Heart for Medicine
I've been blogging since December and trying to find the right mix of information and interesting, maybe a little bit controversial, posts to keep people interested. Since I'm blogging for WebMD, you can be sure that I have some concern about not offending anyone outright. That wouldn't be appropriate, and it's not really me, for the most part.
There are some things that tick me off in medicine, such as the problems with professional liability and the need for tort reform, and I have alluded to them. Another is discussed in my last post, the idea that people should come to see me expecting to "buy in" to a plan of treatment.
Currently I'm thinking about lousy health care providers, and how passionate I am about doing the right thing for people. That means that when I spout off about patients needing to do what I'm asking of them when they come for my advice, there is a flip side: I owe them an obligation to be thoughtful about what I chose to have them do. I have to choose tests, medicines, and treatments with care and a purpose. There are a lot of providers out there who are "fishing" for their medicine. These people order a lot of needless tests, including blood work, or try medication after medication until something works, hoping to hit on a workable solution.
There is supposed to be a method to medicine; after a history is taken the provider develops a list in their head of possible causes of the person's complaints. The provider then performs a physical exam and comes to an educated conclusion about what he or she thinks is wrong and what the treatment options are. Only then are additional tests ordered to support the diagnostic conclusion that the provider has already determined to be the likely cause of the complaint.
I'm interested in what experiences my readers have had with this type of medical care. This is the part where I hope to stimulate some comments! If there is anything a blogger lives for it's comments about their posts, and I'm told that I have to be a little more patient about that as a newcomer to weblogs. That's easier said than done! But I'm hoping to get a big boost in traffic since I have been honored by being the lead off post at Grand Rounds today. Yippee! A great big thank-you to Kevin, MD for this honor.
Laurie
Related Topics: Diagnosing Your Doctor: What Should You Know?, How Much Does Health Care Truly Cost?
Technorati Tags: Medicine, Medical Blogosphere, ethics, Medical Practice
There are some things that tick me off in medicine, such as the problems with professional liability and the need for tort reform, and I have alluded to them. Another is discussed in my last post, the idea that people should come to see me expecting to "buy in" to a plan of treatment.
Currently I'm thinking about lousy health care providers, and how passionate I am about doing the right thing for people. That means that when I spout off about patients needing to do what I'm asking of them when they come for my advice, there is a flip side: I owe them an obligation to be thoughtful about what I chose to have them do. I have to choose tests, medicines, and treatments with care and a purpose. There are a lot of providers out there who are "fishing" for their medicine. These people order a lot of needless tests, including blood work, or try medication after medication until something works, hoping to hit on a workable solution.
There is supposed to be a method to medicine; after a history is taken the provider develops a list in their head of possible causes of the person's complaints. The provider then performs a physical exam and comes to an educated conclusion about what he or she thinks is wrong and what the treatment options are. Only then are additional tests ordered to support the diagnostic conclusion that the provider has already determined to be the likely cause of the complaint.
I'm interested in what experiences my readers have had with this type of medical care. This is the part where I hope to stimulate some comments! If there is anything a blogger lives for it's comments about their posts, and I'm told that I have to be a little more patient about that as a newcomer to weblogs. That's easier said than done! But I'm hoping to get a big boost in traffic since I have been honored by being the lead off post at Grand Rounds today. Yippee! A great big thank-you to Kevin, MD for this honor.
Laurie
An honor is not diminished for being shared.
Lois McMaster Bujold, "Shards of Honor", 1986
US science fiction author
Related Topics: Diagnosing Your Doctor: What Should You Know?, How Much Does Health Care Truly Cost?
Technorati Tags: Medicine, Medical Blogosphere, ethics, Medical Practice
14 Comments:
Hi Laurie - love your post/rant. I wish it would really work that way. Reasonable, methodical care. I went to a new internist last year. Had the complete initial phys exam and whole nine yards. Was told to start working on loosing weight and so forth. Took the advise, joined the gym and made a large concerted effort. Except I just kept getting tired. Was flat out exhausted. Kept working out though! But kept getting dizzy. And more dizzy. Finally a month later I go back in. I was just dusted off as benign vertigo. I said I don't think that is what this is. "Tough it out it will get better." I took a whole week of vacation as I was so run down and thought that would help. It did not. I finally was at a follow up with another doctor - who ordered a ferritin level. This was not going to be the "Plan" at Dr A until 4 more weeks. My level came back at 2. I have been on IV Iron ever since. I don't store it anymore and so I have to have it replaced. The "Plan" would have had me dead in another week. From my point of view method medicine sucks. Sometimes you need to think outside the box and oh, my gosh - actually listen to a patient's opinion. I live in this skin - I have a good idea of what is going on. Just because you have a "plan" sometimes you need to move on to plan B.
Laurie,
Welcome to the blogging community. I'm a health care lawyer who has been experiementing with blogs as a part of my practice for the last year. I noticed the new WebMD blogs via Grand Rounds and just wanted to welcome you and your colleagues to the growing health care blogging community. I'm interested in the growing use of blogs in health care by health professionals and patients.
I think you raise some interesting concepts in your post. Health care has become so driven by reimbursement issues and a need to move patients through the office quickly. Also, the splintering of health care (and lack of continuity of care for patients) due to the increasing specialization of offering health care is problematic to me. For example, last week my wife went to the pediatrician with our almost 2 year old. The 2 year old turned out to have strep. My wife had been feeling bad for a time prior and likely had strep but they could not test her and provide her with a prescription. Instead of treating the family -- she had to turn around and go to urgent care later that evening, testing positive for strep and making a second trip to the pharmacy for a prescription. This example illustrates some of the waste of time (and money) of both provider and patient and the need for more focused efforts on coordinated care.
Hi Laurie,
We are of the same mind on opposite sides of the coin. I experienced the most horrible time with medicine in the 2 year illness of my mother where she eventually died (my rant is at http://gag@judyanddan.com for gory details). I know there are those who would do well. But I found hospital administration blocked them, insurance companies regulated what they would do and hospital budgets and desire to not have medicare patients around over better paying ones dictated the day.
I share your fustration.
Judy
My spouse and I had to find a new PCP because our previous excellent one decided specilize 100%.
Our hunt took over two years. We expect our physician to work in partnership with patients.
We are very informed regarding our medical problems and expect physicians not to be defensive when we push back a little.
Since few (none) physicians offer compatibility interviews we had to blindly schedule very expensive intake appointments - and another, and another, etc.
I'd like to see a patient feedback data base to help in identifying the pros, cons and general experience with a paticular doctor.
My wife and I are new to this community. We came from a small SD town where our Doc was super. He knew us and he cared about us. He did many things for us in his office.
Now we have a PCP who refers us for EVERYTHING! It seems that these guys don't do anything but keep the gate for the rest of the community!
I am having some chest discomfort that we are currently working on. This call for a cardiology specialty. I have no problem with that, but it is the fourth new doctor I have seen in the past year and I am sure I'll see more before this is over (unless I don't survive!)
I have a question. Is it common practice for a cardiologist to prescribe a beta blocker and a colesterol inhibitor while he is completing his diagnosis?
Anyway, I am not real pleased with the way medicine is practiced now days. I long for my old doc, but I know that today we probably wouldn't get the kind of service we had been getting because of all the issues you raised in your comments about the "fears" that surround the practice of medicine today. I could almost see it in the eyes of the young doctors I am meeting.
Thanks for the opportunity to vent!
I live in a small Iowa town. I go to my PCP for all my small complaints. But I prefer to go to specialists for my OA. I have 3 Orthopaedic Surgeons. One for my knees and feet, one for my back and one for my hands. I prefer that because they specialize in those areas and I know that they will do better than someone else can. I go to Minnesota for most of my specialists. I go as far as 21/2 hrs. away. My PCP is about 20 miles away and I also go to my cardiologist in the Twin Cities and my Lung Specialist in a town about 40 miles away in Iowa. And yes, I have Medicare as my primary insurance and have not had a problem with any doctor taking me on as a patient but I have a good second insurance from my husbands employment. I choose all of my doctors carefully. Sometimes I am referred but if I don't like them the first time I see them, not the diagnoses, the personality or the job they do, I move on and find someone I like. That is my job as an informed consumer or someone who takes an active role in her own healthcare.
I have found that recently I went for a check up and and ekg was performed. The doctor, which is my regular one ran a EKG. He compared it with one that was 1 yr. old and found some changes. I told him when I was under some stress recently I had some sensations in my chest, He told me to make an appointmwnt with cardiac doctors and I did. They inturn discussed my slight pain w/ me. It turned out that I some fiberations,and have extra beats and am now awaiting the results of a Nuclear stress test and Echo and another test that took a series of pictures of my heart.
So to get to the point of The Plan I feel the needed steps were performed from my information that I passed onto my doctor.My doctor took what I was telling him and ran the EKG to see what was going on. My issue isn't the initial decissions of the doctor it's the quality of the care and treatment that I AM GOING TO GET NOW that they have found the problem. I think it's like that old saying Get another opinion that is the issue here.
I am certain things like the post stated get overlooked and diganosed wrongly all the time. Doctors don't know everything and why wasn't a blood test used to show the iron levels esp. if the exam was a complete physical? Thanks
very good information. when I go to my doctor, he is given a list of my symptoms, so none of them will be forgotten. He reads them, and we talk about them. then he asks me questions, does the exam, orders blood work, or any other test that may be indicated. I tend to worry that something worse is wrong, and he usually sets my mind at ease, and it is not as bad as my mind had conjured up.
My belief is that when a patient goes in, the doctor is not a mindreader, he needs to have all of the information about my condition that I can think of, even if it is not pertinent, that is for him to decide, not me. I pay him to treat me, however, I have to do some work also, like following his advice, let him know if there are any problems following the visit, keep follow-up appointments, get the tests done, take the medication, etc. He knows what to worry about way more than I do. If losing weight will help my asthma, then that is my job. He can treat the symptoms, but the patient must take an active part in the responsibility of their care. Too often, I have seen family members with chronic conditions get progressively worse only because they did not adhere to a diabetic diet, stop smoking, exercise, lose weight, then, when something catastrophic happens, they want to try and do the things the doctor told them a few years back. Only by then it is too late. And it is so sad, if only they had taken the advice seriously, they would not have had a heart attack or stroke, and would have a much better quality of life.
My doctor has told me for years to lose weight, several times it has come off and stayed off for long periods, then I get lazy, or whatever, and find that in the last year that I have put on thirty pounds! Whose fault is it? Who can I blame? Well, only me.
At the present time it is coming off again, and at my age of 57, I realize that it had better stay off this time, or be looking at some of the conditions my relatives and friends have. My doctor used to give me mini-lectures about losing weight. He stopped that after awhile, when he saw that I was not doing it. He knows that I know the consequences.
For me, I can remember having the thought, "it hapens to other people". Now I am realizing that my health is mainly my responlibility, the doctor can help me, but ultimately, it is my choice. Pay the price and be healthy, or be unhealthy, and pay the price for that. Your site is very good, this is the first time visiting, will read it each time I log on. Thank you!
my great doc. listens to complaint dose not lecture.orders what I think I need and what he feels i need.tells it like it is. is open minded if i suggest a medicine as treatment(that i have researched) knows no matter what he says the patient will allways do what they want anyway. knows his own limits of knowlege.never refuses to refer to a specialist.knows that x-rays can cause dna damage.believes his patient when they tell him the lst time what they think is wrong.Is able to get his patient a bed at the hospital in minutes if nessary.saves all the sample meds for the poor and uninsured.And finally knows most people don't all live to be 80.Also he knows his meds and keeps up to date with new meds.spends vac time helping the sick and poor around the world
i have a great doctor. i live in a small town in monticello, but my doctor is part of a larger group of doctors. i have found most of the doctors who practice there are great. they take the time to listen to the complaints and take them seriously. they are willing to help with problems other than the original one that brought you into the office that day. i'm getting ready to go to the dr for my asthma, but he is also going to help me with a weight loss plan, and getting allergy testing. and he's more than happy to do it too. my gynocologist is also with teh same group of doctors and he's awesome too. the people at this group are there to help, notmake money. cause god know, with the HMO that primarily services them, they don't get all the money. and don't forget about the nurses. they are critical too. they may only be in there for a minute, but they are the one that relays all teh info to the dr. so make sure to tell them everything. a lot of nurses knowalmost as much as the drs, so if you want to use them as a sounding board before you see hte doc, feel free, most welcome that. thanks a bunch for listening.
uif you think methdone sucks then you dont know what pain is..I think you shoud find someone that is on it now and ask me what I think???? or woud you have some one on something that you need to tack more&&&&&&&&&and more to become a rell pill head..??ask me and I will be more then happey to tell you were to go put your minde.
Hi Laurie, I am a self pay person. In December I casually mentioned my heart doing a few flip-flops to my new Dr. She sent me for a stress test with a cardiologist. He scared me to death by telling me what he saw on my test was NOT stress-it was very likely coronary artery disease and I should immediatly have a heart catherization or the very least a thallium stress test both costing approx $3,000.00. I opted for the thallium test-it showed no blockage so my husband and I left to winter in Fla as planned. My heart has been getting increasingly worse so I went to my father-in-laws GP. He is starting with blood work and a holter monitor. I recently received a bill for the thallium test for $6,000.00!!! I went to the hosp on Dec 27th to pay my bill in full and they did not have anyway of finding out how much it was. I was hoping for a tax deduction. The hospitol refused to discount anything. Anyhow, I am hoping the holter monitor and blood tests show what the cause is but I also am angry that the first Doctor didn't go theless expensive route first. Any thoughts on that? Thanks for listening to my rambling. It is 12:30 and I can't lay down because my heart races!
WELL I HAVE A COMMENT FOR YOU EVER SINCE MY DOCTOR FOUND OUT I HAVE HEPATIS C EVERYTIME I GO SEE HIM INSTEAD OF A GOOD PHYSICAL EXAM HE USED TO GIVE ME HE IS IN THE ROOM FO R LIKE 5 MINS WRITES ME A SCRIPT AND THEN WALKS OUT. BEFORE HE USE TO BE IN THERE FOR LIKE 20 MINS EXPLAINING WHY I FEEL SICK OR THE EFFECTS OF THE MEDS HE WAS PRESCRIBING NOW IT IS JUST IN AND OUT. ALSO TO PROVE MY THERY I GO BACK TO HIM ONCE A MONTH TO GET MY BLOOD CHECKED FOR MY THYROID AND I ASK FOR MY PAIN MEDS BE FILLED HE DOESNT ASK QUESTIONS HE JUST FILLS THEM BUT NOW HE PUTS REFILLS ON THEM KNOWING I WILL BE BACK IN A MONTH. HE SHOULD KNOW AS A MEDICAL PROFEESIONAL YOU CANT GET IT JUST BY BEING IN THE SAME ROOM AS ME BUT I FEEL SO TAINTED ANDHOW I ENJOY YOUR BLOGS
Hi everyone! I have WPW syndrome, aortic stynosis, SVT, andnerve damage around my heart due to an ablation that I had done, and now cuse me to get siezures and tremors. The doctor that I am going to now has been writing me a prescription regimine of Propanolol(beta-blocker) and Soma( for the pain in my chest that I get.) M Dr is on the verger on alzheimers and said that hen the pharmacy called to verify the medication and refills he said he never wrote me a prescription for that med. Now to add insult to injury he called the cops on me for forging a prescription. I have had nothing but problems with Dr.s since I was diagnosed which was when I was 9 yrs old I am now 23. I would give anything to have a doctor that listens to me and my problems and not look at my age and diagnose by my age. They dont get that all of the things wrong with my heart that they diagnosed me with causes EXTREME PAIN and I cant sleep I live in a small town and am now without a Cardiologist and on the last few meds I have left and am so scared to go back to the hospital. I feel like giving up sometimes. Im tired of the pain and the neligence that I have always endured from the Drs that have treated me. Thanks for letting me rant I have just really had it and dont know what to do. Thanks Shannon
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