Medical Decisions are hard to make. Even when they seem easy.
I'd say that the TV show "House" is popular because Dr House seems to focus on giving patients what they need (honesty, transparency, certain treatments) and not necessarily what they want. In his case – the difference between the two are entertaining. Does that make him a good doctor?
In real life – this is much harder. There's ample evidence that physicians' decisions are based on many factors. What's best for the patient is simply one of these factors.
We've had a medical student working on our office recently – and it's been interesting to see my practice style mirrored in her eyes:
- I "actually listen" to my patients (who doesn't? I wonder …)
- I spend lots of time with my patients (no wonder I come home late every day!)
- I hear what they mean – not just what they say (the hardest part)
I re-told this story to her – in abbreviated form. I posted it nearly 5 years ago – but the principles I tried to highlight then remain important yet under-represented on the Internet today. Medical blogs are now far greater in quantity – yet I still think there are rather few of them that express the transparency that the initial work a few of us were striving for back then. There are so many competing interests – for our time, our money, and our attention. Without good principles – I'd argue that there is no way for physicians to stay the course – and really make the best decisions for our patients.
The National Physicians Alliance is a relatively new organization that's building steam – based on good principles. It's great to see an organization that is committed to "Advancing the core values of the medical profession: Service, Integrity, and Advocacy." You can also read the NPA’s ISSUE BRIEF outlining reasons why physician prescribing data should not be made readily available to pharmaceutical companies. The issue brief mentions describes how to opt out of pharmaceutical industry data gathering by enrolling in the AMA's Physician Data Restriction Program (PDRP). Cool. Check. Done.
Integrity is so important – yet so often suspect when there is opacity. Exposing our patients to the uncertainties of our profession is a cornerstone of shared decision making – yet it takes so much more effort – and so much more time – I'm not surprised that so few physicians actually do it.
The same goes for plumbers. We had a "free" cleaning of our furnace performed by these folks last week. The service rep called my wife at work and told her we needed a new humidifier element for $45. He happened to have one. Said OK. We also needed a new solenoid for the humidifier for $89 "on order." Turns out – I replaced the humidifier element about 6 months ago (should be done once/year) and the solenoid seems to work just fine to me. You can listen to his explanation – left on our voicemail. Now - look at the picture. Water running pretty well, if you ask me! I filled an 18 ounce cup in under 30 seconds. If that's a "very small amount of water" – I think Gary needs to go back to plumbing school.
Either Gary is stupid – or he's lying. Either way – I can't trust him or his company ever again – as I suspect that he's got his interests above mine. I could buy the solenoid (see link above) for $45 if I really needed one. And I'm a little mad that he took my 6 month old humidifier element with him when he sold me the new one (it's the honeycomb thing in the picture). Either way – he can't be trusted.
We need trustworthy plumbers, doctors, bankers, lawyers, software developers, etc. The principles of the profession must guide our decisions. If not – we will always be distracted or seduced by the many other choices on our path. Plumbers who invent problems, doctors who self-refer, and software developers focus more on the icing than the cake – all compromise their integrity in the same way – and will ultimately lose.