PSA: When to fire your doctor.

[Katsmeow]

Quote:

11. Your doctor has been disciplined by his/her licensing body. .

A year ago we moved to our current house which is about 55-60 miles away from our existing physicians. DH and I have debated whether to keep our regular family practice physician. We really, really like him but it is an hour and a half drive to his office. I haven't needed to see him since we moved so I am still on the fence.

Anyway, DH called the existing physician's office and asked for a referral to a physician in this area. We got a name and I looked him up and found a news article from a couple of years prior. He had been disciplined from having a personal relationship with a patient and prescribing medication without writing in the patient's record.

The article quoted the physician as saying he had a personal relationship with her and prescribed medication and that you can't treat people you are personally involved with.

He was required to take an exam and do some continuing education and pay a penalty.

I really had mixed feelings about whether this would be a physician to go see. Reading between the lines it certainly looked like this was a girlfriend (I don't know if he was married to someone else or not) and that he prescribed medication to her without keeping proper records and that he shouldn't have been prescribing for her anyway. It seems like poor judgment, but not really something showing lack of competence.

On the one hand, I would rather have someone who didn't have this issue at all. On the other hand, I would prefer to go to someone where I have a referral than just have to find someone totally blindly....

[Meadbh]

Interesting dilemma, Katsmeow. The issue is whether this tells you anything about this physician that makes you uncomfortable becoming his patient. You might be very liberal personally about mixing business with personal relationships, or not.

But....(1) What do you think this says about this physician's integrity? How is he likely to deal with situations in which a great deal of trust is required? (2) He prescribed medications to a patient without documenting them. What does this tell you about his attention to detail? What if the patient had been in an accident and the medications were not known about when she reached the ER? This could have affected the quality of care she received. It's just not good practice.

Those are the questions I would be asking myself. Given that you have choices, I would request another name.

[Nemo2]

[obgyn65]

This behavior is inexcusable. This is medical ethics 101. When it comes to medical ethics I am ruthless. Don't see him.

Quote:

Originally Posted by Katsmeow The article quoted the physician as saying he had a personal relationship with her and prescribed medication and that you can't treat people you are personally involved with. .

[obgyn65]

I just saw Meadbh's answer after I posted mine. I am beginning to believe we agree about everything. :-)

Quote:

Originally Posted by Meadbh Those are the questions I would be asking myself. Given that you have choices, I would request another name.

[Sarah in SC]

Both mine and my DHs docs have gone concierge, at $1500 yearly retainer. We just aren't willing to pay that at our current level of health.
Haven't found new docs yet, but we do live in a town full of them thanks to the medical school.

[Midpack]

Quote:

Originally Posted by Sarah in SC Both mine and my DHs docs have gone concierge, at $1500 yearly retainer. We just aren't willing to pay that at our current level of health. Haven't found new docs yet, but we do live in a town full of them thanks to the medical school.

That seems outrageous to me. Talk about misguided incentives. Health care just gets more and more unreasonable as viewed vs the rest of the developed world, though doctors salaries don't seem to be the biggest discrepancy.

[imoldernu]

Then, on the other hand...
When you pray that nothing happens to your doctor.
We were her third patient(s) nine years ago. Just out of Med School, and very smart, and compassionate. The first appointment was 1 1/2 hours apiece, and each check-up is whatever time it takes. In one year, her practice was full, and the quality of care has just grown better. In those short years, she has moved from her small associate office to a brand new building, bringing in four other young doctors.

She prescribes tests, medication, and courses of action, with follow up and she listens. So far, so good. It took us 68 years to find her, and she is part of the family now. Some swear by their financial advisor, in our case, it's our doctor. Without going in to details, we could do with less money, but not without our lives. For both of us, our doctor played a big part in keeping us here... alive and so far, well.

After years of assembly line medicine, it's great to have a small town (smart) physician.

An interesting aside, on the matter of tests, and medication. Like many of our members, I was loathe to do either. In retrospect, had we not followed the "doctor's orders" DW and I may not have still been here, and most assuredly, the cost of preventive medicine that might have seemed high at the time, would now be many times higher, if we were still alive.
.................................................. ..........

Short, true story... Yesterday at the mall, the local hospital had a booth set up in the Local Business Expo. As I waited for a blood pressure and diabetes test, there was a couple in front of me. The lady was saying to the nurse, something to this effect... "If he had listened to what the doctor said five years ago, he would have taken the Lipitor, and maybe he wouldn't have had the heart attack".

[ERD50]

Quote:

Originally Posted by obgyn65 Quote: Originally Posted by Katsmeow The article quoted the physician as saying he had a personal relationship with her and prescribed medication and that you can't treat people you are personally involved with. This behavior is inexcusable. This is medical ethics 101. When it comes to medical ethics I am ruthless. Don't see him.

I meant to respond earlier, got busy/distracted....


obgyn65, in another thread you mentioned that your food budget is very low, because you often eat meals supplied by the drug reps.

Now, 'ethics' and 'ruthless' are subjective terms, and one can certainly argue that it doesn't affect one's judgement (as I'm sure this Doc in question told himself at some point). But I'd bet that most patients would not consider accepting gifts that amount to a significant part of their food budget to be consistent with a 'ruthless' stand on ethics.

I know it bothers me to sit in the waiting room, and see these reps come in with freebies, knowing that my Doc has me on some of these meds. It doesn't sit well with me. I'd question him on it if I thought I'd get a useful response.

Full disclosure: Yes, I've been taken out to lunch by some of my suppliers. It was pretty far and few between, never any significant $ amount over a year, and it was always accompanied by meaningful business discussions. And a few gift baskets over all those years at the Holidays, and at least one gift I would not accept - it went beyond 'nominal' value, and I didn't feel comfortable accepting it (DW thought I was nuts!). Even that is 'questionable'. But I never claimed to be 'ruthless' regarding ethics anyhow.

Just providing some perspective from the POV of a patient.

-ERD50

[gerrym51]

I'm a pharmacist.

the question i get the most from customers-believe it or not is-Why is my doctor giving me this drug.

my first impulse-which i don't say-you just went to the doctor don't you know?

i can only tell them the main use for the drug.some drugs however have multiple uses.

then i get-I don't have that?

what can you do. although doctors are not perfect usually it is patient innatentiveness at the doctors office

[Mulligan]

Quote:

Originally Posted by obgyn65 This behavior is inexcusable. This is medical ethics 101. When it comes to medical ethics I am ruthless. Don't see him.

That why I like this forum. I learn new things all the time. I did not know you couldn't treat a person you were involved with. If I was dating a lady Dr. I would certainly expect not to pay for the visit, and preferably get the free sample packs. I would have been shocked when she told me she couldn't because it was illegal. I must not have any ethics!

[obgyn65]

Ok. I have up to 5 slices of pizza a month, or Mexican, or Chinese, or Indian food. All in all, 10 free lunches max per month. Big deal :-) Sometimes, some patients who come to see me at the free clinics bring me tacos or burritos. I am not paid for any of this work, and I could work somewhere else and make more money. But instead I want to serve them, especially those without any papers or resources.

I can confirm in writing that I have NEVER let any supplier or drugs rep interfere with my standard of care. Case closed.

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Originally Posted by ERD50 obgyn65, in another thread you mentioned that your food budget is very low, because you often eat meals supplied by the drug reps. -ERD50

[urn2bfree]

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Originally Posted by Mulligan That why I like this forum. I learn new things all the time. I did not know you couldn't treat a person you were involved with. If I was dating a lady Dr. I would certainly expect not to pay for the visit, and preferably get the free sample packs. I would have been shocked when she told me she couldn't because it was illegal. I must not have any ethics!

This is jumping to conclusions given the scanty info we have. I can imagine a neighbor or friend saying to a doctor, "hey, can you give me An Rx for this rash?" The Md writes the Rx for the friend, for whom no chart or professional relationship exists. BAM! violation of state rules governing practice. Was it anti fungal or maybe a controlled substance? What was the relationship? There are many innocent scenarios I could imagine that would even involve pain meds, that technically a doc might try to be helpful to a friend that would be a violation and be no big statement about the doctor's skills ethics or fitness.

[ERD50]

Quote:

Originally Posted by obgyn65 Case closed.

Relax, you aren't on trial (and I'm not a lawyer), I was just sharing my perspective on this.

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Ok. I have up to 5 slices of pizza a month, or Mexican, or Chinese, or Indian food. All in all, 10 free lunches max per month. Big deal :-) Sometimes, some patients who come to see me at the free clinics bring me tacos or burritos. I am not paid for any of this work, and I could work somewhere else and make more money. But instead I want to serve them, especially those without any papers or resources. I can confirm in writing that I have NEVER let any supplier or drugs rep interfere with my standard of care.

Whatever you say. But 5 slices of pizza a month didn't seem to jibe with your explanation that your food budget was 'very low' due to free food from the drug reps (not patients).


Regardless of your specifics, I'll stick with my statement that I am not comfortable with my Doctors accepting anything from suppliers. The Doctors are supposed to be working for me, they are professionals in a highly paid field. I'd feel better if they bought their own lunch, and prescribed drugs w/o that question hanging in the air. And I don't feel that accepting such things meets the level of being 'ruthless' with regard to ethics. To be ruthless to me, means to eliminate even the pretense of influence. JMO.

-ERD50

[tinlizzy]

I know the ultimate goal of a pharma rep is to get a doctor to prescribe their drug but how do doctors learn about new medications if not for the reps?

[gerrym51]

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Originally Posted by tinlizzy I know the ultimate goal of a pharma rep is to get a doctor to prescribe their drug but how do doctors learn about new medications if not for the reps?

since i'm a pharmacist. the government has far more restrictions on pharmacy companies and reps.

when i started in pharmacy reps gave drugstores samples all the time.

now we get NONE.

reps are restricted by statute on what they can give doctors in ways of samples and other frebbies.

i believe obgyn and so should you

[tinlizzy]

Quote:

Originally Posted by gerrym51 since i'm a pharmacist. the government has far more restrictions on pharmacy companies and reps. when i started in pharmacy reps gave drugstores samples all the time. now we get NONE. reps are restricted by statute on what they can give doctors in ways of samples and other frebbies. i believe obgyn and so should you

Who me? I was just wondering how doctors find out about meds if not for the drug reps.

[gerrym51]

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Originally Posted by tinlizzy Who me? I was just wondering how doctors find out about meds if not for the drug reps.

sorry i clicked on the wrong post-but to answer your question-from the reps-they just can't give freebies like they used too.

[tinlizzy]

Quote:

Originally Posted by gerrym51 sorry i clicked on the wrong post-but to answer your question-from the reps-they just can't give freebies like they used too.

That's alright but I wasn't thinking about free samples. I assumed the reps give the docs the run down on the med itself. I think it would be hard to keep up with all the meds they come out with and doctors might like a rep to pop in with all the info.

I think the reps just bring food to schmooze the office staff.

[Meadbh]

Quote:

Originally Posted by tinlizzy Who me? I was just wondering how doctors find out about meds if not for the drug reps.

In many countries, including the US, physicians are obliged to complete and document continuing medical education (CME) in order to maintain licensure and professional designations. That CME can take many forms, including reading journals, doing background research for quality improvement, attending conferences, doing e learning, etc. When a physician works in an academic center and is on faculty, there are multiple opportunities to participate (and present at) academic sessions, e.g. grand rounds. Usually, these sessions involve a professor or trainee (e.g. a resident or fellow) or sometimes a visiting professor, presenting a common or perplexing clinical problem and reviewing and critiquing all the new developments about it. This often leads to a vigorous discussion and eventually to new guidelines, after rigorous reviews of benefits, risks and costs.

Physicians working in private practice are at a disadvantage because they rarely have the time to attend grand rounds and rely much more on attending conferences. Physicians commonly attend at least one major conference every year (generally at their own expense) and that involves travel. Sometimes pharmaceutical reps will sponsor an educational presentation, in that they pay for a speaker to visit. Medical organizations that I belong to have ethical codes that outline an expectation that such events be funded by "unrestricted educational grants", which basically means that the sponsoring company has no control over what the speaker talks about.

When I was in practice as a baby doctor these sponsored events were rare. I did notice that drug reps were more active in obstetrics. They usually represented firms that make contraceptives: a huge market. They certainly do visit private physicians in their offices, although in the academic centre where I worked, that was strongly discouraged and was not permitted during clinics.

I have always felt uncomfortable about anything that might smack of conflict of interest, and even about gifts from patients. I figure that pharmaceutical (and device) manufacturers would only spend money on this if it is effective in improving their bottom line. My interest is in what's good for the patient first, and for the founders second.

Hope that helps.