Comments on: Good doctors sometimes may make patients unhappy

By: Allen

Allen — Wed, 17 Feb 2010 08:26:42 +0000

There are too many situations to judge saying "no" or "yes", though "say no" is a simple way to review a doctor.I did a brief intro of this essay here in chinese.

By: skepticus

skepticus — Tue, 16 Feb 2010 02:11:28 +0000

Doctors are only bad when they restrict in unjustifiable ways human choice. If people want to get addicted to pain meds, it’s their business–not doctors, not the governments. Making doctors government agents is absurd. Doctors are a retail service–and when we forget that, these “conundrums’ emerge.

CT scans? Make people pay for them out of pocket. Problem solved.

By: richard md

richard md — Sun, 14 Feb 2010 12:52:11 +0000

Best post I have ever read. Our hospital calls back every pt from the ER & asks how everything was. Pt’s say nasty things especially when they left the ER cursing me because I looked them up on “Inspect” & found that they were pill shopping. Administration wants our satisfaction to be 90% but that is probably not realistic. I am comforted that I am not alone in being villified for saying no; and I believe as you do that i should continue to do so when my judgement says so.
Thanks for this post.

By: Robert Berry, MD

Robert Berry, MD — Fri, 22 Jan 2010 15:24:16 +0000

Dr. Leap said it well:

“Because our government limits access to narcotics, I have to stand in the middle and make decisions about who does or does not receive them. This makes things ugly at times.”

So ugly that about a month ago a rural physician in Kentucky was shot dead in his office by a patient for whom he had refused to write a narcotic prescription. As a primary care and ER doc, alot of visits are about pain meds. In my practice, I do not take any new patients who require a narcotic on a regular basis, but I turn away patients daily with legitimate pain and stacks of records and MRI’s. Perhaps with the best of intentions has government decided to force doctors to decide who gets and does not get narcotic painkillers. The downside to this is:

1) puts doctors, nurses, and patients with narcotics at risk to having violence committed against them
2) keeps legitimate pain patients from receiving the care they need
3) encourages an underground economy that rewards potentially productive people for providing no real useful service
4) wastes a sustantial portion of the clinical time of primary care physicians when this time is already in short supply
5) fills our jails with opioid abusers.

Now…no one wants people to become addicted to narcotics. But is it the role of government to protect these people against themselves given the five “downsides” above and given the fact that this policy has not prevented narcotic addiction?

Maybe it is time for therapeutic narcotics to be dispensed in ways alcohol is and so take doctors out of the loop, allow legitimate pain patients unfettered access to the treatment they need, and decriminalize an activity the govt has not been able to prevent so addicts can get the treatment they need and return them to taxpaying jobs in the economy rather than tax consuming inmates in our prisons.

By: MB

MB — Thu, 21 Jan 2010 06:34:16 +0000

Wanna fix it? How about some tort reform?

But it’s just one of MANY things that is NOT in the House/Senate Healthcare reform bills that the team of Obama/Pelosi/Reid have tried to ram down our throats…..That’s exactly what the captain of the Titanic said.

Well said.

By: Dr. Mary Johnson

Dr. Mary Johnson — Wed, 20 Jan 2010 17:32:05 +0000

“We take no responsibility” is ALL about the lawyers and the uber-lititgious environment doctors practice in and hospitals/pharm companies currently operate under.

Wanna fix it? How about some tort reform?

But it’s just one of MANY things that is NOT in the House/Senate Healthcare reform bills that the team of Obama/Pelosi/Reid have tried to ram down our throats.

Even now, in the wake of “the big one” in MASS yesterday, Obama is saying it’s “full speed ahead”.

That’s exactly what the captain of the Titanic said.

By: SarahW

SarahW — Tue, 19 Jan 2010 22:29:04 +0000

Sometimes I think we ought to re-think the gate-keeper status of physicians to pharmaceuticals. It certainly would solve a lot of problems if abusers, who tend to remain a fairly steady percentage of the population, could feed their habits legally and face the consequence that are natural to their situation. Prudent people in real pain would then seek out a doctors attention and guidance for pain relief and be more likely to not only follow a safe regimen willingly, but to get needed relief currently denied them because physicians want to avoid encouraging lying and cheating addicts, and the heavy hand of the law coming down to hassle them thoroughly.

By: Edward

Edward — Tue, 19 Jan 2010 14:51:11 +0000

There are lots of ways to say no, empathetically, sarcastically, as a “know-it-all” doctor. Many times we can get to no and the patient will at least understand our reason and “empathize” with us for making the right choice, even if it is not the choice they want. Admittedly sometimes we will just leave them angry, but I find this seldom if I am “on may game” and do a good job of making sure the patient knows I have made a reasonable medical opinion that is just different from the one they wanted.

By: W

Tue, 19 Jan 2010 11:51:35 +0000

Acceptance of personal responsibility is a good thing, whether you’re the patient or the doctor. Increasingly, I find that every piece of paper I receive from our local clinic, every web site they create, every sign in their offices, includes some variation on “We take no responsibility…” And I’m supposed to trust these people to make good choices about my health? I’m supposed to shut up, be 100% compliant, never question anything, never try to break through the rush-rush-rush in the hope that something I say might actually lead to a faster, more accurate diagnosis?

If you’re saying “no” to patients who’re just feeding a drug habit (and I’d hesitate to call those people patients), good for you. If you’re saying “no” to accepting responsibility for the choices you make in the career you’ve chosen…it’s not that easy.

By: Lockup Doc

Lockup Doc — Tue, 19 Jan 2010 01:19:22 +0000

Well said, Dr. Leap. Generally speaking, we physicians want to be liked and want our patients to be satisfied. But the goal really should be good medical care, not placation. Fortunately most of the time it’s possible to arrive at a mutually agreeable plan. There will be other times, though, in any specialty where physicians must set limits in order to avoid prescribing unnecessary, costly, and potentially harmful diagnostic or treatment interventions. It’s our responsibility as doctors to see that we do the right thing. (I wonder how much money the U.S. really could save if we all avoided doing the unnecessary or inappropriate…) And being able to set appropriate limits is crucial for anyone providing treatment in correctional settings.