"For every complex problem, there is a solution that is simple, neat, and wrong." - HL Mencken
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"I hear and I forget. I see and I remember. I do and I understand." - Confucius
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"The good physician treats the disease; the great physician treats the patient who has the disease" - Sir William Osler
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" The best test of a person's character is how he or she treats those with less power." - Bob Sutton
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"Those are my principles, and if you don't like them - well, I have others." - Groucho Marx
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"The difference between genius and stupidity is that genius has its limits." - Albert Einstein
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"It is hard enough to remember my opinions, without also remembering my reasons for them" - Friedrich Nietzsche
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"Anyone can make the simple complicated. Creativity is making the complicated simple." - Charles Mingus
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"Not everything that can be counted counts, and not everything that counts can be counted." - Albert Einstein
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"A foolish consistency is the hobgoblin of little minds, adored by little statesman and philosophers and divines. With consistency a great soul has simply nothing to do." - Ralph Waldo Emerson
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"This ain't no party, this ain't no disco, this ain't no fooling around." - Talking Heads, Life During Wartime
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"What is hateful to you, do not do to your neighbour. This is the whole Torah; all the rest is commentary. Go and learn it." - Hillel, Talmud, Shabbath 31a
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"You will never understand bureaucracies until you understand that for bureaucrats procedure is everything and outcomes are nothing." - Thomas Sowell
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"An idealist is one who, on noticing that a rose smells better than a cabbage, concludes that it will also make better soup." - HL Mencken
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"If you only have a hammer, you tend to see every problem as a nail." - Abraham Maslow
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"A great teacher is one who realizes that he himself is also a student and whose goal is not to dictate the answers, but to stimulate his students creativity enough so that they go out and find the answers themselves." - Herbie Hancock
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"There are no facts, only interpretations." - Nietzsche
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"An education isn't how much you have committed to memory, or even how much you know. It's being able to differentiate between what you do know and what you don't." - Anatole France
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"In character, in manner, in style, in all things, the supreme excellence is simplicity." - Henry Wadsworth Longfellow
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Workouts by month - Goal 200 from 11/1/09 through 10/31/10
http://ow.ly/1mYi7 - ABIM MOC program - two differing viewpoints - you can guess my voteMarch 16, 2010 5:06
RT @yejnes: My thoughts on the annual exam, etc., final letter ACP Internist, March 2010 http://bit.ly/9FNcXn wel-stated & importantMarch 15, 2010 12:47
A note to the professors, from the "real" world, on the use of ICDs in a fee for service community... http://ow.ly/1jaPy - great postMarch 13, 2010 2:19
RT @paulinechen: New "Doctor and Patient"; Learning to Keep Patients Safe in a Culture of Fear http://nyti.ms/bYA14V - blog post comingMarch 12, 2010 1:35
RT @tom_peters: @kevinmd Spoken like an MD. - true primary care is very complex - it is not simple care -March 11, 2010 12:43
RT @efalchuk: Seriously, what is Nancy Pelosi Talking About? http://bit.ly/9sHSc2 #healthreform #hcr #healthcare think Dazed and ConfusedMarch 10, 2010 7:53
Obama Says Health Overhaul Should Trump Politics - http://nyti.ms/bwKRyo - and he is correctMarch 8, 2010 7:28
@BertDecker multiples of 37 - trivial - any factor of 111 would factor into the others. The key here is that 37 * 3 = 111March 7, 2010 9:00
Physicians’ concerns about malpractice (53%), their desire to earn more (45%), and their desire to meet patients’ demands (45%) are seen as the main causes of unnecessary care, according to the poll. Another 30% feel misleading information doctors receive from drug and medical-device companies contributes to overly aggressive treatments.
As a pathologist I may have a skewed perspective but I have often thought that even physicians have little understanding of the cost/benefit trade-offs of their recomendations. With the increase in patient directed care and HSA’s it seems to me that it would be extremely useful for the public to have available objective numeric data on incidence of diseases, diagnostic testing strategies, and treatment effectiveness, along with, eg, relevant medicare fees. This would surely cut down on more egregious waste such as cranial imaging for headache.
do we blindly accept the repair reccommendations that our household plumber or electrician suggest? do we always listen to the advice of elders? do we not frequently ignore even sound advice to exercise and eat regularly? just because a doc suggests a plan of action, many of us (docs included) do not do it.
Do you think there is something inherent psychologically that might cause this? Drs want to help thier patients. What I’ve noticed over the last few weeks is that when they can’t help me or don’t know what to do they get either angry or confused. The poor ER docs are the most lost. However if the opportunity arises where they can help, they get this perky excited look. My endo doesn’t really want to understand what is causing the problem, just that the proper mix of meds have resolved the problem. Perhaps sometimes docs don’t know how to solve a problem so pass out a script instead. My GP hands out scripts and samples like candy. It is an easy solution and perhaps it makes the patient “feel” like youv’e done something even though you don’t know what to do.
I have found rather than too much testing they actually rely on far too little testing and at times don’t really understand the limitations of the tests they are running. If you even try and mention that you get treated like you don’t understand what you are talking about. It feeds into the idea you guys have that patients are really incapable of understanding thier own condition. I told the first ER doc it was an adrenal problem. I told the first endo it was an adrenal problem. I told the second and third ER docs it was an adrenal problem. I told the GP it was an adrenal problem. I told the fourth ER doc it was an adrenal problem. I told the second endo it was an adrenal problem. They all treated me like a hypochondriac and an idiot for reading information on the internet. Guess what? It was an adrenal problem. You are all conspiring to kill me.
Well all we need is tort reform and may be we won’t feel like every chart is up for legal review. I feel sorry for the Emergency and Internal Medicine docs. I have arbitration agreements to scare away the litigious. The ER docs don’t (at least in my state).
I like gbrown’s idea. This may make people look at the medical resources they are consuming and think twice about the phrase “Don’t worry, your insurance will pay for it.”
6 Responses to Patients believe we overtreat and/or overtest
elliottg
September 13th, 2005 at 10:34 am
Just ran across this at balkin.blogspot.com and thought it had some relevance. It’s a discussion of the weighing of risk.
http://balkin.blogspot.com/2005/09/secret-ambition-of-cass-sunstein_13.html
gbrown
September 14th, 2005 at 3:57 pm
As a pathologist I may have a skewed perspective but I have often thought that even physicians have little understanding of the cost/benefit trade-offs of their recomendations. With the increase in patient directed care and HSA’s it seems to me that it would be extremely useful for the public to have available objective numeric data on incidence of diseases, diagnostic testing strategies, and treatment effectiveness, along with, eg, relevant medicare fees. This would surely cut down on more egregious waste such as cranial imaging for headache.
m
September 14th, 2005 at 4:01 pm
is this unusual?
do we blindly accept the repair reccommendations that our household plumber or electrician suggest? do we always listen to the advice of elders? do we not frequently ignore even sound advice to exercise and eat regularly? just because a doc suggests a plan of action, many of us (docs included) do not do it.
tina
September 14th, 2005 at 4:50 pm
Do you think there is something inherent psychologically that might cause this? Drs want to help thier patients. What I’ve noticed over the last few weeks is that when they can’t help me or don’t know what to do they get either angry or confused. The poor ER docs are the most lost. However if the opportunity arises where they can help, they get this perky excited look. My endo doesn’t really want to understand what is causing the problem, just that the proper mix of meds have resolved the problem. Perhaps sometimes docs don’t know how to solve a problem so pass out a script instead. My GP hands out scripts and samples like candy. It is an easy solution and perhaps it makes the patient “feel” like youv’e done something even though you don’t know what to do.
I have found rather than too much testing they actually rely on far too little testing and at times don’t really understand the limitations of the tests they are running. If you even try and mention that you get treated like you don’t understand what you are talking about. It feeds into the idea you guys have that patients are really incapable of understanding thier own condition. I told the first ER doc it was an adrenal problem. I told the first endo it was an adrenal problem. I told the second and third ER docs it was an adrenal problem. I told the GP it was an adrenal problem. I told the fourth ER doc it was an adrenal problem. I told the second endo it was an adrenal problem. They all treated me like a hypochondriac and an idiot for reading information on the internet. Guess what? It was an adrenal problem. You are all conspiring to kill me.
John Di Saia MD
September 14th, 2005 at 9:22 pm
Well all we need is tort reform and may be we won’t feel like every chart is up for legal review. I feel sorry for the Emergency and Internal Medicine docs. I have arbitration agreements to scare away the litigious. The ER docs don’t (at least in my state).
Steve Lucas
September 15th, 2005 at 3:58 am
I like gbrown’s idea. This may make people look at the medical resources they are consuming and think twice about the phrase “Don’t worry, your insurance will pay for it.”