” mentality. This not only costs more money to the system, but it can cause harm to the patient. Read more »
Doctors are all-familiar with marketing efforts to promote new drugs, but once the new drugs displace older drugs in the medical marketplace, who serves as advocates for the continued manufacturing of older FDA-approved drugs?
In a short answer: No one.
For those of us dealing in cardiac arrhythmia management, this presents difficult challenges for patient care if people are unable to take the newer drugs due to side effects. These patients no longer have a fall-back option to turn to for medical therapy when the older drugs have become extinct on the marketplace. Read more »
*This blog post was originally published at Dr. Wes*
Spring and standardized school testing become synonymous in many areas of the country for many public school students, including for my own children attending schools in Massachusetts.
As this annual rite of passage rolls around, I’m reminded of how important it is to help our kids remember that they’re so much more than the sum of their grades, test scores, and project results. Think back on your childhood: What do you remember? Is it the grades, the teachers, the homework amount? Did you have standardized tests and, if so, do you remember the results?
I recall blips of taking tests and filling out scantron sheets for all sorts of tests throughout my educational life. I recall being in class when graded papers, projects and tests were handed back to us. But the moments I recall the most were the times I overcame a challenge or a hurdle that seemed insurmountable at the time — and grew from it in unimaginable ways. Read more »
*This blog post was originally published at Dr. Gwenn Is In*
Misconceptions about mental health can have devastating effects on individuals, families and communities. National Alliance of Mental Illness’ Wendy Brennan talks with Dr. Jon LaPook about the importance of education and treatment.
The essence of the moral hazard experience through a nice neighborly conversation:
Neighbor: These allergies are killing me. Happy: That’s terrible. I hope you feel better. Neighbor: I tried Zyrtec but it wasn’t doing anything for me, so my doctor prescribed ‘x.’ (inaudible drug name ) Happy: Does it start with an ‘x?’ (Thedrugs name is Xyzal.) Neighbor: Yes, it does. Happy: Oh, that drug (Xyzal) is nothing more than Zyrtec, which the company slightly changed the formula of and now they get to sell it as a patented medication at 10 times the price for the next 10 years. Neighbor: Oh, I didn’t know that. But you’re right. It was $110. Happy: Did it help you with your allergies? Neighbor: Nope. Happy: I guess you just wasted $100. Neighbor. I didn’t waste anything. My insurance company paid for it. Happy: Actually, we all paid for it with higher premiums. Neighbor: (Walks away.)
The doctor doesn’t care — he’s not paying for it. The patient doesn’t care — she’s not paying for it. But everyone complains that their insurance rates are out of control. It’s not insurance company profits that are making healthcare too expensive, it’s patients and doctors who don’t care.
Bundled care solves this problem because the doctor won’t prescribe a $110 medication and offer therapies with no proven benefit over less-expensive options.
It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…
I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…
I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…
When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…
I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…
