Wednesday, April 12, 2006


Today I caught a patient in a lie. Well, not so much me, but when I discussed the matter with a third party, we honed in on the lie. He essentially lied about what I told him in order to get what he wanted. It regarded a test that I said was useless. He got off the phone and ordered another doctor, "Doctor NOS wants the test now."

Getting what we want. That's the thing we all want, isn't it. But sometimes you can't get it. Sorry. Particularly in medicine. We do not run a Walmart (and even in Walmart I doubt you could find everything, like Rhino Jerky). Your doctor will usually get a reasonable test that she doesn't think will help if you stongly want it. But few doctors care so little that they would get a useless test.

"What's the harm?" He asked me, more than once.

Well, that sounds like a reasonable question. But it is not the proper question. The proper question is "What's the benefit?" And if there is no benefit to the test, then there is no further need to ask about possible harm.

He didn't like that. That's OK. I don't particularly like him.


Blogger marybishop said...

Doctors already have the insurance companies dictating policies and procedures, they don't need the patients doing the same.

I think all the pharmaceutical ads saying "Ask your doctor if (fill in the blank with a drug name) would benefit you -- give patients the wrong idea about what their relationship with their doctor should be.

Demanding unnecessary tests; calling up to discuss what they just saw on tv etc. isn't part of the patient/doctor contract. Those TV ads should go -- maybe then the drugs would be cheaper.

12:55 PM  
Blogger acumamakiki said...

Oh lordy. This is a subject that permeates my life because my daughter is at an age where she'll say she's going to ask mommy or daddy to do the thing she wanted when the first answer was no.
As for the patient, well I'm not surprised. I'm all for patients advocating for themselves; sometimes it makes a difference. But to ask another doctor to do the test, on your request when it was exactly opposite, it's f-ed up. But not surprising. Patients often want to hold their practitioner responsible; it's YOUR fault, I'm not responsible. It's deeper than that with medicine, but with acupuncture there have been times that patients started telling me what I should do or what they've always had with the last acupuncturist they saw. Certain issues like weight loss or quitting smoking are loaded guns when they walk through my door and I've become much more frank as a result

5:54 AM  
Blogger Peg Spencer said...

Marybishop- You are SO RIGHT about those ads! I hate them. They are encouraging patients to make uninformed decisions about what they "need", and pressure the docs to give them something we might not think is best for them.

I'm all for being an informed patient. I like it when my patients have done some research about their symptoms or their illness, or even the medications. We can discuss it and make an informed decision together. What I don't like is when they demand something they don't need, like Doc NOS's Liar, or manipulate me or someone else, when they really don't have enough information and expertise to make the decisions they're trying to make.


8:56 AM  
Blogger echrai said...

A well-informed patient is a good thing. They make the doctor's job easier I imagine (coming from the legal standpoint) since it's far easier to handle disclosure. And a patient has a right to know their options, even the ones they probably wouldn't take. But a test with absolutely no benefit? I'd hate to have a doctor go along with that. And the patient? It doesn't fully surprise me, but come on, don't doctors have enough of a difficult time without having to take time to deal with 1. absurd demands and 2. clearing up the aftermath from a lie?

Although, I also have to admit, the legal profession is probably even worse with this. People who want to sue because they read about how much money someone got in the paper. People who think they know their rights but have never read the Constitution, let alone the law. People who see legal action as easy money, rather than a frustrating procedure best undertaken only if there is no other recourse available. But honestly, what can we do? The media's still going to keep a focus on healthcare and legal proceedings and do their best to make it interesting to Joe Schmoe.

9:50 AM  
Blogger Doc NOS said...

In any service industry - and in any human interaction - you've got to deal with the fucking nutballs. Lawyer, alternative or conventional doctor, to ditchdigger, movie goer, and at the playground. All the same. People are crazy.

The pharm sales suck, but I'm seldom asked to write for anything specifically. I almost feel bad for the pharm companies here. Because they certainly do not want to spend their money on advertising. They want you to need their product to stay alive or healthy. But it's the law of the commons that's driving it, and they're loosing cash because of it. I'm pretty sure the pharm companies would like nothing better than a ban on all tv ads, but that's not going to happen.

As far as patients being well informed, I've actually never encountered it. Some have some of the vocab down, some even have a course understanding, but as soon as you push, then there's no solid knowledge. I guess devoting a decade to learning medicine pays off. In this case, the 'knowledge' that was there was just enough to make this guy dangerous.

10:56 AM  
Blogger marybishop said...

And let us not forget the people with Munchausens Syndrome and the less severe manifestations of that syndrome; people so lonely, so looking for attention or so manipulative - that they will come up with neurological or abdominal symptoms that are not easy to disprove...

Should they be ordering their own tests and prescribing their own meds? I guess they're no worse than your run-of-the-mill liar...

12:58 PM  

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