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Time Cover Article: "Q: What Scares Doctors? A: Being The Patient."

Old 04-28-06, 08:39 PM
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Time Cover Article: "Q: What Scares Doctors? A: Being The Patient."

http://www.time.com/time/magazine/ar...186553,00.html

Excellent article that discusses many of the issues with our healthcare system. I'm sure our other resident Otter doc, bhk will have much argue against, which is why I'm posting this in Politics. For me, this article rings far more true than not true. Regardless of your opinion of our much vaunted system, these are very interesting stories and some things that you might not know about.

Too long to paste, but it's here's several clips...

Friedman's doctors weren't incompetent. They didn't operate on the wrong breast or give her the wrong drugs or commit any egregious medical errors--and that is the whole point. While there are bad doctors practicing bad medicine who go undetected, that's not what scares other physicians the most. Instead, they have watched the system become deformed over the years by fear of litigation, by insurance costs, by rising competition, by billowing bureaucracy and even by improvements in technology that introduce new risks even as they reduce old ones. So doctors resist having tests done if they aren't absolutely sure they are needed. They weigh the advantages of teaching hospitals at which you're more likely to find the genius diagnostician vs. community hospitals where you may be less likely to bring home a nasty hospital-acquired infection. They avoid having elective surgery in July, when the new doctors are just starting their internships in teaching hospitals, but recognize that older, more experienced physicians may not be up to date on the best standards of care.
But [the doctor's] innate resistance to treatment carries a message for the rest of us as well. It requires almost a stroke of luck to enter a U.S. hospital and receive precisely the right treatment--no more, and no less. A landmark Rand Corp. study published in 2003 found that adults in the U.S. received, on average, just 54.9% of recommended care for their conditions. Average blood sugar was not measured regularly for 24% of diabetes patients. More than half of all people with hypertension did not have their blood pressure under control; one third of asthma patients eligible to get inhaled steroids did not get them.
Now that the family doctor has been squeezed out of that role, someone else has to step in. But even a doctor--family member may not be able to counter the complexity of the system. Dr. Berwick of the Institute for Healthcare Improvement tells the story of his wife Ann's experience when she developed symptoms of a rare spinal-cord problem at a leading hospital. His concern was not just how she was treated; it was that so little of what happened to her was unusual. Despite his best efforts, tests were repeated unnecessarily, data were misread, information was misplaced. Things weren't just slipping through the cracks: the cracks were so big, there was no solid ground.

An attending neurologist said one drug should be started immediately, that "time is of the essence." That was on a Thursday morning at 10 a.m. The first dose was given 60 hours later, on Saturday night at 10 p.m. "Nothing I could do, nothing I did, nothing I could think of made any difference," Berwick said in a speech to colleagues. "It nearly drove me mad." One medication was discontinued by a physician's order on the first day of admission and yet was brought by a nurse every single evening for 14 days straight. "No day passed--not one--without a medication error," Berwick remembers. "Most weren't serious, but they scared us." Drugs that failed to help during one hospital admission were presented as a fresh, hopeful idea the next time. If that could happen to a doctor's wife in a top hospital, he says, "I wonder more than ever what the average must be like. The errors were not rare. They were the norm."

After he publicized his experiences, Berwick was besieged by other doctors saying, "If you think that's terrifying, wait until you hear my story." One distinguished professor of medicine whose wife was hospitalized in a great university hospital was too frightened to leave her bedside. "I felt that if I was not there, something awful would happen to her," he told Berwick. "I needed to defend her from the care."
It's hard to find a doctor who doesn't worry about how medicine is changing, since they suffer at both ends: as providers of health care and as consumers. "What scares me most about the current medical environment is complacency with the status quo," says Martin Palmeri, an internal medicine resident at Dartmouth-Hitchcock Medical Center in New Hampshire. Burgeoning bureaucracies, managed care, the mass production of health-care services and a worsening malpractice climate only strain the doctor-patient relationship. In this environment, the patient, typically a physician's source of inspiration, can become the source of frustration."When I refer one of my family members to someone," Palmeri says, "I want to make sure that they are the type of physician who leaves no stone unturned and will burn the midnight oil if need be to ensure the highest-quality care possible."

What frightens doctors--young ones like Palmeri as well as older ones--is that those doctors may be harder and harder to find. Scientific knowledge improves, but the care doesn't keep up; it is easier to gather gigabytes of information than to acquire the judgment to apply it wisely. It might comfort the rest of us to think that with just a little more knowledge or a personal doctor at our side, we could get the best out of America's extraordinary health-care system without suffering from its gaps and failures. But since even an insider can suffer, we are left with the much harder challenge: to fix the system for everyone.
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Old 04-29-06, 12:03 PM
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No, I actually don't have any strong disagreement with what parts you posted. The problem is that information is exploding and it is harder to keep up with just your own field let alone multiple fields like the internists and FP's have to. There are so many people that I have referred to places like St. Louis University hosp. and Barnes-Jewish Hosp. that say they never ever want to go back because of impersonal care and hardly ever seeing the doctor.
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Old 04-30-06, 01:49 PM
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This thread does not deliver.
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Old 04-30-06, 02:24 PM
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As I noted before, I am still strongly against any 'tort reform' laws, because I have an extremely high level of mistrust of doctors, hospitals, insurance companies, their lobbyists and lawyers, and the politicians pushing such reforms.

They all may blame mainly litigation for the high costs of healthcare, but I believe there is so much more to that.

So doctors resist having tests done if they aren't absolutely sure they are needed.
I don't think this is true at all. I think it's the exact opposite. Doctors are feeling more pressure to actually do more, unnecessary tests, primarily because of pressure from the patient or the family members.
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Old 04-30-06, 02:41 PM
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Old 05-02-06, 01:15 PM
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Originally Posted by Ranger
As I noted before, I am still strongly against any 'tort reform' laws, because I have an extremely high level of mistrust of doctors, hospitals, insurance companies, their lobbyists and lawyers, and the politicians pushing such reforms.

They all may blame mainly litigation for the high costs of healthcare, but I believe there is so much more to that.
I think it definitely contributes. However, I do think that many doctors also use it as a justification for ordering too many tests and procedures. They can charge more, and since insurance companies are usually paying, doctors don't feel like they're charging the patient, so there's less restraint.

I don't think this is true at all. I think it's the exact opposite. Doctors are feeling more pressure to actually do more, unnecessary tests, primarily because of pressure from the patient or the family members.
Hmm...I think you may have misunderstood the context. I think they mean that doctors as patients resist getting tests done because they know how many are ordered unnecessarily and increase the risk of a complication.
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Old 05-02-06, 01:16 PM
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Originally Posted by wendersfan
This thread does not deliver.
Hmmph. I can't help it if bhk won't respect our adversarial relationship. If he won't disagree, what can I say?
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Old 05-02-06, 03:33 PM
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I think it definitely contributes. However, I do think that many doctors also use it as a justification for ordering too many tests and procedures. They can charge more, and since insurance companies are usually paying, doctors don't feel like they're charging the patient, so there's less restraint.
I'm sure that some doctors view ordering more tests with a financial angle but I don't think a majority of them think this way. We have been trained to address every complaint that the patient has. We're trained this way as medical students and as residents.
I think they mean that doctors as patients resist getting tests done because they know how many are ordered unnecessarily and increase the risk of a complication.
Depends on what you mean by tests. The usual high ticket tests that are done are CT(pretty much routinely done at every hosp. ER for abdominal pain or headaches) or MRI's. Those have very low complication rates. The thing that makes physicians hate being the patient the most is psychological, they lose the feeling of being in control and are at the mercy of someone else.
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Old 05-02-06, 03:47 PM
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bhk,

Is Barnes-Jewish hospital the same as Barnes hospital in St. Louis?

My wife, decades ago, attended Barnes for her anesthetist training.

Pardon my off-topic question.
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Old 05-02-06, 04:50 PM
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Is Barnes-Jewish hospital the same as Barnes hospital in St. Louis?
Yes, that is the one. My patient complaints with it don't have to do with the actual quality of care there but the fact that it is inconvenient(around a 2 hr. drive), the institution is very large(10 times the hosp. beds), and less responsive nurses, and less available physicians. All of this combines to make them feel that the care is somewhat impersonal. More than a few have said they feel like they're a treated like a number.

Last edited by bhk; 05-02-06 at 04:53 PM.
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Old 05-02-06, 10:58 PM
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Originally Posted by hahn
Hmm...I think you may have misunderstood the context. I think they mean that doctors as patients resist getting tests done because they know how many are ordered unnecessarily and increase the risk of a complication.
Oh yeah. My bad.

What I'm curious about is if the doctor was the patient and needed to keep seeing a specialist for maybe something like a long-term condition or disorder, would he or she prefer to keep seeing oniy one specialist or change specialists every now and then?

I think if people deal with the same doctor or specialist for too long, the relationship might get too comfortable or routine and some laziness may develop on both sides. I think it might be more healthy to familiarize yourself with different perspectives though YMMV.
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