Thursday, July 05, 2012

Probing a doctor's view

kw: medicine, diagnostic procedures, philosophy

I recently spoke at some length with a close friend who is an orthopedic surgeon. At one point he complained about "over regulation", using this example: He is legally barred from purchasing an upright, weight-bearing scanner (CT or MRI) to use in conjunction with his practice. While I sympathize with his frustration, I agree with the ban. As we talked, I was thinking, "What part of 'conflict of interest' do you not understand?" Perhaps I should have been blunt enough to state it out loud.

I already knew the important facts of the matter. A perusal of records has shown that where the patients of orthopedic specialists have convenient access to such imaging devices, but outside the doctor's facility, there is a certain level of referral for such tests, but where the imaging device is available on the premises, the rate such tests are performed is about double. Patient outcomes were not affected to any significant degree. That is, the higher rate of imaging didn't result in an improvement in patient recovery. The primary difference was the level of remuneration to doctors who did or did not own the imaging scanner. It may be that the more ethical doctors who do own such equipment are using it at the same low rate; if so, then the less ethical ones must be scanning nearly every limb that is brought through the door!

Most doctors are good and ethical, but not all. It is a pity that the activities of a few "bad eggs" has led to legislation that affects them all, but that is part and parcel of the regulation of a civil society. Most of us will never need the locks on our doors, but nearly all of us lock our doors because of a few criminals. My friend stated that doctors ought to be allowed to regulate their affairs, "just like everybody else." I stated that this is not so, that most business activities are regulated, and for good reason. Those areas where self-regulation has been allowed are hotbeds of unethical and even criminal activity, including the banking establishments that are largely responsible for the crash of 2008 and the ensuing recession. Too bad so few of them were jailed.

I have two things that I look for when I must come under the care of a new doctor. Firstly, what schools are his or her degrees from? Better schools are the best indicator of a better doctor. Secondly, how many drug company "trinkets" do I see around? An office packed with things bearing advertisements, such as pens, note pads, anatomical posters, and even, sometimes, the TV on the wall, are a bad sign. So is a closet well-stocked with "samples", though you'll only find this out if the doctor writes you a prescription and hands you a packet or two "for the first few days."

So many things are made so convenient. Vigilance is needed to avoid feeling beholden to the purveyors of those "trinkets". Better the practice of a very, very few doctors, to turn away the drug company reps at the door and accept nothing from them, not even a pen. Even more vigilance is needed by patients (I prefer being called a customer!). And when I find a doctor who, the best I can determine, is worthy of my trust, I treasure him or her.

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