We are a commune of inquiring, skeptical, politically centrist, capitalist, anglophile, traditionalist New England Yankee humans, humanoids, and animals with many interests beyond and above politics. Each of us has had a high-school education (or GED), but all had ADD so didn't pay attention very well, especially the dogs. Each one of us does "try my best to be just like I am," and none of us enjoys working for others, including for Maggie, from whom we receive neither a nickel nor a dime. Freedom from nags, cranks, government, do-gooders, control-freaks and idiots is all that we ask for.
We know, for example, that when a patient goes to his primary-care physician with a very common problem like lower back pain, the physician will deliver the right treatment with real clinical benefit about half of the time. Patients with the same health problem who go to different physicians will get wildly different treatments. Those physicians can't all be right.
Give surgeons a written description of a surgical problem, and half of the group will recommend surgery, while the other half will not. Survey them again two years later and as many as 40 percent of the same surgeons will disagree with their previous opinions and change their recommendations. Research studies back up all of these findings, according to Eddy.
One of the authors is a highly respected and experienced classmate of mine. That is to say we're both close to being old codgers. However, he has a meme to sell that is important to maintain his chosen career track. I am not so sure that electronic medical records, "evidence-based" medicine and computer based order entry coupled with rigorous government oversight is going to improve things.
One point ignored here is that about 3/4 or more of Primary Care medicine is really all about mental and emotional health. And despite all efforts, behavioral medicine is no fixed science with established double-blinded studies without bias to back up recommendations. Not yet. So whatever efforts a provider makes in these areas is likely to not meet a cookie cutter standard of care no matter what the "experts" and "current literature" proclaims is the only way to appropriately deal with a problem. Set in a milieu of toxic economic, culture and legal factors poisoning the practice of medicine, it is a wonder providers get it right at all.
When a patient goes to their primary care physician with a complaint of back pain, and they are not treated for their back pain, but alcohol and tobacco abuse, obesity, poor physical endurance/flexibility/ergonomics and depression, they really are getting quality care.
Most docs simply write a pain pill and a muscle relaxer, neither of which are indicated and often aggravate the underlying problems. Their motivation USUALLY is because this is what the patient requests or demands from the outset of their visit. Also its an easy way to make money for the visit with minimal effort, and at least initially results in a satisfied patient. The patients are not motivated to change their lifestyle or attitudes, their insurance is not motivated to have them approach the problem in a behavioral manner with repeated visits and counseling, physical retraining and coaching, and they usually complain loudly if that is what is offered to them.
After repeated visits and an unsatisfactory outcome, the frustrated practitioner refers the patient on elsewhere, often at the patient's insistence, for a "surgical solution" and expensive imaging. Thus they avoid the anger (which can proceed to tort) and dump the patient into someone's lap who can only make money if they perform procedures on the patient, who is demanding a procedure (to fix what their obesity/tobacco addiction/depression/lack of fitness/physical abuse of the body has engendered). Poor outcomes are fairly predictable.
It takes a lot to get me to see a doctor. Once I get advice, I read up about it before I take it. The chances of my agreeing to a non-emergency invasive procedure (or even a long-term course of medication) without a lot of preliminary research are slim.
I've usually found doctors pretty cooperative about discussing alternatives as long as I'm both pleasant and up-front about the fact that I'm the one who's going to make the decision -- not my doctor, and not my insurance carrier. I'm also the one who will accept the consequences of my own decision. I don't expect doctors to be 100% certain of most things. I just expect them to be prepared to discuss their level of certainty.
Heck, in Texas doctors can forget about their patients without having to be accountable. Literally, forget about them. The Tort Reform Act of 2003 protects them, whereby they can practice in any other state after they drop the ball.
Emergency Rooms in Texas can get away with "murder" under the Tort reform Act, because in Texas there has to be malice. Now can someone tell me how malice can be proven?
Had to make a video about this and sent it to every person mentioned in it, which included Ron Paul, the man from Texas who wants to run for President.
Or, just Google Cleveland Mark Mitchell, then click on youtube.
I even sent a link to the doctor who dropped the ball. Received the reaction I expected.
When there are laws on the books that prevent the common man from getting accountability, no telling what will happen.
Cilla Mitchell, Galveston Texas
30 years ago I had some balance problems with dizziness and assorted other symptoms. The internist forwarded me to a neurologist and six months of testing, etc. to rule out MS. It was a trying time as I wasn't sure if I had it or not and the symptoms didn't resolve themselves. Finally, the HMO I was in at the time decided it was time for a spinal tap to rule out MS. Which it did - no MS.
Turned out that I had a low level inner ear infection - a week of anti-biotic treatment and I was fine.
I mentioned this once to a friend who told me I should sue for emotional stress for the lousy diagnosis.
I told him that I was happy I didn't have MS and that was enough for me.
Doctors are getting less able to take a history and examine patients as they are reaching for high tech imaging that regularly reveals "incidentalomas" that require more follow up or invasive procedures. Persoanlly I am starting to despair... same thing with nursing - since it went degree based and not hospital apprenticeship model we have trained a generation of "clipboard nurses" who quickly disappear when confronted by human filth, misery and despair in any of its forms.