Friday, March 27, 2009

wal mart mentality?

someone's gotta do it, right? actually, someone is already doing it. and more are joining in every year it seems. i'm talking about urgent care, after hours, etc. 
it's being done, so instead of fighting against it, i should use the aikido strategy and take the opponent's strength and turn it to my advantage, right? i cringe when a mom takes a baby or a child to an urgent care center. why? two reasons: 1) i'm not the one seeing them so i don't know what they really had and whether the treatment was correct/appropriate, and 2) it means i wasn't able to see them. both reasons show my control freak nature, and my insidious pride - like they would've been diagnosed and treated correctly if i had seen them because of course i always make the correct diagnosis and prescribe the correct treatment. right. that we've established that...i can't work 24/7 - at least not for long, and i have to trust that there are other physicians/np's/pa's who can take good care of my patients after hours - of course i trust cathy - hello - so why do i resist it?
1) it's really not necessary. ok, neither is it necessary to be able to buy eggs at 2 in the morning, but if someone offers it, someone will take them up on the offer. need is not the issue. this is a drive thru world and by gosh, my kid got a fever an hour ago and i want him seen now. truly i understand this with work/school/fears of serious disease/too much information available to make people worry, etc.
2) it's an extra expense. it costs more after hours. and then many parents bring the child in within hours to days of the after hours visit for me (or their pcp if they aren't mine) to see them and to confirm the diagnosis and treatment. 2 visits, one problem, could've waited but didn't have to (see #1).
the solution? an urgent care where a trustworthy person over whom i have at least some control in hiring/supervising/advising/backing up is going to see that patient after hours. someday, maybe. but i think i have to give up trying to buck the current mentality of parents and go with it. but doing what the people want is not always the best thing for the people. how does one convince the people of that? 

Thursday, March 26, 2009

just ask your doctor

man, i hate commercials for medicine! 'just ask your doctor' puts you in a position where you are forced to ask permission for something and me in the position to either grant or deny you that permission. it puts me, as the doctor, in the role of power over you, the patient. and it shouldn't be this way. the drug companies make it sound and look as if there is a perfect life out there waiting for you if your doctor will just let you have this medicine.  the same thing happens with various tests, especially mri's. we laugh at 'therapeutic' ct's and mri's - once a patient goes through the whole deal of getting one of these tests, even if it's not necessary, it seems that they get better. was it just the attention paid to the problem? your doctor watches the same stupid commercials you do, and he or she gets bombarded daily in journals and in person with other advertisements for drugs or treatments - each with articles 'proving' how much better their particular treatment is than the one they were selling last week. 
don't assume you have a disease just because you have the symptoms on the commercial. most diseases have symptoms that are similar to common problems like the flu or other viral illness, and these are way more common than the diseases they are advertising the treatment for. sure, everyone's depressed or anxious or fatigued or whatever - some of the time - but if it took a commercial to make you realize it was it really that bad? open your eyes! these people are selling something! they don't care about you and your health and your family. they care about making money.
don't let their advertising put me in a false position of power over you - holding in my hands the pen that can write you the prescription that will be the answer to all your problems. the drug companies have put the patient and the doctor in an adversarial position and they are capitalizing on it. don't let it work. be smarter than that. new is not always better. expensive is not always better. 
consider the source of the advertising and their ultimate motive - $.
sure, they have drugs that can help problems. but just because they have a great commercial doesn't mean they have a great treatment. listen to the end of the commercial. unless it's for an erectile dysfunction drug, then the side effects sell the drug.