Wednesday, August 08, 2007

All doctors not equal

…HA has seen a lot of doctors in the last 9 months since her right retina fell off (well, four, but two of them almost weekly) and was beginning to feel like a citizen of Sick World.

…No more! Mind over matter. HA has decided to be a dim-visioned Well Person.

…This got to her thinking about doctors. Today half the people who apply to medical school get in. This used to be 10%. HA is just sayin’.

…Just because someone is a doctor, does not mean that person is not human. They might have been in the bottom third of the class, you don’t know.

…HA has had the fleeting feeling that she knows more about the people she used to have a drink with in DC than her doctors.

…When you check your state’s database for past lawsuits, that person might have come from another state or have violations more than five years old.

…Sometimes, too, the doctor really does not have good options to offer you. Some options come next in the rotation, but are iffy—even the doctor knows that. HA calls these the “worth a tries.”
…A recent New York Times story said a majority of cancer patients did not get the evidence-based, best sequence of treatments.

...Another study said heart attack patients often do not get the most lifesaving treatments as a matter of course.

…You don’t have to do anything the doctor recommends. Certainly, not everything. Of course, then you have no one to blame but yourself. How confident are you of your decisions?

…But—you may say—medicine is an art, not a science. Someone suggested to HA that it might be a craft rather than those two. This is not to denigrate—doctors have a long educational period and much hands-on apprenticeship.

…But like all craftsman, some have better skills than others. Writing in the WSJ on July 11th, Laura Landro talks about proceduralists. This is an emerging set of doctors who practice over and over to do tricky procedures, such as draining fluid from vital areas of the body or tunneling a catheter into a vein.

…Instead of watching another doctor do the procedure, trying it, and then teaching it, as of old, proceduralists practice long hours on specially constructed dummies.

…This is the person you want if you need a spinal tap. Not a resident who has done it once before.

…But you need to speak up. You need to ask how many has the doctor done. You need
to insert yourself into the equation, even if you are uncertain.

…It’s your body. You want the superb craftsman, not necessarily a scientist or artist..You know—like Norm Abrams on The Old House. HA would almost trust him to take out her appendix.

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