Additional Assumptions Patients Should Not Make

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This is a continuation of blogs from May 10, 2012 and October 17, 2012.

Don't assume the doctor knows whatyou are thinking.I wish I would have been listening morecarefully when Dr. Peter A. Ubel of Duke University was on the TavisSmiliy program on PBS discussing his book “Critical Decisions.” I just happened to hear him make the above statement on the latenight early morning (locally 0100 AM) show of Oct 18, 2012. Hecommented that patients need to speak up because doctors are not ESPaware. After reading the reviews about his book here, I looked atthe other books he has written. They are interesting and oncontroversial topics of health care rationing and assisted suicide. Many physicians and nurses are pushing for assisted suicide andhealthcare rationing (euthanasia), so be alert to the position ofyour doctor if you are opposed to assisted suicide.
His answers to Tavis's questions aboutcommunications were most interesting and he stressed the need forcommunications between the patient and doctor, even if the timeconstraints prevented extended communications. This is why peoplelike David Mendosa and me write blogs about preparing for the doctorappointment. Yet many people just don't understand the need tooptimize the time with their doctor. My health depends on optimizingthe short time I have with the doctor.
Do not assume that your doctor iscompletely independent of interest conflicts.This is something many patients do notconsider about their doctors and is a fact of life that needs to beat the heart of every patients concern about their doctor(s). Manydoctors are honorable, but they are human and can be influenced bymoney or other enticements. Even with this being on a neurologywebsite, it is applicable for all medical professions and doctors.
Three states do have mandatorymarketing disclosure laws, which require the reporting of physicianpayments. The states are Minnesota, Massachusetts, and Vermont. Anyone can also access Dollars for Docs (bit.ly/cZzi9A), a freeProPublica database that allows individuals to search by physician inorder to find disclosed payments made by 12 pharmaceutical companiesto healthcare practitioners. Some patients are already using thisresource. Much of the data available may be incomplete.
As patients, help is on the way. Unless there is delays (and do expect them), beginning in 2013, theimplementation of the Physician Payment Sunshine Provision of theAffordable Care Act will provide a database of financialrelationships that will be available to patients. The finalregulations from the Centers for Medicare and Medicaid Services (CMS)are not complete, and many physicians are concerned about theaccuracy and manner in which the tool will display information. Itis expected the physicians will call on CMS to delay implementation.

Never assume that the doctor willfollow protocol or your wishes near the end of life. Yes, in a survey conducted by Medscapeand published in their 2012 Ethics Report asked several questionsrelated to end of life. It is immoral the percentage of doctors thatwould do things in violation of do not resuscitate (DNR) orders andorders to resuscitate. Many look to sidestep orders by going to anethics committee and follow those recommendations over wished of thepatient or their families.
Never assume that the doctor isgiving you all the information.In the same ethics report above, thepercentage of doctors that would withhold information is only tenpercent, but another 18% hide behind the “it depends” defense. In cases where the doctor feels a procedure is necessary, ten percentthink it is right to withhold adverse information and another tenpercent use the “it depends” defense.
Take time to view the slide show tofind out what the doctors think of the 20 ethical questions. You maybe surprised!
Finally, never assume that thehospital is working in your best interest.Hospitals and healthcare facilities arerequired to review code status with authorized decision makers,(i.e.), administrators, to see if they can ration your care andthereby bypass legal barriers to resuscitation orders. This is a twoedged sword for the well-being of the patient. Those who wish tohave every reasonable attempt made to keep them alive are ofteneuthanized in the name of quality of life to avoid wasting money andresources. Others that have do not resuscitate (DNR) orders areresuscitated because according to the hospital and doctors, they aretoo young.
Therefore, it is always wise to havefamily members involved in any hospitalization where end of lifequestions may become a factor. It is even wise to have a familymember that is capable, or two that agree with your wishes, empoweredwith a medical power of attorney or full power of attorney to seethat your wishes and desires are followed. If a family member is notavailable, if you have a friend that you trust, then give them amedical power of attorney.
Always be aware that some hospitals andhealthcare facilities will attempt to bypass legal orders and may tryto ration care. Many hospitalists and nurses are known to pulltogether to cover up adverse advents. Yes, I am very wary of manyhospitals and even more wary of most healthcare facilities for themistakes that are hidden from patient's relatives and investigatoryagencies.