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  • #46
    Originally posted by EyeOfRound View Post
    You're quite wrong, to put it mildly. I can only speak from the medical side of things, but the baby boomer docs would never have made it into medical school if they were to go through the selection process we have today, and many have even acknowledged that publicly. I sit on a medical school admissions committee and we reject students in the top 10% of their undergrad classes on a routine basis.
    Of course that begs the question....does your more strict admissions policy actually produce more competent doctors or does it just limit the field and exclude some people that could have been great talents?
    Last edited by Neckhammer; 10-06-2012, 05:42 PM.

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    • #47
      Originally posted by zoebird View Post
      Just looking around in general, there aren't any laws that assert that a doctor HAS TO prescribe statins for people who have cholesterol issues (or any drugs for that matter). I haven't seen any regulations or cursory laws about it either (ie, medical boards of a couple of states via google searches).
      You're not very good at searching. I put in "Standards of Practice Statins" into Google and on the first page I came across multiple clinical guidelines. ACP Pressroom - ACP Guidelines: Many Diabetics Should Be Taking Statins http://www.nhlbi.nih.gov/guidelines/...ol/statins.pdf Executive Summary: Standards of Medical Care in Diabetes

      et cetera

      If you had a patient with high cholesterol who you did NOT put on statins and then they had a heart attack, you can be damn sure that you will be found guilty of malpractice. Malpractice compares what you did to what a "reasonable colleague at the same level of training would've done" (except for when you're a GP branching out into subspecialty areas, in which case you'd be held to the standards of a specialist), and if the clinical guidelines suggested putting your pt on a statin and you didn't, and there's no good reason (like intolerable side effects e.g. myalgias), you're held responsible for the adverse outcome.

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      • #48
        Originally posted by EyeOfRound View Post
        You're not very good at searching. I put in "Standards of Practice Statins"
        Guidelines are not laws. Any practitioner not going exactly with the grain will need to document why they are not, but the reasons I stated earlier suffice and any malpractice lawyer worth their salt should be more than able to find you an expert for the defense....as long as you truly were not negligent. Stop giving them a free pass for substandard practice.

        The other way a GP could handle this is by completing training in functional or holistic practices. Then they would have to include colleagues at that level of training when assessing the practitioners treatment. The defense could easily argue against any MD that did not have this additional training that they are not of the same level of competence or training and request that another FM practitioner present their views. It would be a cheap way of mitigating this issue. I have looked into FM courses....they are very reasonable.
        Last edited by Neckhammer; 10-06-2012, 06:14 PM.

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        • #49
          eye of round --

          Did the same google search. You are not very good at understanding what a "law" is or what constitutes the "a reasonable colleague at the same level of training would have done" -- which in medicine asserts to practicing "evidence based medicine."

          First, a guideline is not a law. The NIH is not a law-making organization nor a regulatory organization or a licensing organization (ie, medical licensing board). There are certainly laws that doctors must follow, but most of those do not have to do with the individual practices of medicine with individual clients.

          Thus, a person not following the various guidelines of professional organizations (such as the AMA), academic organizations (NIH), malpractice insurance providers, or health insurance providers who would put the doctors in network are not at risk of losing their license to practice for simply ignoring these guidelines if they are practicing evidence based medicine.

          Which brings us to malpractice law.

          As you note, in general malpractice focuses on what a reasonable colleague at the same level of training would have done. To demonstrate this, while it is fair to say that there is a common practice, there is also a thing called evidence-based practice. A lot of common practice is not evidence-based practice (see: obstetrics), and so any doctor who is practicing outside of the common practice but within evidence-based practice would not be guilty of malpractice.

          In addition, the doctor also needs to demonstrate that s/he discussed the options of treatment with the client and the evidence involved. This is commonly done via record keeping. Our family doctor practiced well otuside of common practice but well within evidence based practice, and working with him was a *dream* because he would explain everything from lifestyle advice all the way through to pharma and hard-core allopathy, and we would weigh the pros/cons together, and then move forward with a decision. It was brilliant -- and in my opinion what medicine should be.

          Sadly, most medicine these days is 5 minutes with the doctor looking at some paperwork, asking a few questions of you, and then prescribing a medication and/or assuming something that is patently false. There's nor elationship, no discussion of the drug -- it's benefits, side effects, etc -- and no discussion of alternatives. It's in and out. And that's a problem. That's not medicine, and it's certainly not best practice, even though it's common practice (or what reasonable colleagues do). And it's out of this that these guidelines are designed.

          But, at the end of the day, a malpractice suit costs money, too -- and both malpractice insurance companies and doctors prefer to stay away from the court system due to the expense in both time and money. Thus, some might find it much easier to simply follow various guidelines than actually practice evidence-based medicine.

          but again, this is not because there is a LAW that says the HAVE TO do this. Doctors are choosing it for a variety of reasons that have nothing to do with the law or with medicine, really. It has to do with what is easy and convenient in terms of what they do.

          It's easier to follow the hospital's guidelines -- even if they are against evidence-based medicine -- because then I can maintain my privileges and continue to practice.

          It's easier to follow malpractice insurance guidelines -- even if they are against evidence-based medicine -- because then I can more easily avoid malpractice lawsuits which makes it easier for me to practice.

          It's easier to follow the various guidelines of my professional organizations to maintain my membership and relative prestige of that, as well as to make my practice easier in terms of being able to get through more clients in a day, or see more people, or basically meet there needs, etc.

          It's not because the "HAVE TO" by law. It's because they choose to follow those opt-in, private organizational guidelines for whatever reasons.

          ----

          I studied this area of law in law school, btw -- so that's just my mind-process in this perspective.
          Last edited by zoebird; 10-07-2012, 09:35 PM.

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