13 Aug The Doctor Conundrum
Being a doctor is a funny thing. Externally – we look it as somebody who went through specific training to be able to listen to our problems, poke around and run some tests, and give us an answer how to treat it. I’m equally as guilty. Not immediately addressing health problems, over-expecting from doctors, and usually disappointed. It’s funny when I look back though and analyze what disappointed me in the overall care. Funny enough, it’s not the quality, it’s not the doctor, it’s the fact that they specifically structured their follow-up to include unnecessary appointments that could easily be addressed over the phone. Literally follow up appointments to discuss results and schedule further testing. I’m also hyper-critical so maybe I am not the best judge of proper care? But if I can’t be happy with my own care then where does it leave the average consumer? At what point was it decided that I needed to take time off work to see a doctor to discuss my negative results that couldn’t have been done quickly (and for free) over the phone?
Doctors wear multiple hats. Initially and specifically – we evaluate and treat. Sometimes cases are simple and require a single visit while others require ongoing care or multiple treatment attempts to figure out what works. There are diagnoses of exclusion and idiopathic anomalies to spice it and up leave us scratching our heads. For most diseases and treatments there is a preset standard of care. These standards have been developed based on researching outcomes overtime. Some have been around for years and years while others incorporate newer techniques, drugs, etc. When new drugs and devices are developed there are non-inferiority studies comparing these new treatments to the reigning champs.
If you’ve turned on the TV, opened a magazine, or listened to the radio at any point in the last decade you’ve been sure to hear an advertisement for the newest, latest greatest X drug, or Y device, with implicit instructions to ask your healthcare provider whether the treatment is right for you. Maybe it is, maybe it isn’t, but there’s no arguing that there is big business and big money behind the R&D, the approval process, and the frontend of getting doctors to Rx these drugs. Most of these early studies are done in conjunction with the FDA to prove non-inferiority to current gold standards. Most others are directly funded by the manufacturer. Often-times, even as providers, the first time we have any real interaction with these medications Is when a drug rep or device rep comes to our practices with samples, self -funded research studies claiming to be better than current gold standards, the promise of steak dinners and expert testimony. We know that these are biased, because it is their job to sell the products. It becomes our job to evaluate this information and decide whether or not to implement the drug into our current treatment regimen.
As patients, we expect our doctors to be experts in the field and have their pulse on new and emerging technologies. We try – reading trade magazines, articles, research, etc. on a daily basis. Speaking with our colleagues and discussing what’s going on in their practices, trends they’ve been seeing, and we work on building relationships and learning from these interactions. We are constantly bombarded with information from all sides. It’s our job to find where each new drug or device fits in between our knowledge, patient base, and ethics. Even once we have made this decision – how will it affect our patient population? Will it be covered by insurance and even so, is the price astronomical? With high deductible plans are our patients going to be displeased with the treatment once they wind up paying full price for an emerging treatment. It’s our job to have these conversations with the patient, to build these relationships, to understand how the whole “system” works.