Is medicine shady?

[Street Philosopher]

Not saying that it is, just asking. Here are some reasons why I sometimes think so:

1. all doctors (not surgeons) do is push pills to patients. basically, taking a history, exams, etc, is all done to figure out which medicine to prescribe.

2. drug companies throw money at doctors, trying to sway them to use their drug. why is it that college athletes get punished for getting a few gifts here and there, but it's ok for doctors to get free tickets to basketball games paid by drug companies?

3. doctors don't really know if a medicine will work. it's like "here take this, and tell me how you feel later. if something bad happens, i'll give you a different pill"

4. when all the drugs don't work, the doctors just send patients to surgeons to do the real work.

I admit these reasons aren't well thought out and may be wrong, but when i asked my older sibling (who is a physician) if medicine is a scam, she tended to agree that it was a scam in a way.

what are your thoughts?

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[kreno]

Indeed, many of the things you say are correct... except what you say with regard to surgeons. you'd be surprised how many Surgeries are unnecessary, unproven, and parallel in many of the same respects that you just mentioned - ie personal incentives, etc. In fact, surgery is worse in some regards... new techniques and surgeries are often not put up to the same type of "double blind" standards that are required for pills in the USA. historically though medicine has always been like that... but i'm an optomist, and i think it's getting better.

 

[cchoukal]

I think Schoolboy raises an excellent point, and one that I've been struggling with for the last year or so as I've gone thru the application process and started medical school. I've often thought that for a good percentage of what walks into a primary care physician's office, a good computer algorithm could weigh the symptoms and come out with a pretty plausible diagnosis and treatment, and that all we'd really need are good programmers and good technicians to operate the computer (entering presenting complaints, current medications, etc.) and deliver the diagnosis. The fact that current prescription decisions are somewhat heavily based (depending on whom you ask) on marketing from big pharma, this idea makes even more sense; while it's impossible to remove this bias from a human being, you merely don't wait "marketing" in the computer algorithm. Anyway, I was pretty sure all this would work for a large number of situations. And then I got sick.

It wasn't really a big deal, but for a week or so, I was scared to death, and the only thing that made me feel better was the reassurance from my doctor who I perceived to be an expert. There's just something about that human contact and the perception that the person knows what they're doing... I can't quite explain it, but having experienced it, I know it exists.

Now, that said, if THAT is what we get from doctors that we couldn't get from my proposed computer algorigthm, we're going about medical training all wrong. I shouldn't say ALL wrong, most schools are at least paying lip service to the therapeutic relationship and teaching patient interaction skills and things. Anyway, this is a huge interest of mine, so I'll be curious to see what kinds of things get posted here (that is, before it inevitably degrades into a shouting match like most other interesting topics on this board...).

 

[Soupbone]

You have a very very cynical view of the medical profession <I am being generous>. You insights appear to be influenced by some bad experiences with doctors. And I am very sorry if that is the case. If I were you, I do a little more research. Posting to a discussion board geared at doctors, med. students, and pre-meds asking what they are dedicating their life towards is a "scam" is a little rude <basically trolling>.

Soupbone
UASOM IV

 

[Sonya]

I feel there is nothing rude about this post, even if he has done no research, and the claims are truly bogus.

So... I have some points to make.
All proffesions are like this. Doesn't a car dealer try and push on you a car with all sorts of fancy features when all you need and want is a basic? The big difference with medicine, is that, most often, the patient has no clue how correct the doctor is. Also, we are trained to believe and have supreme trust in our doctors. We assume they are looking out for our best interests.
We KNOW we don't need the extra sunroof on our car, we have no idea whether the medication he gives us is neccesary.

Have you considered what happens in Fee For Service vs. HMO doctors. Fee for service, yes they will dump meds on you. HMOs, they will often do just the opposite. Of course, all these statements are over generalizations.

But, lets face it, the doctors DO perform useful deeds. Maybe it would've been cheaper if he prescribed the generic medicine, but either medication is a whole lot better than none.

I think it is EXTREMELY uninformed/biased of you to think prescribing medicine and performing surgery is all doctor do, and that prescribing medicine is useless, and surgery is always great. Often, this is the case, that doctor will stuff you with meds to relieve pain when a surgery is more appropriate. But, equally often, medication is what is needed, and is a good treatment.

But, i do agree to a certain extent that the population in general is much more trusting of their physician that one should be. I have had several experiences that treatment would have been greatly improved for someone i know if they had been taken to a specialist and given more appropriate treament soon enough.

Also, let's face it, medicine is an art rather than a science. All drugs don't have precisely the same affect on everyone.

 

[Street Philosopher]

Soupbone,
I take your point. Maybe 'scam' was too harsh.

I also take the point about doctors being supporters in the doctor/client relationship - the human aspect of the practice.

However, I don't feel my views are too cynical. After all, I said I SOMETIMES feel this way, not always. I didn't yell out "ALL DOCTORS ARE CROOKS!" I was merely asking a question, seeking further insights that might quell my doubts about the profession.

and cchoukal, I've been thinking about the same things about machines taking over. Once I heard about robots doing surgery (albeit with the control of a surgeon), I thought, well a diagnosing program can't be that far off. But even more distressing is the seeming lack of distinction in the roles a physician plays compared to that of a NP, or other members of the team. I think society is beginning to view physicians as overpaid people, earning more for the same work that other people do; achieving that through politics and lobbying.

I admit I have little experience in this. I am not on my soapbox shouting my propaganda, but merely presenting doubts and concerns from my admittedly naive view with the goal that others with more experience can provide more insights.

 

[Elvis25]

Ok, I understand that these comments were coming from someone with no clinical experience. So I'll try to be light and to the point. First of all, you claim all doctors do is push pills. Well how about extending the average life expectancy from 45 to 75? A person with cystic fibrosis had a life expectancy of 15 years, just 30 years ago. Now it's pushing 40, and often extends that. Diabetes complications have dropped, as well as the infant death rate. That didn't happen by surgery, and it didn't happen by free basketball tickets. It happened due to professional management of medicines. And if you think pushing pills is all it takes to be a doctor, or that a computer could do the job, I hope you never find out how wrong you are. How would you like to hear you have cancer from a computer. How would you like it to be a computer who sits with your mother when she dies? Any doctor would tell you, the medicine is the easy part.
Secondly, yes, drug companies do throw money at doctors. It's called advertising. Just like budwiser puts a commercial on TV to entertain you, drug companies pay for golf tournaments to entertain us. Makes sense, since we are their target audience. Does it work? No. But I still like golf. And I would argue that there is no difference between fee for service and HMO docs because doctors aren't allowed to collect on prescriptions. It's a conflict of interest if they receive money from a pharmacy, and it's self referral if they own part of a pharmacy. Either way (though I won't argue that some docs still do it) it's illegal.
Third, it isn't fair to say the docs have no idea if the pills will work. They have a very good idea. We know how they work, even to the molecular level. But every person isn't the same. So just because it works in most people, doesn't mean it will necessarily work for you. So yes, sometimes you have to change medicine, but that's because there is an individual aspect to medicine. Not because the doc just picks a pill out of a hat and says here, try this.
Fourth, the surgeons thing. Kreno brought up a good point. Many surgeries have never been proven affective. Just read about the mammary artery ligation. Secondly, most surgeries aren't curative. Take a bypass for example. Most people who get a bypass surgery either die within 10 years, or need another bypass. It doesn't cure anything. But, if you add some cholesterol meds, aspirin, and a beta blocker, that percentage that needs another surgery drops dramatically. Both are important, there is no "real work". The only things surgeons can fix are structural defects and acute problems. They can remove a tumor, but they can't cure cancer. And for the chronic things like asthma, diabetes, cystic fibrosis, arthritis, etc., where are the surgeons? I'm not bashing surgeons. They're critical to our health and do a lot of amazing things. I'm just arguing the point that medicine docs don't just try every pill on the market, then send the patient to surgery.
Anyway, if you want to talk about a scam, how bout that 90% of the medicines used in kids is not approved for people under 16. Or that resident docs don't even make minimum wage. Or that somehow, the USMLE has managed to convince the entire country, that they, and only they, have the ability to determine who knows enough to be a doctor. Find something with some truth to it.

 

[Street Philosopher]

Elvis you bring up great points! But are you implying that what I brought up has no truth to it at all? (in the last sentence)

I agree about your point that hearing about a disease is better coming from a doctor than a computer. But if that is your argument, then what's stopping a counselor or nurse, or your parents from (in the hypothetical future), running a little program, getting the results, and reporting it back to you? Or more realistically, these people sending their case history to a panel of experts? (in a similar but not exactly parallel way in which a doctor takes blood tests, MRI's etc. and sends them to the lab for the results) I'm sure these people are far more skilled in providing the support that someone of such serious problem needs.

And if medicine is truly the easy part, why aren't interpersonal skills emphasized as a critical part of a medical student's training?

I really appreciate your comments. It was a good reminder, and a good lesson for many people including myself.

 

[edmadison]

I liked several things that Elvis said, but thought wanted to dispute a few as well. First, if you think the drug companies are spending billions on phycian advertising without a proven benifit, think again. If you have the choice between two drugs with virtually identical properties don't you think you'd be tempted to prescribe the one made by the company that just paid for your trip to Florida? I think for Docs to claim it doesn't affect them is laughable.
Second, on the issue of drugs proven to work in children, how do you expect them to get proven? No one in their right mind would do clinical trials on kids -- think of the legal liability. Same reason why all of the newer drugs haven't been tested on pregnant women either. That leaves the docs in the awkward position of deciding to treat with a new "unproven" drug -- sometimes you gotta do the best you can based on your understanding of the drug's pharmicology.

Ed

 

[mary]

You bring up some interesting points to think about and I have, so here is what I have come up with...
First, many doctors probably are guilty of the faults you name, and most are probably guilty of at least some of them, but there are also many people with purer intentions than you realize. In the sea of medicine, these true physicians who are caring for the patient and not the disease may be few and far between, but they should not be discounted.
Second, one of the main responsibilities of a physician is preventative (or interventional) medicine. Often times a family practitioner can catch risk factors that could lead to full blown disease in the future, which leads me to my third point..
Patient Education. A computer may be able to diagnose a disease or even figure who it at higher risk for those diseases, but if some computer told me to stop eating fatty foods or drinking so much alcohol, I would never listen. However if a person who trained for over seven years to treat patients told me the same thing, I might listen a little more (this is not to say anybody with these problems would, but it makes sense to think someone with more education and possibly a long term relationship with the patient would have more of a chance of convincing them to make lifestyle changes). I realize that this reasoning doesn't exclude NP's or PA's from the same roles, but I prefer to think that I am not wasting four years of my life and getting myself into a truckload of debt in order to propagate some "scam". My patients would not be the "scam's" only victims at that point. maybe the extra years are so someone knows how to treat the patients that aren't in the majority (rare diseases, fast/slow metabolizers of whatever drug, etc.). Some physicians may just try to figure out which pill the patient needs, but I have had some, and plan on being one, that treats more than just diseases.
Mary

 

[DrWBD]

http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?uid=1623766&form=6&db=m&Dopt=b" target="_blank"

 

[deleted4401]

I'm just a first year med student, and I have some of the concerns that Schoolboy does. Some points I'd like to present.

-When I get sick and go to the doctor, almost regardless, I end up getting some medication. I would feel cheated if I didn't (and, supposedly, I should know better). Last week I went in for shoulder/neck pain, got some Motrin. Well, my shoulder still hurts, and Motrin just made a couple bucks.

-Efficacy and utility isn't tested as much as people think. Think about tonsillectomies. Everyone and their brother used to get one way back. Now, I don't think a lot of physicians even bother with it, since people realized it was a waste. Like someone said - how about CABG - mortality rates and QALY measures should be researched for this procedure. How about hysterectomy rates being variable all over the industrialized world and across the US, and the US having sometimes 50-75% higher rates of them compared to the Nordic countries (and other top notch health systems)?

-Antibiotics are still prescribed like crazy for just any infection - bacterial or viral. Doctors know better, hell, patients even know that virii aren't affected by antibiotics, yet doctors still give out Amoxillan or whatever. What's the point?

-The Americal medical slave labor force (called "residents") are being denied simple rights as workers and this hurts patient care. No matter what argument people come up with, fact is, the hospitals will continue to use this system until there is a restructuring. And if and when this happens, I am willing to bet that quality of care in teaching hospitals goes up markedly.

-I can't say for sure yet, but I complained in another post about this: I think a fair amount of what we are learning is worthless. I mean, it's great from an anatomical point of view or a histological point of view to learn some of this stuff, but from a clinical point of view, I am missing the point. We could cut out some time (e.g. - combine Histo and Path and make it a much shorter course) and make it more efficient. But, for some reason, the length of time of training seems to allow people justify the salaries we get. I don't buy it. We are trained to be clinicians, so let's learn the clinical applications and get on with it.

I'm still happy to be in med school, and I love what I learn. I'm very excited to be a physician one day. But, I think there is a lot of questions that need to be answered. There is a reason that 14% of our GDP goes to health care (highest in the world), even though we don't even provide national health care. We have to learn to provide the most efficacious (is that a word?) therapies, we have to either justify or put in line the salaries of the providers, we have to educate patients about treatments and general self-care, and we have to make the training as high-yield as possible. Then this question of "shadiness" will vanish.

What do y'all think?

Simul
Tulane Med '05

 

[Medic171]

"1. all doctors (not surgeons) do is push pills to patients. basically, taking a history, exams, etc, is all done to figure out which medicine to prescribe."


in response........Ummm, did I miss something, or is this not what a physician is trained to do? It is what they are SUPPOSED to do. It is essentially the definition of a medical practice(very basically and in essence), or at least a description of what goes on at the Dr. office 99% of the time.. From what I understand, and correct me if I am wrong, this is what the profession is supposed to be. i.e. sick guy comes in, Dr. examins sick guy, Dr. prescribes meds for sick guy, and hopefully sick guy gets better, at least that is the point.

 

[tidy_kiwi]

Read "What Doctors Don't Tell You: The Truth About The Dangers of Modern Medicine" by Lynne McTaggart

Quote:

"The following pages will open up to you the trade secrets of what has been largely a closed shop. You'll have a chance to listen to the private conversation that medicine conducts with itself. And, once you discover just how much hokum resides in your doctor's medicine cupboard, just how much medicine relies on blind faith, recieved wisdom and selective facts, not reason, science or common sense, you can grab the power away from this false shaman and begin to take back your health."

and...

"I want to help you to learn not to be a "good" patient. Good patients, the kind who blindly follow orders instead of demanding answer, sometimes die."

Definitely worth a read.

 

[Kevo]

maybe a machine feasibly could do what doctors do, but machines could feasibly also do what accountants, secrataries, engineers, janitors, delivery men, pharmacists, dentists, and factory workers do. maybe even lawyers to a certain extent.
the only professions that machines could not feasibly replace are ministers, academics, and writers.
so, if by stating that machines could do what doctors do you mean to imply that medicine is not as "intellectual" as some may think then you are probably on to something. if that makes you unhappy then go be a professor. the rest of us will become physicians.

as far as medicine being a scam...
doctors don't know everything, but they know considerably more about medicine that the average joe. prescribing pills seems simple to doctors (and it should) because of all the schooling they have. its not so simple to someone not educated in the same manner (lots of people do know that antibiotics kill bacteria, but don't know what is ailing them. hence they hear the doctor say "take these and it'll kill the bacteria" and think "duh, i could have told myself that" but they couldn't have known if it was just a simple bacterial infection or something more serious without consulting the physician.)
and so what if doctors get free lunches from drug reps? patients also get free samples of $10 per pill medication that the drug reps give the doctors.

 

[Vader]

I am at a medical school which has begun a new curriculum that integrates the basic and clinical sciences in a system-based approach. Currently, we are studying the cardiovascular system, diseases, and treatments. Fully integrated into the curriculum are topics including behavior, psychology, sociology, and others that attempt to give us background on the patient's biopsychosocial status and factors that might affected the medical care provided. For example, in this block we have had lectures on medical adherence, risk factors for cardiovascular disease, and others. In addition, we take a 2-year long course on the foundations of patient care, including the doctor-patient relationship, professionalism, physical exam skills, and ethics.

Here are your questions and my responses:

1. all doctors (not surgeons) do is push pills to patients. basically, taking a history, exams, etc, is all done to figure out which medicine to prescribe.

First of all, doctors come in many varieties--there are primary care docs and there are specialists in a variety of fields. Some fields tend to be medical, some tend to be surgical. Others are a combination of both. In addition, some doctors choose to do medical research as part of their careers, and thus arrange or participate in clinical trials, conduct basic lab research, etc. Other doctors study public health or participate in hospital administration. What I'm trying to say is that medicine is a big, complex world with many players, who all contribute to providing patient care. True, the H&P is the bread and butter of medicine, but a computer is simply NOT capable of doing the job. If my computer started palpating my abdomen, I'd be a little concerned. Also, medical therapy is not always warranted in certain situations. For example, in mild and moderate hypertension, you would generally start out by attempting to get the patient to make lifestyle changes (i.e. quitting smoking, less fat/cholesterol in diet, exercise, etc) before heading to medical therapy. Whenever possible, lifestyle changes and/or other preventive measures are preferred. When there is a need to medicate a patient, the drugs are chosen on a rational basis, which take into account a variety of factors to predict response to therapy. But like a person above noted, individuals differ in their response and side effects. Thus, if a patient experiences a large number and severity of side effects on a particular drug, you might want to switch medications and try something that will be better tolerated. To the outside observer (and often to the patient) this might seem like the physician is just playing a guessing game. However, there should be (and usually is) some rationale behind given therapy. Surgical procedures are considered under specific criteria, having to do with the efficacy of treatment, possible complications, etc. To consider a therapy (medical or surgical), there must be INDICATIONS for that therapy. Sometimes patients require both medical and surgical intervention (i.e. heart valve replacement with prophylactic antibiotic therapy in cases of valvular disease). The point is that doctors do a large degree of critical thinking in terms of managing patient care that a simply algorithim cannot replicate.


2. drug companies throw money at doctors, trying to sway them to use their drug. why is it that college athletes get punished for getting a few gifts here and there, but it's ok for doctors to get free tickets to basketball games paid by drug companies?

It is true that drug company advertising has an influence on the types of prescriptions doctors write. The goal as a physician is to not be swayed by free lunches, pens, pads, etc and to remain as objective as possible, critically evaluating the data.


3. doctors don't really know if a medicine will work. it's like "here take this, and tell me how you feel later. if something bad happens, i'll give you a different pill"

Answered above.


4. when all the drugs don't work, the doctors just send patients to surgeons to do the real work.

Medical doctors and surgeons are both essential components of the medical team and both contribute the management of patients. To say that one or the other "does the real work" is incorrect.

Medicine, with all of its problems, remains one of the most noble professions. Physicians are given a special and sacred responsibility to care for the health of those who are sick and to prevent illness. Doctors have a role as health educators, as well as source of compassion and empathy. In addition, many of the discoveries that will provide new preventions and therapies will come from physician-scientists. Thus, whether you believe medicine is a "shady" profession or not, doctors certainly have a vital role in society.

 

[Street Philosopher]

thank you everyone who replied, especially vader. there is a lot of good information in this thread!

 

[Elvis25]

I can say one thing for certain. Schoolboy has a lot of class! You presented your opinions, heard everyone elses openly, raised your questions. I wish all message boards ran like this thread. Hat's off to you schoolboy.
One more comment on the pharmacy thing. I guess all docs are different on how the advertising affects them. My weakness is when I have a choice, I always try to start with what I have samples of. If it works, I stick with it, even though a cheaper medicine might work just as well. Maybe I should just start with whatever's cheapest. Hmmm, that sounds like a good plan.

 

[srlondon]

When you have the chance to spend some time in the clinic, you will realize that what most patients are looking to get out of a doctor is much more complicated than something that can be objectified and quantified and fed into a computer. To begin with, the assumption that an algorithm stored in a computer can even come close to providing a correct diagnosis is flawed. Why? People are very unreliable and subjective creatures. If a computer's "pneumonia routine" asks the patient if they're a smoker, at least 75% of the people will lie, by either denying that they're smokers (b/c at this point everybody knows that they shouldn't) or underestimating what they do smoke. An experienced clinician, on the other hand, will notice the person's tobacco breath, nicotine stained fingertips and teeth, and gently suggests, "Perhaps you smoke just a little bit?" In addition, various cultural biases and personal preferences are going to take a long time to work out of our society. Only just more than half the people in the USA have 'net access, and of those, almost a third are too mistrustful of computer security to even input their _credit card number_. A lot of people still refuse to use bank ATMs, despite the fact that they have to wait in line for a teller and can only get to one as little as 6hrs a day, as opposed to ATMs, which are plentiful and available 24/7. So you expect people to be okay with a machine asking them if they've ever had gonorrhea? I think that medical computers will have a place in places where docs are inaccessible... submarines, spacecraft, and the like... but even then, most people would prefer expensive, slow, and choppy videoconferencing over a slick computer program.

In addition, most patients are looking for aspects of care that only human interaction can provide. Sadly, the only time that people really have somebody pay attention _just to them_ and their problems alone is when they go to the doctor. Their spouses are busy, and their kids don't care. Some elderly people don't have any interpersonal contact besides their trip to their healthcare providers. A computer will be a very poor substitute in this regard.

Furthermore, what really separates doctors from other healthcare providers is that they are the only ones who have the depth and length of training to really explain the how and why of disease processes. In the current environment in which patients are encouraged to rigorously question their healthcare providers (a good thing, in the end, I believe), a scripted answer or "'cause it says so in the book" just isn't going to cut it.

As far as interpersonal skills in medicine go, I think that this is a problem which goes much deeper than what med school curriculums can address. It has only been in the last 5-7 years that non-science majors have really been starting to be accepted to med school in any great number. Med schools should be accepting people who have seen the world a bit and have had some diversity of education and life experience rather than what a guy who spent his undergraduate years locked in a lab can bring to the table. If you have to explain to somebody that they shouldn't forget to see their patients as human beings, I think that they're missing the point entirely from the get-go. Locking an emotionally shut-down lab monkey in a room with a touchy-feely doc for a semester who tells him/her to feel their patients' pain and "treat the patient, not the disease" isn't going to make a silk purse out of a sow's ear...


Schoolboy wrote:

posted November 20, 2001 04:22 PM ??? ?? ?? ? ?? ? ? ??
------------------------------------------------------------------------
Elvis you bring up great points! But are you implying that what I brought up has no truth to it at all? (in the last sentence)

I agree about your point that hearing about a disease is better coming from a doctor than a computer. But if that is your argument, then what's stopping a counselor or nurse, or your parents from (in the hypothetical future), running a little program, getting the results, and reporting it back to you? Or more realistically, these people sending their case history to a panel of experts? (in a similar but not exactly parallel way in which a doctor takes blood tests, MRI's etc. and sends them to the lab for the results) I'm sure these people are far more skilled in providing the support that someone of such serious problem needs.

And if medicine is truly the easy part, why aren't interpersonal skills emphasized as a critical part of a medical student's training?

I really appreciate your comments. It was a good reminder, and a good lesson for many people including myself.

 

[Street Philosopher]

nicely done srlondon

 

[Neurogirl]

Everyone has made excellant points but I'd just like to add a few insights. First of all, determining whether a patient needs medicine or surgery is NOT, for the most part, an either/or proposition. One of the jobs of the internist or PCP is to determine whether or not a patient has a surgical condition. If they suspect that they do, then they consult the surgeon. Keep in mind that most non-elective surgical conditions actually require surgery (unless the patient is thought to be too ill or old to survive). Therefore, it would be ridiculous to assume that physicians would "push pills until they've exhausted their options". Also, for those who believe that only surgeons do "real work", just wait until your first IM rotation.

Secondly, saying that a computer or midlevel practitioner could take the place of a physician when it comes to delivering bad news or interpreting test results is a little naive. It's been my experience that when a patient receives a malignant diagnosis, they want REAL information. They want an explanation of their disease process and they want it in plain english. Without an indepth understanding of the physiology of the diagnosis, it's nearly impossible to assimilate the info and present it in simple to understand terms. Nurses and PAs/NPs are great at knowing whether or not a disease has a good/bad prognosis, but they come up short (no offense) when it comes to explaining the whys/hows of a particular disease. When you're forced to explain the anatomy/physiology of leukemia or MI or the progression of renal failure, etc., to a patient with no medical knowledge, you'll really appreciate all that "useless" information you're being required to memorize.

Finally, midlevel practitioners are great at doing a large percentage of the work done by physicians. However, what most people don't talk about is what they can't do. I've yet to meet a PA/NP who was interested in making life and death decisions and I doubt that patients would want them to. Also, I doubt they'd want a robot or computer program making these types of decisions...I know I wouldn't. Just my two cents.

 

[Pureride]

Wow, I liked the header when I was browsing "is medicine shady"

But, simply too much garbage written here to try and make sense of. There really must be a shortage of work to do at your med-schools.

Good header though

 

[deleted4401]

Not a shortage of work ... a shortage of motivation... hehe... happy thanksgiving, folks

Simul
Tulane Med '05

 

[Vader]

Originally posted by SimulD:
•Not a shortage of work ... a shortage of motivation... hehe... happy thanksgiving, folks

Simul
Tulane Med '05•••

Sometimes we will find anything to keep us away from studying just a little bit longer.

 

[cchoukal]

I have to admit, I'm impressed by the level of discussion on this topic. Although I haven't read it ALL (histo exam coming up...), one idea that keeps popping up is this notion that maybe the science of medicine isn't as important as the humanity behind it; a machine isn't so good at "being with" a patient in their hour of need. I couldn't agree more. The problem is, many doctors are really bad at it, the worst ones (in my admittedly limited experience) are academic physicians entrusted to teach us how to be good at it, and I'm not sure it should take 8 years and thousands of dollars to learn how to be a counselor and confidant.

Maybe we should have two types of medical schools: one for primary care physcians that focuses more on the humanity in medicine, and one for other specialists/surgeons/whatever... Clinical psychologists do it; they have schools that give PsyD degrees to people who just want to be counselors and schools that give PhD degrees to those that want research and academic training as a part of their career.

And for the those of you who think you're not walking billboards for drug companies or that their work doesn't affect you, check out <a href="http://www.nofreelunch.org" target="_blank">http://www.nofreelunch.org</a>

 

[WSU02]

Sorry, I forgot the name of the one who started the thread but here goes some of my thoughts, as a 4th year student.

1. Yes, a lot of what I do is algorhythmic. But every now and then, a patient will come along and blow up the algorhythm (yesterday, I had a patient who had a rare - 1/1,000,000 - reaction to medication). You cannot program every possible contingent into an algorhythm. That is where my knowledge and critical thinking comes into play.

2. Actually, my knowledge of drugs and how to prescribe them are coming from rote repetition on the floors. I'm going into OB, I pretty much automatically prescribe Keflex for UTIs in pregnant women. That's what is done in the program that I trained in. I know the dosing of 1 and only 1 ACEI - the one that my cardiology attending loved to use. You get the idea. As a student, you learn from those above you. The only thing I get from reps are lunches and pens (although I'm polite enough to take their lit).

3. As has been pointed out earlier, it's the human touch that patients love. I don't know where some of the earlier respondents are going to school, but I can say unreservedly that my attendings have all been wonderful role models for doctor-patient interactions (even if they were @$$holes to the residents and students). And I get great pleasure out of doing an ultrasound for a new pregnancy ("See the heartbeat?"), announcing "It's a girl!", or just commiserating about the pains of pregnancy. No computer will ever do that. I'll bet 90% of the benefit I give is the fact of touching and caring.

4. Yes, there are creeps in medicine. But I challenge you to name a field where that isn't true. That, in and of itself, is just a part of human nature.

5. Yes, we take a history. But what is nice about humans vs some unthinking machine is that we can synthesize the info - we can take the oral history that we are given and combine it with observations - like the fact that the patient cannot maintain eye contact or is hesitant to answer the question. These are clues as to what is really going on, something that AI is not yet capable of doing.

6. And no, pills and surgery are not always the answer.
HTH,
Kristi

 

[Vader]

Originally posted by cchoukal:
•Maybe we should have two types of medical schools: one for primary care physcians that focuses more on the humanity in medicine, and one for other specialists/surgeons/whatever... Clinical psychologists do it; they have schools that give PsyD degrees to people who just want to be counselors and schools that give PhD degrees to those that want research and academic training as a part of their career.
•••

It is certainly true that there are many doctors that leave much to be desired in the way of their approach to the doctor-patient relationship. However, this is not limited to academic medicine, specialists, or surgeons. It is my belief that ALL medical students should be trained to be caring, compassionate physicians. As several people have noted already, the doctor-patient relationship is key to good medical practice. For example, it is vital that you develop good rapport with patients so that you will have a better basis for encouraging lifestyle changes (i.e. quitting smoking, eating right, exercising, etc) and medical adherence (taking drugs when they're supposed to). Patients will also be more willing to divulge personal information that may otherwise seem embarrassing. As a physician, you will become very attuned to picking up on subtle clues that a computer would no doubt miss. I can't emphasize enough how important it is that medical education emphasize the significance of the doctor-patient relationship (which it traditionally has neglected, in favor of a pure biomedical approach). Complex psychosocial factors influence prevention, natural history of disease, adherence to treatment, healing, and a variety of other processes. Thus, it is essential that even sub-specialists who see limited types of cases understand their patients from a multi-dimensional perspective.

 

[deleted6669]

Secondly, saying that a computer or midlevel practitioner could take the place of a physician when it
comes to delivering bad news or interpreting test results is a little naive. It's been my experience that when
a patient receives a malignant diagnosis, they want REAL information. They want an explanation of their
disease process and they want it in plain english. Without an indepth understanding of the physiology of
the diagnosis, it's nearly impossible to assimilate the info and present it in simple to understand terms.
Nurses and PAs/NPs are great at knowing whether or not a disease has a good/bad prognosis, but they
come up short (no offense) when it comes to explaining the whys/hows of a particular disease. When
you're forced to explain the anatomy/physiology of leukemia or MI or the progression of renal failure, etc.,
to a patient with no medical knowledge, you'll really appreciate all that "useless" information you're being
required to memorize.

Finally, midlevel practitioners are great at doing a large percentage of the work done by physicians.
However, what most people don't talk about is what they can't do. I've yet to meet a PA/NP who was
interested in making life and death decisions and I doubt that patients would want them to.
neurogirl-I know you were not trying to be offensive with the above note, however, realize that there are some(maybe 5%) of all p.a.'s who work in surgical ICU/solo ER/hospitalist/primary care provider positions who make "life and death decisions" every day.I do believe as you stated that an MD/DO has a better handle on the science component.if I didn't believe that, I wouldn't be working so hard to go back to school. please do not generalize about p.a. practice. thank you-emedpa

 

[turtleboard]

I know I'm coming into this thread kinda late, but I decided to read it only because I wanted to make sure there was nothing inappropriate for this forum.

Originally posted by Schoolboy:
•1. all doctors (not surgeons) do is push pills to patients. basically, taking a history, exams, etc, is all done to figure out which medicine to prescribe.•

As someone else has already written, you've got a pretty cynical view of the practice of medicine. Being a doctor is a little more complicated than finding out what's wrong and pushing a few pills.

•3. doctors don't really know if a medicine will work. it's like "here take this, and tell me how you feel later. if something bad happens, i'll give you a different pill"•

Do you really expect each patient to react to a drug in the same manner? There's really no way of predicting how each patient will respond. There are no absolutes in life, and medicine is no different.

•4. when all the drugs don't work, the doctors just send patients to surgeons to do the real work.•

Yes, when drugs don't work, surgery may be indicated. Long-term complications from surgery can be pretty serious, so before you even begin to extoll the great gift that God has given man in the form of surgery, read up on it. I'm not knocking surgery -- I rather like it and am thinking of doing that with my life -- but it's not the be all and end all of medicine. If I was the patient, I would consider surgery as only the last resort when pharmacotherapy and less-invasive techniques have failed.

•I admit these reasons aren't well thought out•

No kidding.

•and may be wrong, but when i asked my older sibling (who is a physician) if medicine is a scam, she tended to agree that it was a scam in a way.•

I'd be careful of asking anyone but yourself. Physicians who've been practicing for a while, and even tired medical students, tend to be a little on the cynical side. I didn't enjoy my second-year of med school and developed a pretty cynical attitude toward the whole process of becoming a doctor. I let that rub off on my little brother who recently started as a first-year med student, and as predicted, he views med school as a big pain in the ass. Is it entirely sincere? Probably not as some of that, undoubtedly, is coming from me.

Do your own research and come up with your opinions. By the way, is your sister a surgeon?

 

[Kimya]

Neurogirl wrote:

"Secondly, saying that a computer or midlevel practitioner could take the place of a physician when it comes to delivering bad news or interpreting test results is a little naive. It's been my experience that when a patient receives a malignant diagnosis, they want REAL information. They want an explanation of their disease process and they want it in plain english. Without an indepth understanding of the physiology of the diagnosis, it's nearly impossible to assimilate the info and present it in simple to understand terms. Nurses and PAs/NPs are great at knowing whether or not a disease has a good/bad prognosis, but they come up short (no offense) when it comes to explaining the whys/hows of a particular disease. When you're forced to explain the anatomy/physiology of leukemia or MI or the progression of renal failure, etc., to a patient with no medical knowledge, you'll really appreciate all that "useless" information you're being required to memorize."

I thought this was an interesting point, because I've known several doctors that DON'T DO THIS! They are either too much in a hurry to explain it in plain english (and the patients are too intimidated to ask) or they just have been desensitized. I specifically remember one doctor who breezily told her patient undergoing a minor surgical procedure to protect her baby- whoops, looks like it's too late! We'll just have to abort right now, and it would be better to just do it now since you're prepped and everything, OK? So this woman is prepped for surgery crying her heart out asking if she can wait for her boyfriend, and the doctor sighs and impatiently walks out. It was the nurse who sat down, held her hand and explained why this was happening in "plain english".

Also, I used to work for an information line for an organization providing information on a certain disease. So many of the calls were from people who didn't understand what their doctor had told them and were too intimidated to ask- this includes for surgical procedures.

 

[Doc Holliday]

Can someone prescribe me some eye drops? I just read this post through and have halos around everything I look at.

Loads a good comments in this thread. I keep looking over my shoulder for some of our more boisterous posters...

Since much has been said already, I only want to add a couple of obscure almost relevant points:

[1] Have you ever read the "Medical School Survival Guide"? Can't remember the author right now, but it was REALLY cynical about the process. You know, do what the patient wants to keep them coming back, kiss everyone's a$$ and never complain, etc. It really dehumanizes the "service" aspect of our career. It definitely gave me a "shady" feeling, if you can call it that, maybe "jaded" is a better word.

[2] SimulD made a really good point about over prescribing antibiotics. I did some research on this for one of my undergrad classes... Wow. The numbers were staggering and the evidence is there to explain the resistant bugs we are facing today. Docs really do comply with patient demands at the risk of public health far too often.

All of the troubles we face are exacerbated by so many links in the chain, pharm marketing, resident work hours, tradition, underpayment from insurance companies, underinsured patients...

Where do we start folks? Most of us say we will follow are principles and do what is right when we get there. How many of us can say that we are? dh

 

[efs]

"The Medicla Student's Survival Guide" Third Edition was written by Stephen Polk. ISBN 0-940401-45-2

How you see it depends on how you read it. Jaded might fit. Or cynical. Or realistic. This edition was published in 1992, and could use an update. There are many changes that should be made.

I still think it's worth reading.

 

[ENTer sandman]

Hello all,
Everyone makes some interesting points here although some are far too inexperienced to make certain generalizations(I'm sure I thought the same things as a premed).
I think the way you practice medicine is entirely up to you. If you want to treat every sore throat with antibiotics, do it, if you would rather wait for culture and sensitivity results before prescribing the best med, do that(that's what I would do). Do you think drug companies will affect the way you prescribe meds, not if you reject their offers for free goodies(no pharm rep bashes your office door down and forces their shpeel on you). What I'm trying to say is that what all these people say is only true if you believe it and practice it. There is no law that says you must prescibe an antibiotic for every sore throat (its not taught in med school either). The way I decide what med is best for my patient is by reading the most current medical literature, determining if is it valid, and than prescibing and/or treating accordingly(of course personal experience plays a large role). So when you are released into the medical world you can be the "monkey see monkey do" type of doctor or you can be your own wo/man and do what you know is right.
Medical school will give you an excellent background(both scientifically and clinically) but the way it is praticed is up to you.

 

[Mr. Eastern Medicine]

Schoolboy is right. Some if not many MDs are there to prescribe medicine and nothing else. They pretend they give a damn about their patients, but in fact, all they give a damn about is their new BMW X5 or their new a million dollar houses. And OMT techniques for DOs are just BS. DOs tend to see their patients as a whole? BS. We need better doctors who actually care for their patients, not their new Mercedes-Benz. Perhaps, we need more medical students from disadvantaged backgrounds or schools such as Howard or Morehouse, not like UCLA.
I've always wondered why so many MDs wear those damn white lab coats when all they do is prescribing drugs.

 

[Freeeedom!]

HAHAHA! I am sure the students at Moorehouse or Howard would love to know that they are disadvantaged!!!!
I have seen more docs drive minivans than I have seen drive BMW's!

 

[Mr. Eastern Medicine]

Freeeeeeeeeeeedom,
Yes, they are from disadvantaged backgrounds such as growing up with a single parent or in a bad education system such as in D.C. or even living in a bad or dangerous neighborhood. You people will never understand how it feels to live in these circumstances.

And does that doctor who drives a minivan has 9 fat kids who refuse to eat anything except pizza or KFC chickens for 6 times a day or something?
Or does that doctor has 4 kids to support from his/her previous marriage?
If this is the case, then I guess there is an exception.

 

[Freeeedom!]

Dude you are pretty angry.

Uhhhh, once again, if you were to say at a Moorehouse graduation "Congratulations! We are proud that even disadvantaged kids can be Doctors!" you would get quite a snarl!

I am the product of divorced parents, neither of which went to college. My grandmother was shot and killed in a robbery attempt at the gas station she owned. To assume that ONLY disadvantaged students go to Howard and that every one else in Medicine (except for snobbish Self-proclaimed Eastern Medicine gurus) are some how privledged...is naive and wrong.
It is more than wrong, it is *****ic.

My friends, regardless of background, have worked hard to get to where they are now. Some choose to have many children and drive mini-vans, other choose to have none and drive very nice cars. And still others give much of their time to mission trips or others and drive Hondas.
Doctors are diverse as the cars they drive or the motorcycles they ride...and none I have EVER met are as condescending or ignorant as you.

 

[Mr. Eastern Medicine]

Freeeeeeeeeeeeeeeeeeeeeeeedom,
Dude, you didn't have to tell me your personal story.
There are pretty good minivans out there u know?

 

[rickmyster78]

Mr. EasternMedicine,

You are a riot. You and your posts and threads!Either you have a great sense of humor or...you can't be serious!

 

[Mr. Eastern Medicine]

Okay buddy~

 

[Street Philosopher]

bump
let my ignorance serve a didactic purpose.