November 23, 2012

Additional Assumptions Patients Should Not Make

This is a continuation of blogs from May 10, 2012 and October 17, 2012.

Don't assume the doctor knows what you are thinking.
I wish I would have been listening more carefully when Dr. Peter A. Ubel of Duke University was on the Tavis Smiliy program on PBS discussing his book “Critical Decisions.” I just happened to hear him make the above statement on the late night early morning (locally 0100 AM) show of Oct 18, 2012. He commented that patients need to speak up because doctors are not ESP aware. After reading the reviews about his book here, I looked at the other books he has written. They are interesting and on controversial topics of health care rationing and assisted suicide. Many physicians and nurses are pushing for assisted suicide and healthcare rationing (euthanasia), so be alert to the position of your doctor if you are opposed to assisted suicide.

His answers to Tavis's questions about communications were most interesting and he stressed the need for communications between the patient and doctor, even if the time constraints prevented extended communications. This is why people like David Mendosa and me write blogs about preparing for the doctor appointment. Yet many people just don't understand the need to optimize the time with their doctor. My health depends on optimizing the short time I have with the doctor.

Do not assume that your doctor is completely independent of interest conflicts.
This is something many patients do not consider about their doctors and is a fact of life that needs to be at the heart of every patients concern about their doctor(s). Many doctors are honorable, but they are human and can be influenced by money or other enticements. Even with this being on a neurologywebsite, it is applicable for all medical professions and doctors.

Three states do have mandatory marketing disclosure laws, which require the reporting of physician payments. The states are Minnesota, Massachusetts, and Vermont. Anyone can also access Dollars for Docs (, a free ProPublica database that allows individuals to search by physician in order to find disclosed payments made by 12 pharmaceutical companies to healthcare practitioners. Some patients are already using this resource. Much of the data available may be incomplete.

As patients, help is on the way. Unless there is delays (and do expect them), beginning in 2013, the implementation of the Physician Payment Sunshine Provision of the Affordable Care Act will provide a database of financial relationships that will be available to patients. The final regulations from the Centers for Medicare and Medicaid Services (CMS) are not complete, and many physicians are concerned about the accuracy and manner in which the tool will display information. It is expected the physicians will call on CMS to delay implementation.

Never assume that the doctor will follow protocol or your wishes near the end of life.
Yes, in a survey conducted by Medscape and published in their 2012 Ethics Report asked several questions related to end of life. It is immoral the percentage of doctors that would do things in violation of do not resuscitate (DNR) orders and orders to resuscitate. Many look to sidestep orders by going to an ethics committee and follow those recommendations over wished of the patient or their families.

Never assume that the doctor is giving you all the information.
In the same ethics report above, the percentage of doctors that would withhold information is only ten percent, but another 18% hide behind the “it depends” defense. In cases where the doctor feels a procedure is necessary, ten percent think it is right to withhold adverse information and another ten percent use the “it depends” defense.

Take time to view the slide show to find out what the doctors think of the 20 ethical questions. You may be surprised!

Finally, never assume that the hospital is working in your best interest.
Hospitals and healthcare facilities are required to review code status with authorized decision makers, (i.e.), administrators, to see if they can ration your care and thereby bypass legal barriers to resuscitation orders. This is a two edged sword for the well-being of the patient. Those who wish to have every reasonable attempt made to keep them alive are often euthanized in the name of quality of life to avoid wasting money and resources. Others that have do not resuscitate (DNR) orders are resuscitated because according to the hospital and doctors, they are too young.

Therefore, it is always wise to have family members involved in any hospitalization where end of life questions may become a factor. It is even wise to have a family member that is capable, or two that agree with your wishes, empowered with a medical power of attorney or full power of attorney to see that your wishes and desires are followed. If a family member is not available, if you have a friend that you trust, then give them a medical power of attorney.

Always be aware that some hospitals and healthcare facilities will attempt to bypass legal orders and may try to ration care. Many hospitalists and nurses are known to pull together to cover up adverse advents. Yes, I am very wary of many hospitals and even more wary of most healthcare facilities for the mistakes that are hidden from patient's relatives and investigatory agencies.

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