Involving Patients

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The article called Could involving patients decrease antibiotic prescriptions? made me smile recently.  I mean, isn’t the title itself ridiculous?  As if there is a choice to NOT involve patients in giving them medication? Well, it seems that our present industrialized model of healthcare makes that commonplace.  From the article:

  • According to her team’s new review of past research, when patients and doctors discuss antibiotic prescribing together, fewer drugs are given out.
  • “Shared decision-making means that the options are discussed; the natural course of the illness is discussed (i.e., these infections usually get better by themselves, so the option of not taking antibiotics is certainly one option that is reasonable to consider and discuss),” Hoffman said.

I worked in the urgent care where I didn’t know the patients.  No matter what I said, if they wanted their antibiotics then they would yell, curse and scream to get it. One even sent a complaint in to the State Board about me for not getting her virus fixed with a Z-pak.  I have also worked family medicine for 20 years and the more I know my patients and the more I have TIME with patients the easier it is to have a proper discussion and give out less unneeded meds.

In summary, the fragmented and rushed medical system leads to this problem and all the studies in the world won’t change it especially when TIME WITH PATIENTS is not a quality metric but patient satisfaction is.

 

Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  2 comments for “Involving Patients

  1. Steve O'
    November 29, 2015 at 8:07 am

    “Bulldogging,” in prison, is just the principle that if you want something, you keep on it and don’t let go, like a bulldog on a bull. A lot of prisoners get what they want in prison by bulldogging staff and other inmates.
    It is a skill which many patients are adept at. Very occasionally, they are right – something has been missed by the medical ‘system’ and they want an accurate diagnosis. I enjoy that sort.
    Often, it’s the Z-Pak. they come in wanting the Z-Pak, and they will go out with either a z-pak or a complaint to the Authorities. The presence of non-physician Authorities is one of the greatest symptoms of the decline of medical care. There is some mushwit up the food chain who will reach out to the solution of ignorance, the compromise. “How about giving them a partial Z-Pak? That sounds reasonable.”
    I have been bulldogged numerous times, and even punished by the Authorities for not “being reasonable,” i.e. giving the patient what they want. Go with the flow, give them what they want, see the next patient.
    The other point is the poverty of new and useful ideas in improving healthcare – disguised behind the tidal wave of “ideas,” such as above. It also was a symptom of a failing culture. Advise people to take mind to the simplest think.
    “Workers! Do not sign off on defective widgets!” That means that workers ARE signing off on defective widgets. REAL management gets down and dirty, and finds out why. Probably, they’re running the assembly line too fast at the widget factory, and there’s nothing to do but sign off, or fall behind.
    The undertone to the paper is, “Given that the problem stems from something systemic that we are afraid to fix, what busywork can we engage in to seem like we care?”
    There is no attempt whatsoever to give doctors a clear guideline what to do. There are always two, four, eight guidelines that are handed out, and are mutually conflicting. When you see this, it’s the bureaucracy trying to paper-down the blame to the provider/sucker.
    I predict in five, ten years, we’ll see “Providers! YOU MUST NOT show up to work intoxicated!” because, like the old Soviet factories, the only way to tolerate it will be to get half in the bag before your shift starts. If all you need is mindless process handling, your workers will adapt to the burden. That’s my guess.

    • Perry
      November 30, 2015 at 1:07 pm

      “Providers! YOU MUST NOT show up to work intoxicated!” because, like the old Soviet factories, the only way to tolerate it will be to get half in the bag before your shift starts.

      That’s assuming there will even be any suckers left practicing medicine in the next 10 years.

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