Thursday, February 16, 2012

Good Doctors vs Bad Doctors

In my experience growing up in a family that eats, sleeps and breathes healthcare and medicine (father owns several healthcare-related companies; mother is a primary care nurse practitioner and is also the owner of a Covington skin care spa; and a sister who is a MD (ENT, to be specific), I have a few thoughts about an article I came across at about (no pun intended) how to distinguish good doctors from the not-so-good ones. I take exception to the title of the article, which is why I will refrain from using it here.

The article mentions a survey that was obviously conducted in such a way that doctors would appear to be dishonest creeps once the results were in. Not surprisingly, the survey was conducted by Massachusetts-based researchers, most affiliated with Harvard University.

I'd like to see the context and the way in which the questions were presented and phrased before taking any statistics from the study at face value. There surely must have been more information provided to the doctors surveyed than the minimal information reported in the 'Patients.About' article. No doctor would answer the questions supposedly asked without context. The author of the piece included a link to the abstract, but offered nothing by way of details in terms of the use "gotcha!" questions in conducting the survey.

Good Nurse Practitioner Pam Egan
"Good" Nurse Practitioner Pam Egan
That said, I somewhat agree with the 6-point plan for patients proposed as a solution to a problem the article claims exists (although this author has his doubts about the size, scope and nature of the problem, if it even exists at all). The alleged problem is doctor dishonesty, and the six-point plan suggests such things as seeking second opinions, trusting one's intuition and urging patients to not 'put up with arrogant doctors...'. To read the entire piece, see the above link (for more practical reading, continue on with this piece).

To begin, there is this thing called Google these days, and anyone in the civilized world can use it to access any information that exists in the world to be presented at the user's fingertips at the speed of light. Anyone taking a medication for which the person has any questions, it never hurts to do a little self-research to compliment the information provided by the doctor and/or manufacturer of the drug.

Additionally, intuition is an extremely important and often overlooked component of finding the best doctors. If you feel uncomfortable around your doctor, it's probably not because he or she is wearing a white coat and has loads of credentials that may make he or she appear to be some sort of authority figure to some patients. If one feels uncomfortable around his/her doctor, there's probably a good reason --- even if one cannot pinpoint the exact source of the discomfort.

Patients should always ask about treatment options. If a doctor does not provide all or at least most of the credible information available via the internet, it may be time to either ask the doctor the reason why he or she omitted one of more treatment options for whichever condition or disease the patient was diagnosed. If the answer is unsatisfactory, it may be time to find a new doctor.

I would take patient reviews of physicians with a grain of salt. As a business owner, I am well aware of the myriad of tactics, tricks and paid services businesses (inevitably including some physicians, clinics and other healthcare professionals) use to artificially control and/or manipulate their own respective reputations. This may come in the form of reviewing oneself under a different name, or exchanging friendly reviews with other businesses, professionals, etc. Other tactics include writing false negative reviews of competing businesses/professionals and paying companies to manage reputation. A number of companies have cropped up over the past 18 months purporting to specialize in "reputation management", for what its worth.

Furthermore, there are myriad reasons why a legitimate customer may leave a disproportionately negative review of a company or individual. Some customers, clients and patients lack the degree of honesty and integrity necessary to be credible when writing a review of a business, person or organization. Just look at this example of an incident involving a couple of scam artists and a used bedside commode.

I wouldn't seek a second opinion unless the health or medical issue/condition/disease was very serious, or if I intuitively felt as though the doctor was (or may be) wrong.

I wouldn't attempt to self-diagnose, which is essentialy what differential diagnosis is when conducted by the patient; but I would research the symptoms. If another condition seemed more plausible than the diagnosis issued by the physician, then it would be time to seek a second opinion.

One final means of weeding out bad doctors is to talk with them about nutrition. The days of reactionary 20th Century medicine are over. The amount of research that has been conducted involving the relationship between nutritional deficiencies and propensity for disease is staggering, and probably more than double the amount of such information available just ten years ago when vitamin D supplements contained a plant-based form of the nutrient that is not well absorbed by humans (vitamin D2, ergocalciferol), but which is cheaper to produce than the more bioactive (readily absorbed for use by the body) form used in most supplements today (vitamin D3, cholecalciferol).

21st Century physicians should not be averse to discussing the role of nutrition in the big picture of one's overall health. The information is readily available, and slowly but surely the stigma long assiciated with doctors, nurse practitioners and other healthcare professionals making claims regarding nutrition (or the lack thereof) as a contributing factor to disease are (or at least should be) long over. The peer pressure physicians face with regard to the role of nutrition in medicine has started to subside in recent years, and a genuinely good primary care, family/general practice doctor who is well informed will ask his or her patients if they'd like to have a blood test conducted to measure one's nutrient levels in order to identify any potentially harmful deficiencies.

Be very wary of those general/family practice and/or primary care doctors who either won't speak in depth about the role of nutrition towards overall health, or who pooh-pooh the notion that vitamins and supplements can help to prevent disease and/or other health maladies.

Following the advice outlined above should help patients find a good doctor who is trustworthy as well as informed.

Wednesday, February 8, 2012

New Orleans Home Health Care Nurse's Assailants Caught

About a week ago, there was a horribly tragic story in the New Orleans Times Picayune about a home health care nurse who was brutally gang raped while on her way to see a patient. The news shook the community, and the healthcare community in particular.
While there is really no positive way of looking at the crime that took place when that poor woman was victimized, there is one small bit of good news to the story.

The NOPD (New Orleans Police Department) has made an arrest in conjunction with the case, and appears to be hot on the trail of the others suspected to have been involved in the crime. All I can say is that I sincerely hope they catch every single one of them, and that they (if found guilty) never see the light of day again.

Home health care nurses routinely make visits directly to the homes of patients, where they do things like change wound dressings, bathe immobile patients, clean wounds and so forth. They are different from home health aids, which are more like babysitters for the elderly than an actual skilled RN.

Growing up in a household with two healthcare professionals as my parents, I can definitely relate to this poor woman's agony in a way not everyone can.

I hope the DA assigns his best prosecutors to the case, and I hope the defense lawyers aren't any better than they have to be, as if these guys actually did what they are accused of, they need not be allowed to interact with normal society again - every again.

For more on the arrest that was made, there's a pretty good article at the Nursing Ethics Network:

Author's Note: The nurse who was victimized was not employed nor affiliated with my family's respective businesses in any way, although our hearts do go out to her and she is nonetheless in our prayers. Nobody should ever have to endure that. Ever.

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