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Subject:  Re: Poll: Patient Information Date:  10/28/2002  10:32 PM
Author:  rshunter2 Number:  260 of 897

Well, Dan and Joseph both have good points.

The recent posting about "correcting" labelling brought this to mind.

I had a relative, an LPN, who went around with a PDR, dug up all the drugs a person was taking, and terrorized them about the worst things that could possibly happen. And of course, since she is a nurse , more people listened to her than ought to have.

It wasn't even good, educated, or informed and balanced advice; and in any case she wasn't trained, qualified, or legally able to give it.

Growing up in a medical household, I think I saw all sides of it.

But my sympathies generally lie with the physician.

My stepfather dreaded news features, and then later on when drug companies were allowed to advertise, because, we heard at the dinner table, "WELL, you KNOW, the next month or so, EVERYBODY is going to want a presription for XYZ whether they need it or not, or whether it's safe for them or not." And boy was he right. He was, although not perfect, (nobody is) a stickler against prescribing anything he didn't feel a patient needed, and also, unlike many colleagues of his time, doing enough testing and studies to ensure the medication would be safe for the patient, AND, imagine this, extensively counselling them on how to take and use the medicine, what it was for, things to watch out for, and if or when they could stop taking it in an emergency.

My former internist did much the same thing, but skipped most of it for obvious reasons in my case and just cut to the chase if it were really important, like, "Now that you're taking 600 mg of Inderal a day, you DO know you cannot suddenly stop it or miss a day's dose, right?". That was just like an obligatory reminder, he knew I taught pharmacology. But it was nice, and appropriate.

The purpose of the poll, sadly unresponded to as it was, was to divine a sense of when enough is enough, or too much, or not enough.

"Here, I'm writing you an Rx, take one of these at breakfast time every morning and come see me in two weeks.", isn't good enough (hell, I'd pitch a fit if a doctor ever tried to pull that with me, after correcting his mistakes in the Rx, first, and then most likely tearing it up and walking out of the office.)

Between capitation and other cost-control measures due to HMO's, insurance, Medicare / Medicaid, DVA, TriCare, I think the old fashioned doctor is being pushed out of the way he/she used to practice. Time limits on patient visits and consults, a limited formulary/compendium from which you are allowed to prescribe, DRG's, ICD's, all seem to be colliding (seem to be, who am I kidding? are colliding) in a way that is ending up with poorer quality health care, increased adverse drug reactions, misdiagnoses and consequent inappropriate treatment and iatrogenic consequences, and more lawsuits and adverse media for the med/pharma/biotech industry.

The sort of things the old country doctor who did house calls generally would not contribute to. He / she knew their patients without needing a chart, and what their real and imagined woes were.

So, a particular drug. Let's pick Ritalin. It has 8 million warnings and side effects and is Schedule II. A week's worth was prescribed for my grandmother after her husband died, because she was suicidally depressed. It worked miraculously.