Atheists, can you tell me about your beliefs, apart from atheism?
I want to know what you believe. In an earlier question today I said the direct replacement of something is not just the absence of it. That's what I don't understand about atheism. I mean, I completely understand what it is by itself, but it doesn't mean anything in functional society. There are no practical beliefs. You cannot tell someone to just go out into the world and be a good atheist. Atheism is just meant to be described by what it doesn't believe. It doesn't take you anywhere itself. It has to be joined together with something else in order for you to move around and function in the world. You have to either be pro choice or pro life, atheism doesn't care which one you choose. You cannot have a society built on atheism, if you move away from Christianity in America for example. You can't replace Christianity with NOT Christianity and have everyone just walk away and high five each other.
A patient calls and is moving out of town. She is concerned about her medical record. What would you suggest?
there is no need to be concerned.. you can give her a copies of her medical records, or a copy of the whole chart, usually for a fee, to take with her to her new location in order for her to be prepared when she finds a new physician. or when the patient has found a new physician, the office can send a request, for no fee, to have the records transferred to that location, with a release form that she needs to sign. and the records will be available in your office for her disposal, until she locates a new physician, for at least seven years.
Do doctors practice what they tell their patients?
NoDoctors tell a great deal of instructions and advice for a healthy living to their patients, which many don't practice not out of disbelief or irrelevance, but because of their daily routine and timings.FIRST SCENARIO:Advice: Eat all your meals on time for a healthy diet habit.Practice: Many doctors skip lot of meals due to heavy patient crowd or long surgical procedures. They eat random things at random timings. Many doctors you come across skip meals daily due to their duty timings.SECOND SCENARIO:Advice: Alcohol consumption causes numerous ailments, quit for a better life. Smoking causes various health problems.Practice: Many doctors get into this habit of smoking and drinking early in their college days. One thing is they are so stressed, and get into this habit in medical college to relax or to relieve stress when they fail in exams.Second thing is as doctors they know the level of permissible liquor consumption and on the various treatment available. So they drink boldly.THIRD SCENARIOAdvice: Keep calm. The patient is critical but let's hope and pray for the best.Practice: They are worried more about their critical patients and it keeps running over their mind. Even after duty timings they subconsciously think about their patients and about their current status.FOURTH SCENARIO:Advice: Sleeping a minimum of six hours is a must for the brain to function actively.Practice: Doctors don't get enough sleep even if they wish to. Busy duty timings cut short their sleep habits. They even see 48 hours - 72 hours straight shifts with few minutes of sleep here and there.It is always easy to question or criticize a doctor. No one actually knows what he/she is going through. Being human, they too get hungry. They too fall sick. They too make mistakes. They too learn from their mistakes and they too correct themselves.
How do doctors cope with having to tell patients that the end is near?
It’s rarely something you have to drop as a bomb from the sky.You start by just requesting a few investigations because the guidelines recommend them. You confirm there’s reason to suspect a serious illness and you comfort them with their options. You deal with their denial and anger by always remaining calm, whatever they throw at you. You guide them toward acceptance at a rate they’re comfortable with, give space for their anxiety and talk about it. And when it’s time to start preparing for the inevitable you finally have free hands to use medications that have adverse effects in long term use: you know you can make them comfortable and give them a dignified death.Walking someone to their death is a position of attending to another person’s needs not unlike all the rest of medicine. Death is inevitable and a doctor in their senses doesn’t think otherwise. You just focus on the task at hand, make sure you offer your best medical care and your best empathy. It’s draining but it’s the job.It’s the partners that are the challenge. How do you prepare someone for losing a loved one? I’m quite sure it can’t be done. No matter how you cushion the blow their life is about to change. Attending to their needs will leave most doctors feeling inadequate.How do we cope?We take consolation in believing we’ve done our best.We keep believing the contribution matters.We try to maintain a work life balance and talk about it to colleagues, friends and family when it gets to be too much.
Do doctors lie to patients?
There was one 6 month baby in our Pediatrics ward. She came from the same state as me. She was a suspected case of Down's syndrome (I had written about her earlier too, in another answer).The test results were awaited. Karyotyping results take about 10 days to come.All her symptoms pointed towards Down’s. It was more of a clinical diagnosis. The resident on duty asked me to counsel the mother regarding her next pregnancy (she was a young lady) and inform her that her child would not be as normal as other children, and would always need special care and attention. The child may not be able to get married in future and have kids.While I have utmost respect for the resident who is much senior to me in experience (I'm merely a student), I flatly refused.The lady who was standing there could not follow the English and asked me if everything was fine.I told her in our native language, which the resident could not follow, that we were waiting for the test results and till then she should take care of her baby and should not get depressed or worried. Her baby needed her.That seemed to put her at ease.I might have done a wrong thing that day,by not telling her everything, but, I felt one should wait for the test results, no matter how evident it was clinically, before breaking such a news to parents.Further, I felt it was unnecessary to tell her about her 6 month old daughter's wedding difficulty in future. Wedding isn't the ultimate goal in life. She could have Downs and still be a good human being. She does not need a husband to justify her existence on earth.The test results came positive for Down’s, unfortunately, but it was expected. The parents are under counseling at our genetics clinics. The baby will also probably have to undergo an open surgery for her heart defects.She's such a sweet baby that it breaks my heart to see her go through all the troubles that life is putting her through.So,yes,at times doctors might have to lie to or conceal a few facts from patients, till they are themselves sure about it, or till they feel the patient can handle the news.
Why do doctors relocate and not tell their patients?
As Dr Fox has mentioned the primary reason for not wanting to notify the patients is that they actually don’t own that rightTo the lay public they always think that doctors are free to do what they want that is rarely the case in today's US business world.Now most doctors are part of some bigger entity either a group practice or even a hospital or in some cases like Kaiser an InsCo. The entity owns the right to access that patient and when a doctor is moving he legally can’t notify the patients he is doing soIn many cases the doctor has to move a very far distance to even be legally allowed to work at all. this is called a restrictive covenant and can be very detailed and costly if violated. Even if the contract cannot be enforced in terms of preventing him/her from opening up the contract could have hundreds of thousands of dollars in payments due upon violation that the doctor might not want to pay.In many jurisdictions the distance is about 20 miles but that varies based on location and contract. Think about NYC heck 20 miles puts you in a different state on 2 of the 4 sides. Practices spend inordinate amounts of money to develop a population of patients the last thing it wants to do is see the doctor leave, open up shop across the street, and with one newspaper ad and or a letter to each patient at bulk rates of about $0.40 they lose their entire equityYES any patient can leave the practice and follow the doctor even going the 20 miles (or 37 in the case of New Orleans) but that is up to them to do the due diligence to find the doctor and the like. MOST patients won’t bother they simply accept the new doctor who is taking over the spot and atleast see if they work to their satisfactionIn many cases it would violate the terms of employment for a staffer to even assist the patient in finding the previous doctor.We are talking BIG business here with millions of dollars of potential revenue on the line the reality is the only a doctor has in equity is the patient group and some used junky equipment. If both are owned by another they have deep concerns to maintain their investments and equityDr D
Should doctors get paid less if they don't keep their patients healthy?
This movement is already afoot. In Manitoba, Canada where I work and in other parts of the country there are payments that relate to performance. It is not quite as sophisticated as you suggest in your question but there are the so called Chronic Disease Management Tariffs (CDM's). Certain criteria are laid out and if we meet those criteria our pay is bumped a bit. So for example, for diabetes the patients must have had a height, weight, BMI, blood pressure, cholesterol profile, HgbA1c, Creatinine, eGFR and Albumin/Creatinine ratio (off the top of my head I think that is it) done annually. I believe the Creatinine, Weight, Blood Pressure and HgbA1c must be done twice a year. Now, there is an assumption that if they are done that the results will be dealt with. There is no proof that I didn't just ignore them all once they were done. Common sense tells you though that is I did the test just to get the money but didn't act on the results I would leave myself open to disciplinary action and lawsuits when the heart attacks and strokes occur. One of the benefits of this in addition to paying for a better quality of medicine is that it also pays more to the doctors looking after older and more complicated patients. In a walk in clinic in the suburbs where the patients are mostly 30 year old moms and 8 year old kids that are generally healthy the doctors will not make much through the CDM stream. In my clinic where the population is quite elderly we feel rewarded for the complexity of our patients and the evening and weekend time spent managing all those test results.It's not perfect but I think it is a step forward.