Fans of this blog MUST read this post – 10 Rules for Good Medicine
Here are my favorites:
Rule 2: Minimize
Many doctors and patients have a “more is better” mentality. This not only costs more money to the system, but it can cause harm to the patient. Here’s what I think should be done:
- Patients should only be seen when a visit is appropriate.
- Use as few medications as possible, and when necessary, use the cheapest one that will do the job.
- Order as few tests as possible. No test should be ordered for informational purposes only; the question, “What will I do with these results?” should always be answerable. If it is not, the test should not be done.
- When changes are made, make only a few at a time. Many simultaneous changes make it hard to tell what helps and what hurts.
Rule 10: Enjoy the Good Stuff
There’s a lot to complain about in our system. There are a ton of stressful things and a lot of bad stuff we see. The simple fact that so many of us keep going back to work is witness to a lot of benefits. Remembering what’s good about being a doctor is key to maintaining the energy to face the rest. Here are some of my favorite things:
- I have a lot of patients who I really like, enjoying my interaction with them.
- I see a lot of inspiring people, getting up when they are knocked down time after time.
- I get to play with babies and tickle kids (and get paid for it!).
- I save people’s lives and make them feel better.
- I get to say the right thing at the right time, really making a difference when it counts.
- People openly tell me how much they appreciate what I do.
- I work with a bunch of folks who are good to be with and like-minded in their desire to help our patients.
These things are what get me up in the morning. They are what make dealing with insurance companies, stupid government policies, and rude doctors and patients possible. They are the balance to the suffering and pain I see. No, they greatly outweigh all of that stuff. Really. I wouldn’t do the job if that weren’t the case.
My quotes and praise do not do this post justice. I would rate it one of the top 10 blog posts I have ever seen. Please go clickety click.
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heartily agree with all except:
Order as few tests as possible. No test should be ordered for informational purposes only; the question, “What will I do with these results?” should always be answerable. If it is not, the test should not be done.
You don’t want to do dangerous or extraneous tests but I don’t agree with the idea no test should be done for informational purposes only. There are times when you can’t anticipate what you will need in the future. Also there are times when the information will be of use in some other case.
We are always learning and that mentality is a shut-off mentality. It’s one of the reasons we have talked about why people don’t get ABGs anymore, even in situations they are clearly indicated. Of course I’m not talking about frivolous arterial sticks but situations where we can make objective indications even when they may not change immediate management. Having worked ICU for many years I can guarantee you no one can always predict the future course of a patient – if you operate by the principle stated , you will wind up wanting tests you don’t have. And you will not understand the nuances of the tests.
There are times when you will do certain tests, that you will do nothing with the results or you won’t know what to do with the results. Frivolous and dangerous tests should never be done but information bases are fluid and I think you should relook at how and why we obtain information.
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