- Joined
- 2 July 2008
- Posts
- 7,102
- Reactions
- 6
We live in a litigious society. The same applies with the over-prescription of anti-biotics. The GP is forced to cover all his bases.
You and your General Practitioner
- Thread starter Julia
- Start date
-
- Tags
- general practitioner
We live in a litigious society. The same applies with the over-prescription of anti-biotics. The GP is forced to cover all his bases.
- Joined
- 30 June 2007
- Posts
- 7,200
- Reactions
- 1,226
Yes but pleasant caring doctors don't tend to get sued, even when they make mistakes. Whereas uncaring doctors making tiny errors tend to get sued. Proven.
On a similar note, drugs tend to work when the patient trusts and likes his doctor. When the patient doesn't trust or like his doctor, all sorts of weird complications and side effects arise.
Strange but true.
All this points to the fact that being a pleasant caring human is number one need.
- Joined
- 2 July 2008
- Posts
- 7,102
- Reactions
- 6
Wrong. All doctors and especially obsteticians and gynaecologists are considered fair game by ambulance-chasing lawyers.
- Joined
- 30 June 2007
- Posts
- 7,200
- Reactions
- 1,226
Obstectrics is a quite different to all other branches of medicine. I was making the point that caring GPs tend not to be sued even when they make errors. Statistically, all GPs will make at least one error resulting in a patient death in their career. Lawyers have no power to act unless contacted by a client.
Julia
In Memoriam
- Joined
- 10 May 2005
- Posts
- 16,986
- Reactions
- 1,973
No argument from me about the better doctor taking the necessary time to be thorough.
My own irritation is more about disorganised doctors, those who allow interruptions to the consultations, who dictate referral letters after each patient, rather than doing them at the end or beginning of each day, taking phone calls which would better be returned when the patients are gone.
I don't think we regard doctors as gods now, as once occurred. Now, they need to remember that they are providing a service just as any other business, and need to work efficiently. There is no implication in so doing that they will be uncaring or not thorough.
My own irritation is more about disorganised doctors, those who allow interruptions to the consultations, who dictate referral letters after each patient, rather than doing them at the end or beginning of each day, taking phone calls which would better be returned when the patients are gone.
I don't think we regard doctors as gods now, as once occurred. Now, they need to remember that they are providing a service just as any other business, and need to work efficiently. There is no implication in so doing that they will be uncaring or not thorough.
- Joined
- 30 June 2007
- Posts
- 7,200
- Reactions
- 1,226
This came out just a few days ago and relates to the thread.
BMJ 2012; online 8 Nov
Exploring patient priorities could cut health costs
Niamh Mullen
PATIENT preference is often overlooked when deciding on treatment, leading to ‘silent misdiagnosis’ that may increase the cost of health care, an analysis suggests.
Although many doctors think they already incorporate patient preference into treatment recommendations, the authors said the evidence was high for ‘preference misdiagnosis’ with gaps between what patients want and what doctors think they want.
In one study doctors believed 71% of patients with breast cancer rated keeping their breast as a top priority but the figure reported by patients was just 7%.
In a study of dementia, patients placed substantially less value than doctors on survival when they had severely declining cognitive function.
When patients were well informed they frequently changed their treatment decisions, said the authors from the Dartmouth Center for Health Care Delivery Science in the US.
Research involving patients with benign prostate disease found 40% fewer patients preferred surgery once they were told about the risk of sexual dysfunction.
“Evidence from trials shows that engaged patients consume less health care," they wrote.
“It is tantalising to consider that budget-challenged health systems around the world could simultaneously give patients what they want and cut costs.”
The authors advise doctors to adopt a mindset of scientific detachment and resist the natural instinct to ask themselves what they would do in the same situation.
They suggest that if doctors are confident in their treatment preference at diagnosis, they should confirm their understanding of the patient’s priorities before offering a treatment recommendation.
“When patients seek guidance, doctors need to ground their advice in not just a medical diagnosis but also a preference diagnosis – an inference of what a patient would choose if he or she were a fully informed decision maker,â they said.
BMJ 2012; online 8 Nov
Exploring patient priorities could cut health costs
Niamh Mullen
PATIENT preference is often overlooked when deciding on treatment, leading to ‘silent misdiagnosis’ that may increase the cost of health care, an analysis suggests.
Although many doctors think they already incorporate patient preference into treatment recommendations, the authors said the evidence was high for ‘preference misdiagnosis’ with gaps between what patients want and what doctors think they want.
In one study doctors believed 71% of patients with breast cancer rated keeping their breast as a top priority but the figure reported by patients was just 7%.
In a study of dementia, patients placed substantially less value than doctors on survival when they had severely declining cognitive function.
When patients were well informed they frequently changed their treatment decisions, said the authors from the Dartmouth Center for Health Care Delivery Science in the US.
Research involving patients with benign prostate disease found 40% fewer patients preferred surgery once they were told about the risk of sexual dysfunction.
“Evidence from trials shows that engaged patients consume less health care," they wrote.
“It is tantalising to consider that budget-challenged health systems around the world could simultaneously give patients what they want and cut costs.”
The authors advise doctors to adopt a mindset of scientific detachment and resist the natural instinct to ask themselves what they would do in the same situation.
They suggest that if doctors are confident in their treatment preference at diagnosis, they should confirm their understanding of the patient’s priorities before offering a treatment recommendation.
“When patients seek guidance, doctors need to ground their advice in not just a medical diagnosis but also a preference diagnosis – an inference of what a patient would choose if he or she were a fully informed decision maker,â they said.
Logique
Investor
- Joined
- 18 April 2007
- Posts
- 4,290
- Reactions
- 768
The difference between God and a Surgeon? ..God doesn't think he's a Surgeon.
A good practice manager and staff is paramount. Too many surgeries are abysmally managed, and too many doctors are poor time managers. There's more than a bit of over-servicing and over-prescribing going on.
Kill for a Doc Martin type in this town. What's wrong, diagnose, prescribe, get out. Next.
A good practice manager and staff is paramount. Too many surgeries are abysmally managed, and too many doctors are poor time managers. There's more than a bit of over-servicing and over-prescribing going on.
Kill for a Doc Martin type in this town. What's wrong, diagnose, prescribe, get out. Next.
Julia
In Memoriam
- Joined
- 10 May 2005
- Posts
- 16,986
- Reactions
- 1,973
Good article.
Nowhere is this principle more at play than at end of life. Doctors need to get better at explaining patient options when faced with terminal illness. Because many doctors are more comfortable when actively treating, they fail to explain to patients that the surgical option, followed by radiation and chemo, will only extend their life by a few months and in the process cause them to feel much more ill than they would if just managed palliatively.
Perhaps at least some of this is the discomfort some doctors feel with having to discuss the inevitability of death with patients. Sending them off for surgery instead allows them to avoid this.
There are many reported instances of people with Advance Health Directives which make clear the patient's wish not to have heroic measures if there is little chance of recovery, but yet doctors will ignore what's a legal document and do what makes them feel the most comfortable.
Julia
In Memoriam
- Joined
- 10 May 2005
- Posts
- 16,986
- Reactions
- 1,973
Exactly. Receptionists should be capable of discerning what is genuinely urgent. Doctors need to delegate appropriately to their staff.
An example is just having a practice nurse who can easily do routine checks like blood pressure, urine testing, prepare repeat scripts for signing etc.
This might be a crazy idea, but couldn't we just train more doctors?
Julia
In Memoriam
- Joined
- 10 May 2005
- Posts
- 16,986
- Reactions
- 1,973
Sounds so simple and so sensible, doesn't it, saiter. We have in fact trained more doctors in recent years.
No solution, however, as apparently poor planning has resulted in there not being sufficient intern places for them.
So now, whilst we have imported hundreds of foreign doctors who can barely speak English over the last decade or more, we now have a batch of newly minted Australian trained young doctors, with no jobs to complete their training. Many of them will have to seek intern situations overseas.
It would make you cry.
No solution, however, as apparently poor planning has resulted in there not being sufficient intern places for them.
So now, whilst we have imported hundreds of foreign doctors who can barely speak English over the last decade or more, we now have a batch of newly minted Australian trained young doctors, with no jobs to complete their training. Many of them will have to seek intern situations overseas.
It would make you cry.
- Joined
- 30 June 2007
- Posts
- 7,200
- Reactions
- 1,226
Yes, Calliope -- and subsequent growth of Superbugs.
I have two children who are doctors and a son-in-law who is a clinical child psychologist. It was interesting to hear them, two weeks ago, discuss evidence from studies that over-prescription of antibiotics for infants and toddlers alters neurological structures in the brain contributing to ADD and ADHD! The consensus (2 parents, uncle, GP) was that anti-biotics *had* to be given to my 7 month old grandson at that time.
I am so grateful all four of my children were/are healthy.
I found this site interesting:
http://www.helpguide.org/mental/adhd_add_signs_symptoms.htm
Logique
Investor
- Joined
- 18 April 2007
- Posts
- 4,290
- Reactions
- 768
Well I'm off to my GP on Monday. There shouldn't be blood in certain emissions, the curse of the male cyclist! And the treatment is ...antibiotics. Oh dear.
Not happy.
Not happy.
Julia
In Memoriam
- Joined
- 10 May 2005
- Posts
- 16,986
- Reactions
- 1,973
All the best, Logique.
If a course of antibiotics is the worst you are required to endure, might be time to count your blessings.
If a course of antibiotics is the worst you are required to endure, might be time to count your blessings.
- Joined
- 3 July 2009
- Posts
- 27,638
- Reactions
- 24,527
The examination should be interesting, why would you need antibiotics?
- Joined
- 21 May 2008
- Posts
- 664
- Reactions
- 14
If you find a good GP, stick with them. Mine runs behind but I try for either first appt of the day or first after lunch. That usually works. specialists nearly always run late.
What I find frustrating is the lack of "patient-centred" healthcare. They opearet in their own world, send a copy to the GP who may not read it. If you have specialists and a GP, the dialogue between them doesn't exist like it should. I update my GP with specialist information when I see him. I got put on medication temporarily by another Dr when travelling. Then saw the spec who said review the use of it with my GP (though it was his field). The GP said review it with the Spec when I have the followup visit in 3 months. Seemed like an abdication of care.
I'd love to have them all in one room....
What I find frustrating is the lack of "patient-centred" healthcare. They opearet in their own world, send a copy to the GP who may not read it. If you have specialists and a GP, the dialogue between them doesn't exist like it should. I update my GP with specialist information when I see him. I got put on medication temporarily by another Dr when travelling. Then saw the spec who said review the use of it with my GP (though it was his field). The GP said review it with the Spec when I have the followup visit in 3 months. Seemed like an abdication of care.
I'd love to have them all in one room....
Julia
In Memoriam
- Joined
- 10 May 2005
- Posts
- 16,986
- Reactions
- 1,973
Those are good points, johenmo.
I was also amazed to find that in Qld at least if you are treated in the local hospital whether as an inpatient or at A & E, no advice of this treatment is sent to the GP.
I was also amazed to find that in Qld at least if you are treated in the local hospital whether as an inpatient or at A & E, no advice of this treatment is sent to the GP.
- Joined
- 21 May 2008
- Posts
- 664
- Reactions
- 14
Here in Vic they ask who your GP is and I ASSUME they send it. Again, I update the GP when I see them next.