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  1. #41
    zoebird's Avatar
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    It would make senes that the insurance companies (both those who provide health insurance and those who provide malpractice insurance) would have a hand in it.

    I also realized that hospital/office policies will have a roll, as will professional organizations. I remember one OB leaving PA because the hospital insisted that she needed to increase the number of c-sections that she provided or she would loose her privileges (she went ot the news about it, which is how we heard about it), and apparently there were insurance companies pushign the same in PA, so she moved to Maryland where she could practice "more freely."

    Her c-section rate was below 3% for first timers, and she allowed for vaginal birth after c-section (VBAC) which the hospital where she worked in PA does not currently allow. She tends to have fewer high risk patients, largely because she recommends them to specialist OBs if they do go high risk. Basically, she knows what she's good at. *shrug* Still, it's sad that she had to move in order to practice medicine according to her education and conscience.

  2. #42
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    @ Drmike - what was your wife eating before? I presume it wasn't paleo?
    Evolutionary. Ideology that fits biology

  3. #43
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    Quote Originally Posted by john_e_turner_ii View Post
    Medical doctors must follow guidelines. When a patient reaches a certain threshold of cholesterol, then they must be prescribed statins. Same with other lab testing.
    Not quite. There are algorithms and there are guidelines, but they actually all explicitly state that "these are only guidelines and the final decision must be made on an individual basis".

    What most practitioners do is duck their heads and follow the crowd though for fear of being the nail that sticks up. In reality evidence based medicine is based on equal parts of three things....the current reading of scientific literature, clinical experience, AND patient preference in regards to treatment. If the doctors where more forthcoming in the actual side effects of a medicated life vs. making real changes to improve health and they document that the patient had chosen lifestyle change then they would have in all legal ways protected themselves and best served their patients. But, that takes more time and effort than writing a script...getting their bonus...and moving on to the next paycheck, errr I mean patient. So instead they check the box stating they discussed lifestyle with you and prescribe regardless.

    It's a sad state of affairs, but I think it has made more people take their health into their own hands which is evident by online sites like directlabs.com and other ways to monitor your own health. Skip the middle men IMO. Use em for emergency care when needed, but don't delude yourself into thinking you have health insurance or that your doctors practice health care....its a sick care model.

  4. #44
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    Quote Originally Posted by Iron Fireling View Post
    Ugh... unfortunately doctors aren't given many lessons in nutrition!

    I know one sad case of a kid who's just turned 13 and is overweight. He has some sort of liver disease, and his doctors have prescribed him a FAT FREE diet (like... REALLY fat free...he must only get a miniscule amount of fat) and yet, the kid keeps gaining weight (he's also growing very fast and is very tall for his age). The doctors basically accuse his mum of letting him cheat because he's NOT LOSING WEIGHT. They want him to have weight loss surgery . ARGH if only I could explain primal to them... I just don't think they'd be receptive, as it's the opposite of what they've learned.

    Have the doctors checked this kid to see if his growth hormone levels are appropriate? Have they checked him for Marfan's Syndrom? Poor kid - I hope that the parents get some second and third opinions before they resort to surgery. Please, counsel them to check other things as I listed above, and a more natural diet.

    The problem with most doctors I fear is that they have little time for study after they get their jobs. So they are stuck in the things that they learned in medical school which may have been decades ago.

  5. #45
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    Quote Originally Posted by JoanieL View Post
    15-20 years ago the SATs got dumbed down. The public schools are a shambles. This means the quality of student available to colleges decreased. In addition, colleges, in the face of decreased funding and donations, have to focus more on revenue than quality education. This leads to a lesser quality graduate student, which leads to a lesser quality graduate.

    I am not saying that all doctors, lawyers, professionals under 50 are substandard - not at all. I would never be so presumptuous. I am saying that the average doctor/professional comes from weaker stock.

    Old joke: You know what they call the person who graduates last in his medical class? Doctor.

    Buyer beware.
    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.

  6. #46
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    Quote 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 at 06:42 PM.

  7. #47
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    Quote 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.

  8. #48
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    Quote 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 at 07:14 PM.

  9. #49
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    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 at 10:35 PM.

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