6 top medical comments, April 26th 2009

Here are some of the more interesting comments readers have left recently.

1. Mediaslackers on the UK’s proposed 48-hour physician workweek:
I agree there are significant dangers inherent with limiting the number of hours a doctor can work in a week, but I don’t think they are totally insurmountable or all that much greater than when a doctor is working 30 hours straight, getting a divorce and drinking too much.

The training period is much longer than in the States because of this as well, but with 6 weeks of vacation a year AND limiting the hours worked, you’re dealing with a much more sane group of people.

But do you honestly think any of the docs in the UK will even come close to 48 hours a week? Best they can do is closer to 60, but there are fully viable ways for them to work many, many more hours at a higher pay rate as needed. Doesn’t do much for saving the NHS any money, but it does lessen the effects you think will be so drastic on patient care.

2. Anonymous on whether patients should own their medical records:
If the patient owns them, they are no longer medical documents.

Either they’re written for the sake of the treatment (and for billing purposes, these days) or they’re written to keep people with unreasonable demands happy. I’ve never met anyone who wanted to read their own medical records that didn’t want them changed as soon as they saw them.

What is the point of creating the data in the first place if the physician’s obsevations, impressions and treatment plans can be altered?

3. Dr. Dave on Philip Markoff, the alleged Craigslist killer:
Need I mention how someone with sociopathic tendencies is actually an IDEAL candidate to be a doctor?

You’d want someone who can display sympathy (even if faked), impose pain on others (even if for the long-term good of the patient), and has a rather healthy ego (do YOU want a doctor who is racked with self-doubt?). If it were only for the lack of TRUE compassion (or a modicum of it), then your typical sociopath would be the IDEAL candidate.

Heck, I’m surprised MORE doctors are not hiding skeletons in their closets. I’ve known surgeons who hunt: if THAT’S not a contradiction in terms for one supposedly devoting their life to the sacredness of life, then I dunno what is!

I suppose we don’t see more MD killers because they’re doing well in this life, and there’s little motivation to risk it all for the sake of a dark passion/thrill.

4. Philanthropos Fogg on consensual doctor-patient sex:
The rules were written at a time when societal mores were different.

Nonetheless, I believe that even if the relationship is consensual, it can still be damaging insofar as it affects the reputation of the doctor and the profession as a whole.

While it will never be possible to prevent two people from being attracted to each other, it would be prudent for a doctor to encourage a patient to see another doctor if they start dating.

5. James Beckerman on whether radiologists should follow-up on results from pre-operative testing:
Asking a radiologist to coordinate care or provide follow-up is akin to expecting a cardiologist to recommend angiography or valve replacement based upon an abnormal echocardiogram ordered by a referring doctor.

While studies do suggest that providing clinical cues in radiology/echocardiography reports may improve certain aspects of follow up, some primary care physicians may take exception to being told what to do by a physician who has never actually met the patient.

Communication is appropriate, but its absence should not exempt the ordering physician from taking responsibility. If you order the test, you should be responsible for the results.

6. Anonymous on the anti-vaccine movement:
There are a couple hints of a silver lining to this Jenny McCarthy and Jim Carrey anti-vaccine nonsense. It, like the creationism/evolution debate, has continued the work of introducing the scientific method to the larger public. People are aware not just of the content (a lack of a link between vaccines and autism after a number of well done studies), but the process (how rational scientists examine evidence and postulate new hypotheses which are tested in a methodical manner).

Since its development in the Enlightenment, the scientific method has been one of the most enduring human discoveries, allowing us as a species to look beyond our own limited anecdotal guesses and superstitious beliefs about how the world works, which for thousands of years, was how we explained phenomenon we couldn’t understand.

The autism-causing-vaccine-controversy is predicated on belief in the absence of evidence. Four hundred years ago, well, that would be enough to make it true. Jim Carrey and Jenny McCarthy provide excellent models of that paradigm, which has dominated human thinking for millenia.

This debate allows us as members of the public to look at how far we have come, in that we have the ability to make hypotheses, test them, collect data, pool it, examine it, and make rational conclusions, so we don’t have to rely as much on belief or superstition to make sense of this world.

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