Knowledge is power. Increasingly, patients are demanding and receiving access to levers in the medical machine that would have been unthinkable a generation ago. The informed consent process, which I support, can overwhelm ordinary patients and families with conflicting and bewildering options.
Television and the airwaves routinely advertise prescription drugs directly to the public. Consider the strategy of direct-to-consumer drug marketing when millions of dollars are spent advertising a drug that viewers are not permitted to purchase themselves. The public can now with a few clicks on a laptop, research individual physicians and hospitals to compare them to competitors. The Sunshine Act publicizes payments to physicians and hospitals by pharmaceutical companies and other manufacturers.
Every physician today has the experience of patients coming to the office presenting their internet search on their symptoms for the doctor’s consideration. “Yes, Mrs. Johnson, although it is true that malaria can cause an upset stomach, I just don’t think this should be our first priority.”
There are now laws that permit patients to order their own lab tests such as cholesterol or glucose. Even registered nurses working in intensive care units are not permitted to order these tests without a physician’s authorization. Ordering diagnostic tests and medical treatments have always been under the purview of a physician or highly trained medical professionals. Who interprets the results? The patient? The lab tech who drew the blood? The cashier at the retail health clinic? A policeman? A hospital custodian?
I had an office visit with my own physician to discuss how best to manage my own cholesterol level. While this discussion did not have the drama of cardiac bypass surgery, it took time to consider the risks and benefits of various options along with my personal and family risk of cardiac disease. My point is that even two medical professionals had to navigate through an issue that had more complexity than one might think. Understanding the significance of a lab result takes nuance and medical judgment.
Patients already purchase all varieties of heartburn medicines over-the-counter, that years ago were out of reach. Should we permit patients to buy antibiotics, blood pressure medicines, statins for elevated cholesterol and anti-depressants? Why not?
Think of all the money the system would save. A depressed individual, for example, doesn’t have to waste time and money with a psychiatrist. He already knows he’s depressed. He can proceed directly to the Mood Aisle of the local drug store and get the pills he needs. Wouldn’t it be easier and cheaper if patients could just buy antibiotics themselves for those pesky colds and flus? No office visit or time off work for a doctor appointment. The fact that antibiotics don’t combat colds and other viruses never seemed to deter their use.
Eventually, patients can order their own colonoscopies, stress tests, cardiac catheterizations and gallbladder removals. Perhaps, we will see the creation of Amazon MedPrime. Feeling a little chest tightness? Just click the app, and the cardiac cath mobile will be at your door in 30 minutes or less.
Michael Kirsch is a gastroenterologist who blogs at MD Whistleblower.
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