Is medicating students the "new black"?

Parent Cafe
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<p>^Mimke, I am so sorry that happened to your husband. No one should diagnosing chest pains over the phone.</p>

<p>I do agree that it’s very possible to get a physician, who for whatever reason, just isn’t up to snuff. My husband’s neurological disorder was misdiagnosed. Two years later his new neurologist said “This is textbook stuff. I don’t know why your last neurologist missed this.” We also had this experience a few times with son’s pediatric group. A large group, you often saw different physicians. Some were superb and some didn’t seem to know squat. I had two different specialists for two different conditions my son had scratch their heads at the way those pediatricians diagnosed and treated son’s condition.</p>

<p>My brother’s newborn infant spent 8 months at a world-renown hospital being treated for a severe heart defect. The stories my brother can tell you about inept care they often got there are chilling. My brother made it his mission to understand his child’s condition and read medical book after medical book. He would go back to the physicians and question them and it really p*ssed them off but most of the time he was right. It’s unfortunate that patients can’t just trust their doctors on every single thing but the stakes are often very high and patients have both the right and obligation to participate and be knowledgeable about their treatment. </p>

<p>I’ve learned the hard way to never just accept a physician’s word for anything - especially if my gut’s telling me something different. My one unbending rule is I will not return to a physician who refuses to listen and take what I say seriously. There’s no excuse for that.</p>

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<p>great posts, mimk and momlive. Totally agree that ANY profession has good and bad eggs. And certainly one’s personal experience will color their opinion of that profession, especially when it comes to affecting their family members. In these circumstances it is appropriate to talk about the experiences they had with their doctors and what their doctors did (as you did, momlive) without painting all with a broad brush in such derogatory terms. Hard to believe that 80% of Drs are such incompetent boobs, as compmom reports. And yes, I take personal offense at that.</p>

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<p>I agree with you - it’s never as black and white as some people make it out to be. There are outstanding physicians, nurses and other medical professions and there are many excellent drugs out there. Just as there are outstanding plumbers, teachers, police officers, you name it and not so stellar ones. We all need to remember that people’s skill, intellect and aptitude exists on a bell curve. Not everyone is going to be in the top 10% nor is everyone in the bottom 10% - most people are simply ‘average’.</p>

<p>One of the most important lessons I have learned in life is to stop thinking it’s all or nothing and start thinking in shades of gray. Makes life a lot easier and less frustrating.</p>

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<p>Yes, there are incompetent doctors, doctors who don’t care, doctors who are careless. These things occur in any profession. It is frightening that they happen in healthcare because your life or your loved one’s could be at risk when a mistake is made on their part.
But it does happen.</p>

<p>I truly feel for those who blindly go to a doctor or clinic and just do what they are told, doing no research and trusting in the system. As with anything, you gotta shop around and be informed of what’s out there. It doesn’t matter what health care system we end up getting. The ones who will get the best care are the folks who are the most informed, aware, involved in their care. Affording alternatives is also important. I, too, pay extra to stay out of a HMO because I want more choice. I end up paying over and beyond what our insurance pays, as well, because I often go out of network and pay over reasonable and customary expenses. I realize I am fortunate to be able to afford this, but even more fortunate that I am able to make informed, sensible decisions.</p>

<p>Many a time, I hear complaints from people who are well to do about how long they have to wait for an appointment or how they are abused by a doctor or how they don’t like what their insurance is dictating. Well, health is very important. If you need a particular procedure or medication and the insurance is balking, if you can afford it, this is one time that it is important to cough up the money. Especially when your life can be on the line.</p>

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<p>I had three kids with my first OB GYN (changed for the last one for a variety of reasons.) I really, really liked him a lot. When my third child was born, he stopped by for two seconds the next day and was not mentally present. A few things were very off. I called his office at one point and told them that after years of being happy, I felt I’d had very weak aftercare. The office manager, without going into details, told me that he’d had the most upsetting day of his professional life around the time my son was born. I’m guessing he lost either a mother or a child or both. Regardless of what happened or how, he was probably devastated and I noticed he was mentally not there but didn’t know why. I tell this story to show that doctors are human. Who knows whether they just delivered a devastating diagnosis right before they saw us or worse? That said, Momlive’s brother’s experience is too common and there are serious problems in the current system. It seems they are particularly pronounced in hospital settings which is probably because communication breaks down between various professionals.</p>

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<p>Bingo! At my hospital we have recently instituted ‘team rounding’ whereby the physician, the nurses, the pharmacist and other care-givers round on the patient in a group so that there are no misunderstanding about the patient’s care. As you can imagine, some of the professionals have been resistant to this idea because of the time it takes but it’s been mandated in several service lines. It’s working well. We’ve also instituted a lot of other positive changes - for example patient orders are written on a white-board in the patient’s room along with all of the care-givers’ names. Every ER patient receives a personal phone call the next day from the ER physician who treated them. These physicians generally do this from home on their own time.</p>

<p>There is a growing awareness in health care that with the upcoming health care reform, hospitals and physicians are going to be held accountable for patient outcomes and therefore, care needs to be the best possible at all times. I think we will see some positive changes from this.</p>

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<p>There is also a growing awareness in healthcare, that physicians will be held accountable, while extenders provide the care. I guess we will see.</p>

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<p>So it’s better to be homeless with the medication in hand or the procedure done than go without?</p>

<p>If everyone, or even the majority, of people could afford to do that, then we wouldn’t be in the health crisis. It’s just maddening to me when people propose this as the solution. I too pay for things that my insurance does not cover, which means I’m incredibly lucky, not smarter or better educated or have done more research than the next person.</p>

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<p>Again, I have the time, education and resources to do exactly this (although I still run into far too many doctors who can barely contain their disgust that I think I’ve learned anything of value.) </p>

<p>In contrast to what other countries are spending with far superior outcomes, our health system should not come down to how good someones medical DIY skills are. I know the problem is complex as is the eventual solution. But blaming the patient? Good grief.</p>

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<p>I have a question about this:</p>

<p>While I know that the doctors and AMA usually recommend that patients do be well-informed and know how to ask questions, it seems to me that a lot of doctors that CCers/friends of CCers have questioned have a ton of disgust. Is it because they’re too busy, too irritated, or maybe their pride is a bit stung by this? </p>

<p>I can understand that forfeiting around 200k to dedicate your life for 8-10 years is really rough and causes a lot of mental stress, along with everything else related to saving people’s lives, but I thought there was a whole system in place for patient-doctor interaction? I’m just confused, because I thought there would be a lot more cooperation.</p>

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<p>Again, in those “sweeping generalizations,” I was describing the system, and many of the things I listed have been told to me by physicians themselves. I was not painting MD’s with a broad brush, but describing obstacles that affect both MD’s and patients.</p>

<p>I have long done research to prevent harm to my kids, and it can be uncomfortable with some MD’s, and some of these MD’s have skills that we need. So we have developed subtle ways of steering care without appearing to do so.</p>

<p>When we find a doctor who is truly not good to work with, we keep looking. And we find great doctors ultimately, and have been very happy with them.</p>

<p>However, here are some of the experiences we have had:</p>

<p>A major children’s hospital administering insulin to my child at 1 am: I asked them to consult me first, luckily because they had mixed up the decimal point, and the dose, which was therefore 10 times what was needed, would have killed her. What makes this worse is that they did not report the error in the notes, and actually changed the decimal point in the order and notes, to make it correct. I got a copy of this and they used a different pen to add “0” and a decimal.</p>

<p>An ER doctor and staff did an asthma treatment for one of our babies, very sick, and told me to take her home (3rd visit in 2 days). I refused, and they got a nurse to stay with me, as if I was irrational, while they talked about it. I asked for an oxymetry, which showed very low oxygen levels. They said, “Oh my God, the mother’s right” and she was admitted for 7 days. She was too tight to make the wheezing noise they were expecting. She would have died if I had taken her home. At least in that case, they apologized.</p>

<p>A doctor prescribed an anticonvulsant that has major effects of blood sugars (which we researched, but the effect was complicated, and this is a college student on her own). Paramedics had to be called for the 1st time in 20 years of insulin use, to revive the teenager. The doctor who prescribed the meds (neurologist who knew nothing about diabetes) yelled at the patient on the phone, blaming her, and dropped her as a patient. Luckily she was home: in he dorm room, she would have died.</p>

<p>I fell badly on icy steps, landing on my back, requiring ER care, where they did an x-ray, which was negative for fracture. For four months, I went to our PCP saying that my back must be broken, I was in horrible pain, and was told to be patient, it wasn’t broken. I was even sent to a chiropractor for adjustments! When I finally saw a specialist, I learned that spinal fractures didn’t show up on x-rays for 72 hours. My back was broken in 3 places.</p>

<p>My husband’s stroke did not result in paralysis, speech or motor problems. It hit his executive functioning, and caused a lack of insight,as well as other cognitive problems that are not immediately apparent. He told MD’s from the start that he was “fine” which went in the record. The MD’s wrote that he was “normal” because he could touch his nose and had reflexes. A local MD sent him to a local neuropsych. who said he was “just depressed.” He lost his disabilty. I researched and convinced insurance to pay for a neuro-psych who specialized in stroke, who concluded that he had no insight, found many cognitive problems, and concluded he could not work again. This specialist told me that not many MD’s understand this type of stroke, and don’t have time to research it. </p>

<p>I could go on forever folks. At least 20 more stories like this.</p>

<p>When meeting with the many good doctors we do find (and perhaps after some of these experiences I could get a little credit for being open-minded here about all the good ones), we talk about the system, and why certain things happen or don’t happen. I am not saying the doctors I am describing are bad people. The system has a lot of problems, and poses a lot of safety issues.</p>

<p>I have been told by at least 3 doctors that they are unable to do anything outside of appointments, by the way. One of them was a very caring alternative doctor. He would try to make contacts with specialists during the appointment, or research, but that was part of his paid time. One of them was an absolutely magnificent GI MD at a teaching hospital. We saw him in an appointment after a surgery that had gone quicker than usual, and he actually had a few extra minutes, so when we provided a specialist’s care he actually called while we were in the office. Normally, he said, he is too busy and cannot do that.</p>

<p>I have actually had trouble working for the last 17 years because coordinating care for a family with many health issues is so time consuming. And then, I have to act deferential and even act a lot less smart or informed than I am, to access care.</p>

<p>If you think I am bitter, then you don’t understand. I am way, way past that, but it is good for people to hear these stories. This is just the way it is. I don’t doubt at all the hard work and suffering of the physicians, not one bit. We are all caught up in a complicated system that doesn’t work.</p>

<p>There is one poster here who may be the rudest person I have ever encountered on these forums, so once again, I am going to try to stay out of this. But to that person: when you have walked in my shoes for 17 years, you will have a right to “speak” to me that way, but right now, don’t patronize me.</p>

<p>This is way off topic, so with apologies…</p>

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<p>@compmom:</p>

<p>I appreciate your post. I’m an incoming college student, who thankfully never had to deal with major medical issues of any sorts within my family. The only time I’ve seen anything remotely related to the health care system being not what it was, was with a good friend of mine, and even that explanation was shallow. It’s difficult for someone like me, who is not involved, to understand what could possibly go wrong, but I want to know as much as I can about what possibly could be wrong with the system, since I’m surrounded by people who say “I want to go pre-med” but without really thinking about it.</p>

<p>For everyone that has had major issues with the system, in attempting to secure good health care for your loved ones, what do you think needs to be changed within the system? Like, I’m starting to get a better idea of what’s wrong, but I still wonder why there has been mostly technological progress in healthcare, but not so much on the people interaction part.</p>

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<p>PM’ed you Serafina: lots of things going on to address all these problems, both in medical practice and medical education.</p>

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<p>compmom-
I totally agree with you that the healthcare system is in need of a serious overhaul. That said, unless I misread your comments, you did pretty clearly slam 80% of Drs (you said only 1 in 5 were ok) with generalizations such as:</p>

<p>from post # 39:

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<p>from post # 49:

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<p>So while yes, at the end you said <em>some</em> of the problem is due to the healthcare system and the insurance industry, you placed the bulk of the blame squarely on doctors. Not just your specific doctors, but doctors. If you had said in the earlier posts what you said in your last post, I would understand your concern better and perhaps be less offended. In the last post you talked about your specific experiences with specific providers, whereas in the earlier posts you damned the whole profession.</p>

<p>We can probably all share bad experiences with lots of professions (contractors are particularly on my last nerve), and probably all have awful stories with the healthcare system. I have my share with the healthcare system too and I am in it. Certainly the consequences of medical errors or sub quality care has a higher consequence than a sloppy contractor, electrician, plumber, construction worker, architect, etc. (well… not always-- some of those can have disastrous consequences).</p>

<p>Giving specific examples is easier to understand than sweeping overgeneralizations about drs. </p>

<p>And btw, I can relate to the comments about a decent neuropsych eval and the identification of executive function problems. If your insurance allows for an adequate eval (and not just a time-limited screen), a competent neuropsychologist should be able to readily assess executive function deficits. Feel free to PM me and tell me who you worked with, so I know which of my colleagues to refer to and which to skip.</p>

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<p>I am not a parent, but the prevailing attitude in my area is profoundly against over medicating kids. These days, though, it is very common to be over drugged. Frankly, I think that many times drugs are trying to solve poor parenting and bad behaviors, which certainly cannot be healthy for the kid in the future. If your kids do not have an definite needs for medication, I would not “push” it. (I am in no way advocating not using vaccines or anything like that just referring to behavioral control medicines specifically).</p>

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<p>What specifically do you think is a “behavioral control medicine?”</p>

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<p>Is there an emoticon for steam coming out of your ears?</p>

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<p>blueiguana
how’s this? :mad:</p>

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<p>That’s close enough. Thank you for trying.
I’m sure the look on my face IRL if someone used the term ‘behavioral control medicine’, and went further to tell me it was most likely a lack of decent parenting…I’d probably have to walk away.
So if we can make that emoticon being the back of my head, then we’re pretty close.</p>

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<p>And when your back is turned you can do this :p</p>

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<p>This is an interesting parallel to the physicians boards. I don’t know if you can read this, but here’s a link.
*<strong><em>Note</em></strong><em>"Target Audience</em>***This activity is intended for primary care physicians and all other physicians who see patients in an office setting.</p>

<p>But I don’t see anything harmful in what I have copied and pasted. ( How is THAT for paternalistic???)</p>

<p>The Satisfied Patient: Overprescribed and Costly
<a href=“Medscape: Medscape Access”>Medscape: Medscape Access;

<p>"Patient satisfaction is an important outcome of healthcare delivery, and patient requests for products or services factor into the equation that produces satisfaction. Research demonstrates that physicians may be too open to requests for specific medications. In a 2000 study, the satisfaction scores of 200 patients were correlated with disease outcome variables, and patient-centered care was associated with lower rates of death and in-hospital complications.[1] However, patient-centered care was also associated with higher healthcare costs. This review focuses on a 2010 study by Paterniti and colleagues[2] that revealed surprising prescribing patterns, based on standardized patients’ request for treatment. The researchers also analyzed physicians’ responses to these requests and offers strategies to improve patient satisfaction while practicing evidence-based medicine.[2]</p>

<p>Communication is at the heart of patient-centered care, but requests for specific tests or treatments can strain the dialogue between physician and patient. In a study of 887 patients, 84% reported making at least 1 request during their office visit with a physician.[3] Approximately 80% of these requests were granted, and acquiescence to these requests improved patients’ perceptions of their care. Of note, patients who had their requests fulfilled experienced fewer symptoms and health concerns at follow-up, but denial of patient requests did not change post-visit outcomes. In another study of patient and clinician behaviors, patient requests for specialty referrals increased the odds of referral by more than 4 times, and prescription requests increased the odds of getting a prescription nearly 3-fold.[4] Physicians noted that visits with patients were more demanding when patients requested diagnostic tests.</p>

<p>The issue of patient requests for medications is particularly sensitive in this era of direct-to-consumer advertising for prescription drugs. A study compared rates of requests for specific prescription drugs in the United States, where pharmaceutical advertising is legal, with those in Canada, where it is not.[5] Patients in the United States were more than twice as likely to request specific pharmaceutical agents, and patients who reported greater exposure to prescription drug advertising were more likely to request these medications.</p>

<p>How did physicians respond to these requests? They were nearly 17 times more likely to prescribe new medications to patients who made a request for an advertised medication, even though many physicians made it clear that they would not use these same advertised prescriptions for other patients with similar diagnoses."</p>

<p>Mea culpa?</p>

<p>PS jym626…if you can handle the criticism on the physician boards, you can handle ANYTHING!</p>