When do we draw the money line in medicine? (2 Viewers)

[Medman]

Food for thought, "up to 30% of the budget" is spent on things that do not benefit the patients. Patient advocacy is important but this is too much of a waste on resources if it is true, perhaps doctors should make a judgement call on whether to treat or refuse treatment for the greater good of the system.

http://www.nejm.org/doi/full/10.1056/nejmp1203365

 

[Kiraken]

Food for thought, "up to 30% of the budget" is spent on things that do not benefit the patients. Patient advocacy is important but this is too much of a waste on resources if it is true, perhaps doctors should make a judgement call on whether to treat or refuse treatment for the greater good of the system.

http://www.nejm.org/doi/full/10.1056/nejmp1203365

Great article but it does not prove your point.

Why?

Because the "wasted" money referenced in the article refers to

fraud

and

"diagnostic tests and treatments that offer no measureable benefit"

this is actually a separate problem yet one i agree definitely does lead to enormous waste. There are too many doctors nowadays taking sub-standard histories and performing half-baked clinical examinations and ordering practically every test in existence to make a diagnosis rather than being systematic in taking a thorough history, conducting a thorough set of clinical examinations and tailoring the tests they order so they are solely beneficial as to confirm the diagnosis rather than make one.

 

[Medman]

Great article but it does not prove your point.
this is actually a separate problem yet one i agree definitely does lead to enormous waste. There are too many doctors nowadays taking sub-standard histories and performing half-baked clinical examinations and ordering practically every test in existence to make a diagnosis rather than being systematic in taking a thorough history, conducting a thorough set of clinical examinations and tailoring the tests they order so they are solely beneficial as to confirm the diagnosis rather than make one.

I wanted to bring up that article because although it does not reflect 100% of what we discussed here it has valid points about the issue of money. Like I said earlier I'm not saying we should refuse treatment to patients but I think there should be a system implemented for patients requiring expensive treatments to ensure they show up for appointments, take their situation seriously so the benefits of treatment is not actually wasted, thereby leading to a waste of taxpayers money. I understand the majority of patients won't have an issue with this but there are a few people out there who just refuse to do the right things despite proper education and intervention.

As for the tests and treatments, doctors should be the one who makes a judgement whether to offer it. You say doctors should not judge, but unfortunately they have to decide whether the outcomes will be beneficial to the patient (One of the four core ethical principles). Surgeons often refuse to operate on patients because they consider the outcomes poor due to sometimes the patient's lifestyle choices and their inability to manage their other co morbid conditions. All consultations, treatments and tests require money, a chest x-ray, fbc all ordered so liberally in hospital costs ~$70 and ~$30 respectively. Now imagine an organ transplant costing ~$30,000 not including the medication the patient requires to take for the rest of their life. Now if the patient decides not to turn up to appointments to help prolong the longevity of their donated organ. One it shows little respect to the person who actually donated the organ and secondly it is such a waste of a gift which could have potentially been more beneficial in someone else. I do realise it is unethical to withdraw treatment but surely, there must be something that can be done to prevent such waste.

 

[Kiraken]

So please enlighten me on what "medical journals" one should read for the interview. I have never asked my students to read medical journals in my 3 years of training students and they all have done pretty well.

Kiraken. Perhaps I have the surgeon mentality where patient outcomes are proportional to their effort they put in. This being said their lifestyle choices such as smoking, weight gain all effect surgical and medical outcomes. Is it not glorious to defeat disease and to bring a patient back from the brink of death?

Again your definition of a doctor is only about the smaller picture patients. So doctors shouldn't get a say in budgets of health? So doctors should ignore public coffers and treat patients as if we have an infinite supply of money? Normal practice in medicine follows a strict guideline to save the public system money. If we were to only think of "beneficial patient outcomes" all males would get a PSA test, everyone with GI bleeding would receive gastroscopies etc. Why do we not do these things? Money. I can understand you're resolutely against the idea of withholding treatment without understanding the situation but I have not said we withhold treatment but these patients need to come to appointments, receive treatment, get tested or the Government won't fund their treatment in which case they will have to pay a portion themselves. Ad hominem much? Perhaps you should analyse your own responses before accusing me of using ad hominems.

Straw man much? You're making an assumption that I do not give patient autonomy. Well I give them the autonomy to choose their treatment but I don't feel comfortable being doctor who will always "prescribe" them drugs to help them sort out their problems when they have deeper problems. I have met a lady who has visited the GP's office in over 20 occasions and refuses to solve her marriage issues leading to a destructive family life. The GP has consulted her more than 1hr in half of these consultations to get her to realise the root of her problems. She has not changed and constantly asks for antidepressants and other drugs to "treat" her problems. You may have patience for such patients but for me, I would not be able to handle it. I give them the autonomy to choose a different doctor.

I like to bring the issue of organ transplantation. We do in fact withhold organ transplantation for alcoholic patients. Patients in liver failure who has a history of alcohol cannot receive a liver transplant unless they have been 6 months alcohol free. You see my suggestion has already been implemented due to limited supply of resources. Is there not a way to extrapolate this to a broader scale?

GP mentality is great and you're entitled to your opinion. I still think it's a waste of resources to support people who are ignorant to their condition even after doctors have gone to great lengths explaining to them in great detail the consequences and importance of treatment. The problem is implementing a system which can differentiate these people so tbh I don't see it happening but I just wanted to hear what other people thought about this issue.

firstly, i don't really understand what point you are trying to make when you mention the surgeon mentality etc. please elaborate

no it isn't, the definition i provided is literally the definition of what a doctor *is*. I am not saying that doctors should not be mindful of their resources, i am saying that denying a patient treatment based on your own personal judgement of whether they "deserve" it or not is an unethical means of doing this. As i stated in my previous post, less money wastage in ordering unnecessary tests that add nothing to a positive patient outcome is a far more effective and ethical way to ensure less wastage of money.

Nope, in fact what you just said is a strawman, i never stated that you prescribe drugs as the be all and end all of treatment to help sort out their issues, in fact i am totally against intervention with drugs and pharmaceuticals unless it is necessary. There is a difference between prescribing drugs carelessly that a patient does not need(i.e. administering morphine to a morphine addict with no other underlying problems) and what you suggested, which was withholding treatment from a patient who you feel does not "deserve" it. There is a difference between not administering medication to a patient who does not objectively require it and not administering medication because you feel, via your own personal opinion, the patient is a "retard", i am for the former but definitely not for the latter and you made a strawman argument in not distinguishing between the two, which i think is the major flaw in your reasoning, you feel as if your analysis of whether or not a patient "deserves" treatment based on your own moral standards is equivalent to a patient not objectively needing medicine.

If you say, in your own words, you do not have the patience to handle patients who might be difficult, then no offence but i question your suitability to be a physician and perhaps you are more suited to surgery due to the more limited doctor-patient interaction, medicine is not an easy career and you should be fully prepared to encounter patients you disagree with personally but must treat because that is your duty as a doctor to not let your personal bias affect treatment.

 

[Kiraken]

I wanted to bring up that article because although it does not reflect 100% of what we discussed here it has valid points about the issue of money. Like I said earlier I'm not saying we should refuse treatment to patients but I think there should be a system implemented for patients requiring expensive treatments to ensure they show up for appointments, take their situation seriously so the benefits of treatment is not actually wasted, thereby leading to a waste of taxpayers money. I understand the majority of patients won't have an issue with this but there are a few people out there who just refuse to do the right things despite proper education and intervention.

As for the tests and treatments, doctors should be the one who makes a judgement whether to offer it. You say doctors should not judge, but unfortunately they have to decide whether the outcomes will be beneficial to the patient (One of the four core ethical principles). Surgeons often refuse to operate on patients because they consider the outcomes poor due to sometimes the patient's lifestyle choices and their inability to manage their other co morbid conditions. All consultations, treatments and tests require money, a chest x-ray, fbc all ordered so liberally in hospital costs ~$70 and ~$30 respectively. Now imagine an organ transplant costing ~$30,000 not including the medication the patient requires to take for the rest of their life. Now if the patient decides not to turn up to appointments to help prolong the longevity of their donated organ. One it shows little respect to the person who actually donated the organ and secondly it is such a waste of a gift which could have potentially been more beneficial in someone else. I do realise it is unethical to withdraw treatment but surely, there must be something that can be done to prevent such waste.

and this is where the wastage is

the amount per incidence might be smaller in terms of cost but the sheer number of incidence truly reflect the cost on the system

people who are non-compliant with management after a transplant are far fewer in number than patients in hospitals who are not examined properly or have not been interviewed properly and been subjected to innumerable tests because the doctor did not pinpoint the diagnosis effectively or narrow it down. They are also far fewer in number to the thousands of people given antibiotics every day despite their doctor not adequately excluding the infection was viral in origin.

Think to yourself, how many times in hospital have you seen doctors ask for every test under the sun without taking a strong history and examination of the patient that could have narrowed down the diagnosis and thus reduced the number of necessary tests to be performed. How many times has a GP or doctor prescribed anti-biotics to a patient who did not necessarily need it? Tally up the amount of times these incidents happen and the wastage dwarfs any potential wastage from patients that are non-compliant with medication, not to mention the whole ethical argument that a patient can have a host of reasons for non-compliance and it is disrespectful and unethical to assume that their decision is "retarded" and something to dismiss because u feel they do not deserve treatment via your own moral code.

 

[bangladesh]

If you say, in your own words, you do not have the patience to handle patients who might be difficult, then no offence but i question your suitability to be a physician and perhaps you are more suited to surgery due to the more limited doctor-patient interaction, medicine is not an easy career and you should be fully prepared to encounter patients you disagree with personally but must treat because that is your duty as a doctor to not let your personal bias affect treatment.

My thoughts exactly.

 

[Medman]

You are probably right on the point of wastage in the system on tests and unnecessary treatments outweighing the cost of non-compliance. On the most part most doctors I see take a pretty darn good history and do a great exam. As for excluding viral origin of illness, you can't unless you want to run an expensive PCR. Doctors also fear being sued or losing their patients so they bend over and go with their patient wishes. Like I said I can understand where your coming from but non-compliance costs the system hundreds of millions per year. I'm not talking just about organ transplantation. I'm talking about non-compliance with appointments then resulting in their admission into hospital. Do you know how much it costs to keep one inpatient per day in hospital? That's ~$1500 per day, and I've seen complex patients stay in hospital for months and months. I have found literature on clinic non-compliance, 17% non-compliance on average per clinic. That would cost the clinic roughly ~$10,000 per year, extrapolate to all clinics in all hospitals and it will run into the millions.

What happens if the patient does in fact "need some form of treatment" but the true root cause of something else. Would you still continue to prescribe the medication if the patient refuses to address their root cause, I guess you would but can you continue to be their doctor if that was the case?

Anyways great to share your thoughts on this. I'm heading into OB&GYN and have my exams soon so won't be here much. Good luck.

 

[Medman]

My thoughts exactly.

Personal bias, whether you like it or not will always influence what patients you get and what sort of outcome is as a result. GPs have told me they only see certain patients because of their personal bias so you are pretty much saying half the GPs should not be doctors. I also question my ability to be a physician hence I said I had a surgical mentality. I don't like to dwadle think and fiddle with medication that's what physicians are for. If I could handle surgery I would definitely be a surgeon.

Amirbang you are still naive and you act as if you know so much about medicine but in fact you know so little. If you ever enter medicine you will understand the complexities.

 

[Kiraken]

You are probably right on the point of wastage in the system on tests and unnecessary treatments outweighing the cost of non-compliance. On the most part most doctors I see take a pretty darn good history and do a great exam. As for excluding viral origin of illness, you can't unless you want to run an expensive PCR. Doctors also fear being sued or losing their patients so they bend over and go with their patient wishes. Like I said I can understand where your coming from but non-compliance costs the system hundreds of millions per year. I'm not talking just about organ transplantation. I'm talking about non-compliance with appointments then resulting in their admission into hospital. Do you know how much it costs to keep one inpatient per day in hospital? That's ~$1500 per day, and I've seen complex patients stay in hospital for months and months. I have found literature on clinic non-compliance, 17% non-compliance on average per clinic. That would cost the clinic roughly ~$10,000 per year, extrapolate to all clinics in all hospitals and it will run into the millions.

What happens if the patient does in fact "need some form of treatment" but the true root cause of something else. Would you still continue to prescribe the medication if the patient refuses to address their root cause, I guess you would but can you continue to be their doctor if that was the case?

Anyways great to share your thoughts on this. I'm heading into OB&GYN and have my exams soon so won't be here much. Good luck.

For the viral thing, I was referring to ppl who come to the GP with mild chest infection i.e. "flu-like" symptoms. You do not need a PCR for that, if it is relatively mild like most are and you take a history that does not suggest a bacterial infection, you can assume it is viral and let it recover over time (tell them to come back if it doesn't) instead of wasting money on anti-biotics. Unfortunately a lot of doctors do the latter

The huge problem with that statistic you provided concerning cost is that it talks about non-compliance, but it does not give the reasons for non-compliance. As I said earlier there can be an entirely valid reason the patient is non-compliant and if it is valid it is not a "waste" on their part.

Yes because ultimately embarking on treatment and a management plan is up to them, they might want to continue the medication that does not address the root cause because it might address a symptom that is of the greatest concern to them, which is an entirely legitimate reason, plus as stated earlier, their non-compliance with other medication could be due to entirely valid reasons, u can't just assume they are doing it without reason. And yes, if they want me to be their doctor I will continue to be their doctor.

 

[Kiraken]

Personal bias, whether you like it or not will always influence what patients you get and what sort of outcome is as a result. GPs have told me they only see certain patients because of their personal bias so you are pretty much saying half the GPs should not be doctors. I also question my ability to be a physician hence I said I had a surgical mentality. I don't like to dwadle think and fiddle with medication that's what physicians are for. If I could handle surgery I would definitely be a surgeon.

Amirbang you are still naive and you act as if you know so much about medicine but in fact you know so little. If you ever enter medicine you will understand the complexities.

No it doesn't. Have been on a GP rotation and am on an ED rotation right now, the only personal bias that ever came into play is that of the patient, what treatment they would prefer etc. The doctor goes in, takes a history, performs the necessary examinations then deals with the issue in a manner that they believe is best for managing or treating them and which the patient or their guardian agrees to. You cannot let your personal judgement of a patient impact your treatment of them.

The fact you say physicians just dawdle and fiddle with medications shows a lack of understanding, it might look that way and physicians might not always get results at the same rate as surgeons but that is because they deal with patients in a non-invasive manner and sometimes deal with incurable conditions that can only be managed with medication to give the patient better quality of life. Medicine is more than just "cure everything", to think it's all about that shows that you're the last person to be throwing around "naive" at other people, medicine is also about providing people with a better quality of life, of obtaining better health outcomes for themselves.

Healthcare in other words, is patient-oriented not doctor or disease oriented and I feel as if all your comments in this thread so far fail to appreciate this concept

 

[Medman]

Personal bias for selection of patients in GP centers do occur. I never said personal bias for selecting treatment.

I never said medicine was about cure, now you're putting words into my mouth. I am the last person to throw naive around? Don't act like every single person who went to medical school will come as the perfect doctor. I've seen many doctors turn from patient-orientated to just giving up because of the patient's lack of understanding even after multiple explanations. It's emotionally and energy draining to do this for every single patient and it makes it all the more difficult if they do not take charge of their own health. Non-compliance as a result of ignorance and failure to accept their health concerns is what I am addressing not because there is a language barrier or miscommunication on the doctor's part etc. In fact I recently witnessed an excellent consultant great to many other patients get fed up with one particular patient because she refuses to understand her problems is a result from her weight, blaming it on her insulin instead of trying to resolve it. He refused to give his input into her pain management. He's an excellent doctor, thorough and has re diagnosed patients other doctors have misdiagnosed. So in this case he shouldn't be a doctor?

Physicians are smart people and are the thinkers of the medical community. There's nothing wrong with a physician I am just implying I do not want to fiddle with medication for patients.

Your issue is denying patient treatment because of their past. My thoughts on the issue is the potential diversion of money into other areas of need.

My assumption is that you would be against the US healthcare system?

Another off the question topic. How do you have so much time to spend posting on this forum whilst studying medicine?

 

[Kiraken]

I never said medicine was about cure, now you're putting words into my mouth. I am the last person to throw naive around? Oh please save your altruistic bull crap into the bin. I've seen many doctors turn from patient-orientated to just giving up because of the patient's lack of understanding even after multiple explanations. Non-compliance as a result of ignorance and failure to accept their health concerns is what I am addressing not because there is a language barrier or miscommunication on the doctor's part.

In fact I recently witnessed an excellent consultant great to many other patients get fed up with one particular patient because she refuses to understand her problems is a result from her weight, blaming it on her insulin instead of trying to resolve it. He refused to give his input into her pain management. He's an excellent doctor, thorough and has re diagnosed patients other doctors have misdiagnosed. So in this case he shouldn't be a doctor?

You strike me as that stereotyped med student who feels they need to be overly cynical and disregards patient-oriented care because you feel that is how doctors should be

It isn't

if ur talking about patients not compliant due to "ignorance" a) how do u know it is ignorance and not something else more personal to them? And b) this still means ur statistic is irrelevant as it does not differentiate between people who have different reasons for non-compliance

I know other consultants who have not lost their patience with otherwise frustrating patients, as you can see, anecdotal evidence has minimal relevance to a wider discussion, saying u met 1 consultant who lost their patience but is otherwise a good doctor does not in any way prove being impatient and judgemental of patients is appropriate behaviour for a doctor

Doctors who deviate from patient-oriented care are deviating from what medicine is essentially about, and saying a lot of people do it by no means justifies it

 

[Kiraken]

Being a doctor isn't about an ego trip where you enforce your moral code on people, it isn't about judging your patients on what you feel they deserve, it is not about treating people as commodities or as vessels of disease, it is about dealing eith the health concerns people have

By it's very essence medicine is about dealing with the concerns your patient has and giving them the best care you can, where best is defined by the outcomes they want for their own health, not based on what you assume is best for them by your own standards.

 

[OMGITzJustin]

does kiraken even study med?

 

[nerdasdasd]

does kiraken even study med?

Med @ uws... He is currently doing placement.

 

[Kiraken]

does kiraken even study med?

Lol yes, why?

 

[Medman]

You strike me as that stereotyped med student who feels they need to be overly cynical and disregards patient-oriented care because you feel that is how doctors should be

It isn't

if ur talking about patients not compliant due to "ignorance" a) how do u know it is ignorance and not something else more personal to them? And b) this still means ur statistic is irrelevant as it does not differentiate between people who have different reasons for non-compliance

I know other consultants who have not lost their patience with otherwise frustrating patients, as you can see, anecdotal evidence has minimal relevance to a wider discussion, saying u met 1 consultant who lost their patience but is otherwise a good doctor does not in any way prove being impatient and judgemental of patients is appropriate behaviour for a doctor

Doctors who deviate from patient-oriented care are deviating from what medicine is essentially about, and saying a lot of people do it by no means justifies it

Everyone has a boiling point. To say you won't get frustrated towards any patient in your lifelong career is a delusion. Overwork, stress, other commitments all play a role in any normal human being. You will be pushed, prodded to the point where you will lose your patience with your patients even though it's not "supposed" to be. I have 5 friends working as interns right now. They aren't exactly enjoying their jobs and they tell me of how frustrating some patients are. Now if you ask any intern who is not your friend I doubt they would divulge that information to you. Medicine has a shroud where "one" is supposed to be ethical, patient-orientated. On the most part, doctors are but we all have our limits. My friend just worked 80hrs last week, and yes he lost his patience a few times with patients. So according to your logic he is being a doctor for the wrong reasons? Wake up call kiraken, this world is not perfect and neither are you. Failure to understand all doctors are going to have the best approach with all patients is ignorance.

I'm not saying your view is wrong, I respect you still are so caring to your patients. I agree with your perspective but idealistically it does not echo total truth in the real world. And your evidence is not based on anecdotal evidence, have you spoken to all doctors? Regardless, this is off topic.

I raised the point of liver transplantation which, does not allow treatment of alcoholics. What do you say about this? This is real evidence that I brought up that you chose to ignore. Where is your evidence to say healthcare should only be patient orientated without consideration for other factors? Pop health lectures don't count.

Some people burnout faster than others. Kiraken probably has not yet burnout, since he has so much time to spend on the forums. I have had patients die on my team multiple times and if you invest that emotional energy every single time you won't survive medicine.

 

[Medman]

Being a doctor isn't about an ego trip where you enforce your moral code on people, it isn't about judging your patients on what you feel they deserve, it is not about treating people as commodities or as vessels of disease, it is about dealing eith the health concerns people have

By it's very essence medicine is about dealing with the concerns your patient has and giving them the best care you can, where best is defined by the outcomes they want for their own health, not based on what you assume is best for them by your own standards.

So a diabetic patient says I don't want to attend renal, ophthalmology, cardiology consults and check my HB1AC. Just give me more insulin. I thought doctors were meant to promote better outcomes. Going by a patient-orientated approach you are essentially giving them a death sentence.

This is just my personal opinion, if I meet a patient who does not give a rats ass about their own health I would automatically tell them to find a new doctor. This makes my life easier and I can actually spend more time and effort for patients that actually want better outcomes for their health. So that makes me a bad doctor? Perhaps you should respect other doctor's opinions too. Unless you want to dedicate your whole life to being altruistic in which, case you should work in a low income area and bulk bill everyone because specialists fees are insane. I'll be more than happy to refer my non-compliant ignorant patients to you in the future.

 

[Kiraken]

Everyone has a boiling point. To say you won't get frustrated towards any patient in your lifelong career is a delusion. Overwork, stress, other commitments all play a role in any normal human being. You will be pushed, prodded to the point where you will lose your patience with your patients even though it's not "supposed" to be. I have 5 friends working as interns right now. They aren't exactly enjoying their jobs and they tell me of how frustrating some patients are. Now if you ask any intern who is not your friend I doubt they would divulge that information to you. Medicine has a shroud where "one" is supposed to be ethical, patient-orientated. On the most part, doctors are but we all have our limits. My friend just worked 80hrs last week, and yes he lost his patience a few times with patients. So according to your logic he is being a doctor for the wrong reasons? Wake up call kiraken, this world is not perfect and neither are you. Failure to understand all doctors are going to have the best approach with all patients is ignorance.

I'm not saying your view is wrong, I respect you still are so caring to your patients. I agree with your perspective but idealistically it does not echo total truth in the real world. And your evidence is not based on anecdotal evidence, have you spoken to all doctors? Regardless, this is off topic.

I raised the point of liver transplantation which, does not allow treatment of alcoholics. What do you say about this? This is real evidence that I brought up that you chose to ignore. Where is your evidence to say healthcare should only be patient orientated without consideration for other factors? Pop health lectures don't count.

Some people burnout faster than others. Kiraken probably has not yet burnout, since he has so much time to spend on the forums. I have had patients die on my team multiple times and if you invest that emotional energy every single time you won't survive medicine.

and once again you ignore the key point, i already addressed this earlier but you clearly missed it so i shall say it again

There is a difference between feeling frustrated (which is natural and everyone will feel it) and letting it affect how you treat your patients (hint: this is not supposed to happen). Losing your patience once or twice is bad but forgivable, having it affect your entire philosophy of treatment by deciding not to treat patients you arbitrarily judge as "retarded" is completely out of line with what being a doctor entails.

no it isn't off-topic, that is the crux of the topic. It's quite clear you have fallen into some cynical mentality where the patient doesn't know what is best for them, one where doctors such as yourself have some god complex where they feel that they have to enforce their own moral code on every patient that comes through and judge if they "deserve" treatment or not and letting go of a patient's autonomy in deciding what is a positive health outcome for themselves.

I actually did address this earlier, you should perhaps read back. For the sake of indulging you though i will address it again

1) liver transplantation being contra-indicated in those with substance or alcohol abuse is an entirely different situation from non-compliance of treatment. How? Because non-compliance can be due to a host of reasons that can be entirely resolved by a doctor, it could be due to a lack of understanding of how medication works, fear of side effects and wanting an alternative, lack of rapport with the doctor in question, management issues with time and forgetfulness, feeling as if the issue does not require medication as they can cope with this and have other pressing health concerns which have greater priority. Note how none of these have anything in common with a liver transplant recipient with alcohol abuse. Alcohol abuse is not a choice similar to other forms of non compliance, it is an actual psychiatric disorder with strong effects on their physiological well-being, so in terms of their health a transplant would be useless because it will almost always inevitably fail to have any positive health outcome for the patient. Not to mention that transplant involves a donor party, it would not be respecting the wishes of the donor to let their liver be given to a patient it will not end up helping anyway.

In short, the comparison is moot because it has no relation to refusing treatment to a non-compliant patient where non-compliance can be due to one or more entirely resolvable issues.

i also like how you assume i have a lot of time on my hands because i spend time on these forums, and have little hospital experience. It might not be as great as yours but that is entirely irrelevant to this debate which is based on the philosophy behind what a doctor should do. Not to mention i have had patients die under teams i have been in too and have been involved in difficult situations within a hospital setting too, but i do not see how this is relevant to this debate so i'm not sure why you continuously bring up your "experience" point, perhaps it is to indulge and validate yourself?

 

[Kiraken]

So a diabetic patient says I don't want to attend renal, ophthalmology, cardiology consults and check my HB1AC. Just give me more insulin. I thought doctors were meant to promote better outcomes. Going by a patient-orientated approach you are essentially giving them a death sentence.

This is just my personal opinion, if I meet a patient who does not give a rats ass about their own health I would automatically tell them to find a new doctor. This makes my life easier and I can actually spend more time and effort for patients that actually want better outcomes for their health. So that makes me a bad doctor? Perhaps you should respect other doctor's opinions too. Unless you want to dedicate your whole life to being altruistic in which, case you should work in a low income area and bulk bill everyone because specialists fees are insane. I'll be more than happy to refer my non-compliant ignorant patients to you in the future.

that is not what patient-oriented care is about and that example demonstrates you have no idea what you are talking about or what it even means.

"Going by a patient-orientated approach you are essentially giving them a death sentence. "

The sheer arrogance in this statement is astounding, like you assume a patient does not know whether they want to live or not and patients cannot make decisions for themselves. As a doctor you're never supposed to force treatment on a patient, do you seriously not know the basics of consent? Your job is to inform a patient of their options, provide an informed opinion of each and which option would be best for them, pros and cons of each and then they decide if they wish to pursue it. Like no offence, but if you can say something like a patient-oriented approach is a death sentence you really need to go back to first year because patient-oriented care is something taught from the get-go and judging by your example and comments you have little to no understanding of what it actually entails

Let me show you this quote from the Wikipedia article on Patient-oriented care

"Patient-centered care is about much more than simply educating patients about a diagnosis, potential treatment, or healthy behavior. It does not mean giving patients whatever they want; rather, patients want guidance from their care providers, but they expect that guidance to be provided in the context of full and unbiased information about options, benefits and risks."

It's not about giving them whatever medication or drug they want, it's about fully informing them of the options they have, pros and cons and potential outcomes and allowing them to choose the treatment and management that is best for them, because what you might think is their primary concern isn't necessary what they feel is their primary concern. Take for example the fact that some cancer patients are not given anti-emetics etc. because those responsible for their care are so fixated on treating the cancer they neglect that the patient has other concerns too, such as nausea.

Being a doctor isn't about making your life easier, it's about making your patient's life easier, that quote kinda demonstrates that your true priority lies in just treating people you are comfortable with and who make your job easy rather than treating everyone equally. Also as i have stated *numerous* times before, just because a patient is non-compliant that doesn't mean they do not want better health outcomes for themselves. Clearly the fact they have come to you MEANS they want better health outcomes for themselves. And yes if you cannot appreciate a patient's autonomy, if you cannot respect your patients, if you judge your patients based on your own moral code and what is "easier" for you, if you have no understanding of patient-oriented care, if you think being altruistic or caring for your patient's health is a bad thing and worth criticising, if you insult them as "retarded" or "ignorant" without even considering there might be legitimate factors leading to their non-compliance (which you probably didn't establish due to poor rapport or not caring enough to ask) then true it doesn't make you a bad doctor, it makes you someone who isn't a doctor at all because it violates the very principles of what healthcare is based on, including the declaration of geneva:

I will not permit considerations of age, disease or disability, creed, ethnic origin, gender, nationality, political affiliation, race, sexual orientation, social standing or any other factor to intervene between my duty and my patient;
I will not use my medical knowledge to violate human rights and civil liberties, even under threat;

In case you are unfamiliar with the concept of human rights it is important to note the first quote is a human right given in the Declaration that indicates that you should not let any personal judgement intervene in your treatment of the patient, that includes refusing to give them treatment that will be beneficial to them. In fact that violates an earlier part of the declaration which states that your duty is to try your best to provide better health outcomes for a patient, giving up on them because you don't like them is not trying your best and violates this.

Not to mention it violates that second quote as a lack of respect for patient autonomy and a lack of respect for what their concerns are with their health is a violation of the basic liberties any human being should have