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Friday, May 09, 2008

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Ernie

Why didn't you read the prescription when she gave it to you, or ask, "What are you prescribing me?" You see, personal responsibility on the part of the patient does play a part in the medical system.

scott

How typical: blame the victim. :)

You're absolutely right, I should have. But for about a century now our society has propagated the idea that doctors know best, and our current authoritarian administration has made the questioning of those in power akin to treason. And by "akin," I mean "treason."

I, of course, know better. And yet, perhaps because I’d just had people rooting in my mouth for two hours, I still didn’t. You take that as a sign that I’m lacking in some essential quality. I know for a fact that I am, in oh so many, in fact. But in this exact case, I think it’s more a sign of something being very wrong with the ways things are being run. Your mileage may and obviously does vary.

scott

Oh, and I tried to read the prescription. I had no more luck in doing so than in any prescription I've ever gotten. You'll note that upon receiving the medication, however, I read the very legible label and asked questions. Before taking it. But not before paying for it, alas.

DT

Geez, Ernie, have you ever tried READING one of those prescriptions a doctor writes out. The scant amounts of Hebrew I've retained from my Bar Mitzvah make more sense to me.

But that's really besides the point. We depend on doctors to give it to us straight and tell us what will help us best. It just never, ever occurs to most of them - some, sure, but not most - that someone is paying for this out of his/her pocket. And because no one questions them - they're doctors, after all, and appear to know best - it creates a cycle that seldom gets broken.

So while I know "personal responsibility" is a nice watchword some people like to fall back on to shield the status quo from being changed, it seems that in some instances there's a little more to it than that.

Lissa

Well, I'm pretty sure Ernie was teasing, because he knows us, and knows what we've been through. But the point he makes, even if in jest, is one worth discussing. I've had eleven years of intensive experience advocating for our children's medical needs. At some points, it has literally been my full-time occupation. Yet even after over a decade of learning how to navigate the system in three different states, even after seeing one child through treatment for cancer and nurturing another through four years of ongoing medical treatment with cardiologists, neurologists, neurosurgeons, audiologists, surgeons, physical therapists, speech therapists, developmental pediatricians, geneticists, and ophthamologists—all for one child, and not the one who survived cancer—even after all that experience, I still sometimes don't think of all the questions I should have asked until after I walk out of the dr's office.

Even after all I've learned about questioning doctors and being a bulldog about making sure they listen to my point of view--to the point of having my bulldoggery save one child's life in one instance, and another kid's potential to WALK in another instance--even after all this experience, I still sometimes make mistakes. I sometimes forget, during the few brief moments when I have a doctor's attention, to think of every question whose answer might affect my child's well being. I learned early on to keep a notebook for the questions that hit me on the way back to the parking garage. Then I have to spend a chunk of time tracking down a doctor on the phone, which is never easy.

It is really hard to think of everything.

We saw a child die because no one told her mother that Flintstones vitamins would nullify the effects of low-dose maintenance chemo. The child relapsed and died during a bone marrow transplant. Is the mother to blame, for not thinking of the question?

And most of my experience has been as the patient's mother, not the patient. When you're in pain from your own illness or treatment, it can be even harder to think of everything right there in the office. I can totally imagine how the question "what kind of painkiller?" might not jump into your mind when you're sitting there in the dentist's chair with a numb mouth thinking about how you're going to be getting to work an hour later than you expected, and how you need to remember to get your parking validated, and how the heck can it be possible that they're billing you another $250 when you shelled out $1200 for the same procedure last week, and what does the dr mean "she wasn't able to get the tip of the drill out of your gum," and what super-awesome gift you're going to buy your fabulous wife for Mother's Day.

You try so hard to think of everything. You shouldn't always have to.

xixi

i'm just weighing in to say that i read ms. lissa's entire comment. ENTIRE comment. And i LOVED the not so subliminal message carefully hidden in there.

Ernie

Bummer about the chunk of drill bit still in Scott's jaw. Hope that doesn't absess.

Of course I was teasing my friend Scott. But... (Pee Wee Herman said, "Everyone I know has a big but,") as you guys know WAAAAAAAYYYYYY better than I, medicine these days is a balance between trusting your physician and asking knowledgeable questions. A wise woman I know once addressed a group of physicians on "How to Talk to Your Pediatric Patient's Parents." She told them that in the Google/Wiki age, we can find out a lot more than you think we can, so don't bulls#$t us. (paraphrasal). Being a knowledgeable, question-asking patient brings more accountability to the medical system than any government regulation ever could.

As for Ms. Dentist, I think you should write her a kindly-worded letter saying that, though it may seem like a small thing to her, but the advil incident cost you extra money and, worse, inclines you not to trust her nor to recommend any of your hundreds of friends to her. You should tell her that it made you feel manipulated instead of well cared for. I'll bet she correct her prescription writing ways, and she may even send you a nice thank you note.

And finally, to encourage a little free-market mother's day gift competition, I bought my wife a seven-stone diamond pendant for mother's day. Top that, Scott! (Lissa, you can thank me later.)

Lissa

Being a knowledgeable, question-asking patient brings more accountability to the medical system than any government regulation ever could.

Perhaps. Though I think Scott's tangential point about McCain's health care plan was not about accountability but rather speaking to the difficulty the average patient faces in doing the background work necessary to advocate for his own treatment...no matter how well-informed the patient, you can't be well-informed enough to know whether your cardiologist is reading an EKG correctly. At the end of the day, medical licensing is overseen by the government. Government regulation is what currently defines whether someone is a doctor or not. But the question of whether more or less govt regulation would improve the situation is not the key point of Scott's anecdote, as I see it. Yes, it would have been better if he'd asked the question ("What kind of painkiller are you prescribing?") right there in the dr's office, as he himself readily admitted. But even if he had, the point is, she had already, without giving a thought to the cost her patient would incur, prescribed the more expensive form of a drug available over-the-counter at the same pharmacy where he filled the prescription. You trust doctors to have your best interests at heart. There is no way writing that prescription was in the patient's best interest.

One of the other things I told that group of doctors when I was asked to give that presentation (and points to you for calling me wise, LOL) was that because there IS so much information available to us on the internet nowadays, it can be hard to filter the factual from the nonsense.

"So what are we supposed to do?" one of the doctors asked. "You're saying you're going to look up everything yourself anyway, but you can't always tell what information is trustworthy."

I said, "What are you supposed to do? Talk to me like I'm your sister. Like this patient is your nephew. What would you want her to know? She trusts you. Be as frank and direct with me as you would be with her. And if she's not asking the right questions, ask--and answer--them for her."

And I have to tell you, the hundred doctors in that lecture hall reacted like that was a new idea. Being as direct and open with a patient/parent as they would be with a family member struck them as a new idea. I found that disconcerting, to say the least.

I'm betting Scott's dentist would have said to her brother, hey listen, I could prescribe prescription-strength ibuprofen, but it's probably cheaper just to pop four Advil at a time. To which her brother would have said, "Dude! Seriously!" Because: duh.

Writing the dentist a note is a great idea, Ernie, or calling her on it the next time he sees her. When, for instance, he goes in to have the drill bit removed from an absessing gum. (Kidding, Scott honey! It's going to be fine. No, really. I'm sure it will. It'll be fine. Just, um, don't go needing any MRIs of the head in your future. OK?)

Re seven-stone diamond pendant: Hear that, honey? You gonna let him throw down like that? If you need any ideas, I can provide several hundred. Heh. (Ernie, I will thank you now.)

Emily

I HATE it when doctors give you scripts for stuff like that. If you're not going to give me something good, then just don't bother!
With my docs, it's extra strength tylenol or we go to class 3 narcotics. There's no in between. That really drives me up a wall.

fish

Scott, it is very simple. It says right on the Avil bottle that you take 1 to 2 pills. That means you are only getting 200-400mg. Obviously the prescription medication is better, because when you take 1 pill you get 800mg. It is literally 4X better. I am surprised you don't understand this. Your Dr. obviously wanted you to benefit from a medication that is 4X better than anything you can get over the counter. She is a saint.

(and if you are still buying Avil instead of generic, you are already paying 2X more)

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