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From: B. Harris)
Subject: Re: Gregory demonstrates that Medical denial is a reality!
Date: 16 May 1999 19:20:25 GMT

In <> (Carey
Gregory) writes:

>Jim <> wrote:
>>We DO!   But it is a LOT more difficult that you would think.  (See my
>>"snowballing" post)
>Not really.  Your other post describes a level of subterfuge necessary
>only for spies behind enemy lines.  No doctor I've ever dealt with
>would do the investigations necessary to uncover records you don't
>tell them about.  There's no reason Doctor A would come to know about
>Doctor B's records unless an insurance company mentioned them, and
>even that's unlikely.

   Correct.  And if doctor A found out about doctor B's records, it
still would not do doctor B any good, since doctor A would never part
with a copy of them without a release from the patient.  If (s)he did,
he would be wide open to all kinds of lawsuits.

    In principle, I like the idea of patients with long and complex
histories starting over-- with one caveat. The patient needs to get
copies of old lab tests and imaging studies, and simply be up front
with the new doc about the fact that they want a fresh workup,
relatively untainted by previous opinions.  Lab and radiological
studies, treadmill and cath results, etc, are reasonably objective,
since interpretation is either at a miniumum from the lab, or else done
by the radiologist or cardiologist who (believe it) is probably not
much influenced by what is in the patient's 4 inch thick chart back in
some private office, anyway.  Except of course for those cases where
the interpretation is done by the primary doc doing the workup.

    Having this stuff for the next doc saves the patient radiation, and
saves the system huge amounts of money on blood work and inoccuous but
expensive tests (MRI, etc) that don't get repeated.  Of course, a few
tests do bear repeating once, if clinical symptoms suggest something
the lab hasn't found.  But having old test results will save you from
repeating these things TWICE, which is what a good doc will do if he or
she does NOT get the old results.

From: (Jonathan R. Fox)
Subject: Re: Gregory demonstrates that Medical denial is a reality!
Date: Sun, 16 May 1999 20:06:17 GMT

On Sun, 16 May 1999 11:54:36 -0400, Jim <>

>Carey Gregory wrote:
>> We patients?  We're all patients at one time or another.  Believe it
>> or not, doctors, nurses, paramedics, respiratory therapists, and even
>> insurance company executives get sick.
>True.  But the people treating them usually KNOW that they are medical
>people and they get treated QUITE differently as a result.
>They won't pull a lot of stunts on you that they do on patients every day
>because they know that you'll know....
>And they know that you know what a lot of the proper diagnostic
>procedures are,  so they are not tempted to skimp and throw a garbage can
>diagnosis  on you (after all, you know what they are) without doing the
>proper workups.
>And they also know that you know enough about the system to make an
>EFFECTIVE complaint (not possible for mere patients!) if they do
>something particularly stupid.

I understand what you're saying, but I want to make sure you don't go
imagining that medical care for health care professionals is THAT much
better.  Oftentimes it is much worse.  In fact, I personally would
prefer not to reveal that I am a physician if I were to need medical
care because of that very fact, although that is not practical.

Health care professionals often get more unnecessary and harmful
diagnostic tests, or sometimes do NOT get medical procedures that are
necessary, leading to harm, because either the patient knows enough to
ask for the test or deny the procedure, or the physician is trying to
be "nice."  I know of a medical professional as a patient who refused
a Foley catheter in a circumstance where it would be very important to
monitor urine output very carefully.  The attending physician agreed,
but it made managing the patient a LOT more difficult and more risky.

Recently I was working a shift in the ER as resident-in-charge, and
the charge nurse informed me that a neurologist's infant was currently
being registered.  I think she assumed I would jump up and down and
put him ahead of the other patients or something.  She seemed
surprised when I replied, "Well he will get the same excellent care
that all our patients get."  I'm sure she caught my drift -- that we
should be striving to give good, prudent, careful care to all patients
regardless of their status, and if this were the case, then there
would be no need for extra special treatment for a physician's child.

Regarding unnecessary diagnostic tests:  One time a nurse was
frustrated with her child's fevers.  We had done a reasonably thorough
work-up and had found no treatable cause.  She then asked if we should
do a rapid strep test.  Fortunately she understood when I explained to
her that he had no signs of strep pharyngitis and was not in the right
age group, and thus a positive strep test would be so much more likely
to be a false positive than a true positive.  This would mean that not
only is the test unnecessary, we should definitely NOT do it, since
the results would only confuse the picture.  As Jim is well aware,
diagnosing and treating the wrong problem only makes matters worse.
This could have happened because the health professional asked for the
test, if the physician agreed in order to please her.

Jonathan R. Fox, M.D.

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