Sandeep Jauhar, interviewing a cardiologist: “‘When I started in practice, I wanted to do the right thing,’ he told me matter-of-factly. ‘A young woman would come in with palpitations. I’d tell her she was fine. But then I realized that she’d just go down the street to another physician and he’d order all the tests anyway: echocardiogram, stress test, Holter monitor “” stuff she didn’t really need. Then she’d go around and tell her friends what a great doctor “” a thorough doctor “” the other cardiologist was.
‘I tried to practice ethical medicine, but it didn’t help. It didn’t pay, both from a financial and a reputation standpoint.’”
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{ 5 comments }
It’s not that he’s unethical, he’s just a bad physician.
A young woman presenting with palpitations may indeed have something wrong with her besides that double whammy of x chromosomes.
Where is the thorough exam and history, which could point to a host of horses to cause the palpitations…including anaemia and thyroid dysfunction, which could be pinpointed with ordinary bloodword, or perhaps a suspect medication or supplement, or eating disorder?
When that comes up empty, then what is the beef about resorting to reasonable tests to evaluate the palpitations? The point of her going to the doctor in the first place is to rule out something serious, not to be placated that “usually it’s not serious”, so its not ethical to catch real disease.
Chances are that woman with palpitations is anemic. You could at least ask her if she likes to chew ice. Would that be ethical? Or too much work?
pounding said:
“Chances are that woman with palpitations is anemic.”
Chances are that you aren’t “medical,” since you clearly don’t know what you’re talking about. In fact, you have ironically illustrated the point of the post, even though I’m sure you had no such intention.
Judgment in managing expectations is a large part of the visit, though patients seldom come to us specifically for that reason. Furthermore, as per the post, there is no incentive to help patients exercise good judgment. Ideally, this would be rewarded and it would result in efficient care (at a much better overall expense).
If you want a 10 grand evaluation for palpitations, by all means, please go for it; however, the corollary is that I/We shouldn’t have to pay for it.
You twist what I said. …and for one thing we are talking about palpitations in a “fine” patient.
Anemia and thyroid disorders both cause palpitations, among a host of other things. My point was that the doctor was unethically LAZY, unwilling to base his judgement on detailed history and examination.
I don’t see where you have any basis to make disparaging remarks about considering anemia before ordering every farking test in the book. Iron deficiency anemia is an incredibly common condition in women, and many anemic women have palpitations as a result of this anemia…
If he pronounces the female patient “fine” without even considering the simplest causes, he sucks.
Surprise surprise Sandeep! Have you figured out yet that the reason their are ethical systems in place precisely where doing that ethical thing is counter to your own personal interest? That is the entire point of ethical rules. If they didn’t run counter to your personal business interests, why make them!
How do these people get into and through medical school without figuring these things out!
pounding, where does it say what he diagnosed her with? Maybe she was referred by a PCP who had laready ruled out anemia and thyroid disease? You’re assuiminway too much. And you are obviously a dope.
Chew ice? IS that a vague reference to pica? which is a rare late com;ication of anemia. A CBC is just routine. He’s talking about expensive Holter/stress/imaging. Way to totally miss the point. He’s not laz. He’s just smarter than you.
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