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[Martha]

Re: A question for Medical Doctors on the forum............

I didnt get asked or have the option. He said "yeah, pretty much...lets take some x-rays" and left the room. I was 18 or 19. I didnt realize I was being taken for a ride.

I'm sorry, is this going to turn from the doofy doctor who did unnecessary tests on me when I had walked in with satisfactory care already applied to my having done something wrong?

So if I walked in and said my toe hurt, and he ordered a head MRI and I didnt stop him, thats a-ok?

Just curious, as you seem so assertive. But 18 years old isn't forty something.

Last summer I had my hand smashed when a big container of sand fell on it. My doctor said "crushing" injuries rarely result in broker bones, so she wouldn't bother to X-ray unless I wanted it. I didn't.

 

[larry]

Re: A question for Medical Doctors on the forum............

If he had ordered a digital postrate test, then I would have wondered.

...and that would probably have been the last time you ever went to that dentist again. yuk, yuk, yuk

 

[Billy]

Re: A question for Medical Doctors on the forum............

Thanks for bringing the subject back to - uh - something I could follow without blushing... I was afraid someone was going to start talking about dual emergency airbags next.  

Certainly the $428 should have come with an itemized invoice, and in lay terms, please. If not in lay terms, then the codes should be listed. Then the codes need to be explained. No explanation, no payment.

Still, I think that it's fortunate no organs were taken out, or suggested to be taken out. That's positive.  You might want to look at the effects of stress on your body, or lifestyle choices on your body. Couldn't hurt.

Akaisha
Author, The Adventurer's Guide to Early Retirement

 

[maddythebeagle]

Re: A question for Medical Doctors on the forum............

Going to a dr. with "nonspecific symptoms" will almost always end in tests and 400 bucks sounds pretty cheap to me. I am not a dr. or play one on tv, but was diagnosed with a relatively rare problem and spent several years bouncing around from diagnosis, treatment and follow-up. Sometimes you need to just keep narrowing down and be your own advocate. We are talking about people and not cars right    

 

[cute fuzzy bunny]

Re: A question for Medical Doctors on the forum............

Just curious, as you seem so assertive. But 18 years old isn't forty something.

Yeah, thats generally not a problem, but at that stage I was at the "doctor speaks, I listen and nod" stage.

I still figured that even with just a busted toe that there was going to be some sort of cast or other remedy involved than just taping it.

And hell, my tape job and the quality of the tape I used was better. :

 

[Billy]

Re: A question for Medical Doctors on the forum............

Maddy the Turbo Beagle

I am not a dr. or play one on tv, but was diagnosed with a relatively rare problem and spent several years bouncing around from diagnosis, treatment and follow-up. Sometimes you need to just keep narrowing down and be your own advocate.

I have certainly had similar experiences. I consider myself to be an 'active patient.' I ask questions, I want to know why I'm supposed to take a particular test or med, and what is to be gained from it.

I can't tell you how many doctors are shocked at my approach...  However, I must say I do it in a non-confrontational manner, and I try to do my homework beforehand or by follow ups.

Akaisha
Author, The Adventurer's Guide to Early Retirement

 

[shiny]

Re: A question for Medical Doctors on the forum............

I can't tell you how many doctors are shocked at my approach... However, I must say I do it in a non-confrontational manner, and I try to do my homework beforehand or by follow ups.

I once had the nurse tell me to stop reading so much!

 

[2B]

Re: A question for Medical Doctors on the forum............

I think you should go back there and demand that your fuel injection nozzles be power flushed at 2500PSI and your entire exhaust system removed, sanded, acid washed and replaced with quarter inch bolts, nuts and lockwashers.

Stat!

 

[Rich_by_the_Bay]

Re: A question for Medical Doctors on the forum............

Maddy the Turbo Beagle

I have certainly had similar experiences. I consider myself to be an 'active patient.' I ask questions, I want to know why I'm supposed to take a particular test or med, and what is to be gained from it.

I can't tell you how many doctors are shocked at my approach... However, I must say I do it in a non-confrontational manner, and I try to do my homework beforehand or by follow ups.

I think I would enjoy having you as a patient. I feel best when my patients play an active role in their medical decision-making. Having mostly practiced in academic locations, I have many such patients who are faculty members, other docs, etc. They are well informed, and respond to facts and thoughtful decision guidance rather than "orders."

 

[Billy]

Re: A question for Medical Doctors on the forum............

Shiny:

I once had the nurse tell me to stop reading so much!

I don't doubt that a bit.  8) And I realize fully that I am not a doctor, -- it's not my area of training. However, I'm also not a blind follower. I take notes on side effects I may be getting, and I research symptoms and diagnoses. And I don't give up my internal organs freely!

2B

I asked one of my girlfriends to do that and I was lucky to walk away with my life.  However, she didn't have a problem with flushing my injection nozzles.

     

Rich:

I think I would enjoy having you as a patient. I feel best when my patients play an active role in their medical decision-making. Having mostly practiced in academic locations, I have many such patients who are faculty members, other docs, etc. They are well informed, and respond to facts and thoughtful decision guidance rather than "orders."

Hey, thanks! I very much appreciate what you said. 

Akaisha
Author, The Adventurer's Guide to Early Retirement

 

[razztazz]

Re: A question for Medical Doctors on the forum............

I am not a dr. or play one on tv, but was diagnosed with a relatively rare problem and spent several years bouncing around from diagnosis, treatment and follow-up. Sometimes you need to just keep narrowing down and be your own advocate.

Thius is what we're paying for. I get really annoyed when i pay big bucks and the "experts" seem incapable of or indifferent to just looking it UP!. If I can do it should be automatic for them but no dice.

I consider myself to be an 'active patient.' I ask questions, I want to know why I'm supposed to take a particular test or med, and what is to be gained from it.

THis usually gets not so furtive groans, eye-rolling,open displays of contempt and naked appeals to their own "authority". Even data from the pill manufacturer doesn't mean anything to them.

 

[Rich_by_the_Bay]

Re: A question for Medical Doctors on the forum............

THis usually gets not so furtive groans, eye-rolling,open displays of contempt and naked appeals to their own "authority". Even data from the pill manufacturer doesn't mean anything to them.

Razz,

Not to dismiss the other points you made, the data from "pill manufacturers" is not the gold standard for medications. They often include every side-effect reported in "post-marketing" surveilllance to protect themselves legally ("we disclosed that" "told you so"). So, if someone in the study has a headache, that is listed in the side-effect list, even if it was just a tension headache. Whatsmore, many symptoms are nonspecific and when they occur while a patient is taking a drug, they need to be assessed carefully and not just assumed they are drug-related.

Regarding benefit, distortion is also common. Example: risk of heart attack over the next 10 years is 8% on no meds, and 6% on meds, they will report a "25%" reduction in heart attacks (2%/8%). Technically defensible, but the patient really needs to know that in absolute terms it is a 2% reduction, with a 1% serious side-effect occurrence. You may still take the drug but it's a whole different scenario.

These are just a few examples. The doctor should use objective, independent research evidence (readily available) to help the patient make the right decision. Drug companies have done some great things, but generally speaking -- at the marketing and sales level -- they are not your friend.

Hope this is of interest.

 

[razztazz]

Re: A question for Medical Doctors on the forum............

Thanx R_I_T but I'm not talking about the light weight stuff.
I cannot get into detail here or I'l crash the server. A previous girfriend was a doctor and my siustyer works for a pharaceutical co. I knwo what I'm talking about.
I'm talking about life altering stuff clearly listed by the producer and cleary flipped off by the MD.

Also, They never seem interested in identifying real problems, or causes, focusing on appropriate treatment and informed descisons and all that. They inisist on giving out as much medication as possible, give as little relevent information about my condition as they can get away with (hence the atitude when I ask questions) They diagnose via telepathy. It's like eveytime you go to the bank they start twisting your nuts about getting a new credit card or opening some new kind of mutual fund account. Well, a trip to the dr's is like that only with medications... and new diseasses I dont have but they insist, in spite of the test data, that I DO have... and a complete disregard for medical problems I do have but they are not interested in treating because there apparanetly are no drugs for it. Or it's "here take this drug... get lost"

 

[wabmester]

Re: A question for Medical Doctors on the forum............

Rich, I'm curious what you think about concierge medicine.    Seems like it might be the perfect avenue for a doc like yourself who wants to wind down, and I'm sure it benefits patients who are looking for something other than assembly-line medical care.

 

[Rich_by_the_Bay]

Re: A question for Medical Doctors on the forum............

Rich, I'm curious what you think about concierge medicine.    Seems like it might be the perfect avenue for a doc like yourself who wants to wind down, and I'm sure it benefits patients who are looking for something other than assembly-line medical care.

I understand the motivation behind it both financially and pace-of-practice. I do not criticize my colleagues who choose this route. For patients it is a more pleasant experience (and more expensive). BTW, from what I have seen, it is not always the most highly respected or most medically astute doctors who are doing this, although some fit the bill. Caveat emptor.


Personally and professionally, it goes against everything I stand for, and undermines many of the reasons why I chose the profession. I am not naive but truly feel I should provide the exact same level of service for all patients regardless of ability to pay; our health care system doesn't make this easy, I admit, but I have always managed to have a mix of rich, poor, sophisticated and ignorant, paying and nonpaying patients.
Guess which ones have provided the greatest satisfaction? Hint: it's not the society crowd.

What we really need to do is fix the system to that everyone could enjoy the type of access and accessibility that a concierge practice proposes to provide. Most of us would gladly forego the fancy artwork, designer waiting rooms, free Starbucks in the waiting room.

Re: a nice semi-retirement job, I think about "locum tenens" where you fill in a month here and there for various practices around the country. Travel, hotel, malpractice paid, good money, DW can accompany if she wants, no nights or weekens, only take assignments when you feel like it. Cripe - I'd better knock this off before I up and quit today .

 

[Gpax7]

Re: A question for Medical Doctors on the forum............

Rich, I suspect you may be an M.D. (Pls forgive me if that's already established.) I know it is a life consuming thing to become a doctor but are we as a nation educating as many qualified people as we can to become M.D.s or only those who can really afford the tuition?
I am retired now but 10 years ago if I could have figured a way for my wife and me to maintain our lifestyle and me to become an RN, I'd have done it in a heart beat.
I also don't understand the non motivation behind those who graduate and would rather pay back the crippling tuition than to work in some less than desirable setting for 3 or 4 years. Please comment.

 

[Martha]

Re: A question for Medical Doctors on the forum............

Razz,

So, if someone in the study has a headache, that is listed in the side-effect list, even if it was just a tension headache.

Interesting.  One of the asthma/allergy drugs I take lists as a side effect "flu."  This never made any sense to me because flu is caused by a virus, it couldn't possibly be caused by a drug.  I suppose the drug could make you more susceptible to the flu, but it still seemed odd.  

Another example is Flonase, I take for allergic rhinitis.  One possible side effect is a runny nose.  Hey, I take the darn drug to stop my nose from running! And I take Flovent for asthma.  A side effect is wheezing or difficulty in breathing.  Does that mean that the drug isn't working or does it mean it could make your asthma worse?

No matter though, both work great for me.  

 

[Rich_by_the_Bay]

Re: A question for Medical Doctors on the forum............

Interesting. One of the asthma/allergy drugs I take lists as a side effect "flu." This never made any sense to me because flu is caused by a virus, it couldn't possibly be caused by a drug. I suppose the drug could make you more susceptible to the flu, but it still seemed odd.

Another example is Flonase, I take for allergic rhinitis. One possible side effect is a runny nose. Hey, I take the darn drug to stop my nose from running! And I take Flovent for asthma. A side effect is wheezing or difficulty in breathing. Does that mean that the drug isn't working or does it mean it could make your asthma worse?

You got it. What you really want to know is how many patients had higher incidence of the side-effect compared to the placebo group. That is reported in clinical trials, but often not in post-marketing material.

 

[Dawg52]

Re: A question for Medical Doctors on the forum............

Personally and professionally, it goes against everything I stand for, and undermines many of the reasons why I chose the profession. I am not naive but truly feel I should provide the exact same level of service for all patients regardless of ability to pay; our health care system doesn't make this easy, I admit, but I have always managed to have a mix of rich, poor, sophisticated and ignorant, paying and nonpaying patients.
Guess which ones have provided the greatest satisfaction? Hint: it's not the society crowd.

Good for you. I have a drug rep buddy who believes that this is the way it is all headed, at least for the better doctors. He has seen several doctors do this. True, I want a good doctor too but I do not plan to pay a retainer fee any time soon to have one. Fortunately it is not a problem to see most any doctor you need in my area.

 

[Texas Proud]

Re: A question for Medical Doctors on the forum............

i'd pay 428 with my visa and dispute the charge. make them explain the 428 to mbna

This will not work... you got the test done... they will bill you back...

 

[SteveR]

Re: A question for Medical Doctors on the forum............

You got it. What you really want to know is how many patients had higher incidence of the side-effect compared to the placebo group. That is reported in clinical trials, but often not in post-marketing material.

Blame your federal government for this one. FDA requires pharmaceutical companies list ALL reported adverse events (medical symtoms) during all clinical trial. This can add up to several thousand people over several months or years. Each visit to the clinic for a followup requires a ton of paperwork on what medical complaints the patient experienced over the past few days. This adds up to just about anything you can imagine. Rich is correct in that you need to understand the incidence rate of these to see if they are real side-effects or just normal human noise.

Ever try to read a patient insert that you may have received from your pharmacist? All the text in that 15X12 multi, multi, multi folded little gem is also required. Two product inserts are required per shelf pack of drug in the US. One is a Physician insert and the other is a Patient insert. (Europe only requires the Patient insert). The physician insert is chock full of clinical and pharmacological information and makes great reading for those so inclined.

 

[donheff]

Re: A question for Medical Doctors on the forum............

Good for you. I have a drug rep buddy who believes that this is the way it is all headed, at least for the better doctors.

I have Blue Cross Blue Shield (Fed program) and have noticed lately that more and more doctors are saying they won't participate. It worries me that I may end up having a health plan but no real "insurance."

 

[Billy]

Re: A question for Medical Doctors on the forum............

Rich

Drug companies have done some great things, but generally speaking -- at the marketing and sales level -- they are not your friend.

I agree. The amount of drug commercials we see on TV here in the States or hear on the radio is astounding. Some of them actually say or list the side effects (Your nanner will fall off, digestion will be impossible, you won't be able to have a complete thought again) but they say it in this lilting and lovely voice so that we have the tendency to dismiss it, until the nanner falls off. 


Akaisha
Author, The Adventurer's Guide to Early Retirement

 

[HFWR]

Re: A question for Medical Doctors on the forum............

Sure, it's all fun and games until the nanner falls off...

 

[Rich_by_the_Bay]

Re: A question for Medical Doctors on the forum............

Rich
I agree. The amount of drug commercials we see on TV here in the States or hear on the radio is astounding. Some of them actually say or list the side effects (Your nanner will fall off, digestion will be impossible, you won't be able to have a complete thought again) but they say it in this lilting and lovely voice so that we have the tendency to dismiss it, until the nanner falls off. 

I like the one where they try, in a lilting and lovely voice, to say "oily anal discharge may occur." Sometimes it just doesn't sound right .