Thursday, March 20, 2014

Can You Make Docs Be Nice?

Today's post, called Legislating Kindness, can be found on our Clinical Psychiatry News column.  
Please surf over there for the post.   

They no longer have commenting ... I don't know why that is...but please come back here if you want to say something. 


Joel Hassman, MD said...

And you write this column NOW after noting a firm supporter of PPACA/Obamacare since its inception? Seems a bit incongruent/inconsistent to me, thinking you can selectively give slack to politicians to what they should vs shouldn't do in interrupting/dictating clinical care/standards of care practice.

Well, at least you are realizing it now. I guess you have to hope "better late than never" is an adage that will work here!

How is that paving going for that road being laid by physicians who just can't question authority, eh?!

(and the validation word for approving this comment had "stoic" in there, priceless!)

Joel Hassman, MD said...

After leaving here to peruse for current events other than that plane crash obsession going on in all media, found this little article at

Not a fun read if you are a doctor and depend on insurance for reimbursement...

But, I am sure the apologists and defenders will circle the wagons and reject the truth, once again.

Hey, it is about politicians setting the terms, just like this post is saying.

jesse said...

In these instances the issue does not seem to me to be about kindness. The Down's Syndrome bill may be legislative effort to curry favor with the right to life group, which is a large voting bloc. The thirty-minute bill may be another legislative stunt. It would lead office personnel to document the delay was due to an emergency, then inform each patient (who had already waited!) that they will be seen now but they need to sign a form stating whatever is needed.

Every model has its "unfair" aspects, and every attempt to corect them creates the potential for other abuses. Wisdom, good judgment, and a wise balance of factors is difficult to achieve.

The market model is efficient but does not give the "best" or "needed" to everyone. "To each according to his needs" brings in now-famous difficulties.

I’m afraid in our current political climate wisdom and thoughtful compromise are in short supply.

Borderline said...

I sympathize with the Down Syndrome people and their parents. I don't understand why handing out pamphlets with information and a list of resources is so bad. It's better than the doc stating they don't know a thing about managing Downs and the patient best get an abortion :/ Managing Downs is a lot different now. There are a lot more supports, and it's not the nightmare situation that it used to be. I get if it were twenty or thirty years ago why clinicians would push for abortion, but now there are all kinds of job programs and help for people with that condition.

My doc actually has a bunch of pamphlets in each exam room that are on display. You can take or not take them. They cover conditions like Asthma, Diabetes, GERD, etc. It's not that big a deal, especially if you don't have to pay for the pamphlets.

Dinah said...

Jesse -- the rumor that went around was that the legislator had a personal issue and was in his last term -- I don't know if this is true. I also am not aware of a right to life agenda -- they were not testifying-- but who knows.

Borderline-- I totally agree that it would be nice to give people up to date information about resources as they make their decision about what to do. While I believe this SHOULD be done, I don't believe it should be a law and that it should be illegal to not do it, or illegal for a health care professional to exercise individual discretion as to what is appropriate to give patients and when. No one was objecting to the idea of the state creating these resources and making them available (~though I imagine the state may decide not to fund such a project).

Anonymous said...

I think the key is to have a good physician. I don't think legislation like that is needed.


Borderline said...

I actually think it should be illegal for a doctor to withhold information about your medical condition. Otherwise, what are they being paid for? What if your doctor runs a pregnancy test, without telling you, discovers your pregnant, and decides you don't need to know if your pregnant for another oh..six months or so? Think of all the booze you could down in that time.

BTW, I always think that's weird about docs. Every single time I tell them there is no possible way I could be pregnant, they ask for a urine test. I do it cuz I assume it's for something else. And then I find out it was a pregnancy test!!!

Now wasting my time...that has gotta be illegal. Billing insurance for worthless pregnancy tests also should be illegal. What part of: "I am not sexually active and cannot possibly be pregnant" do these people not understand?

Gotta start asking what these urine tests are for. Wasting my time equals major NO, No! Why even ask if I might be pregnant?

Anonymous said...

Dinah wrote:" Borderline-- I totally agree that it would be nice to give people up to date information about resources as they make their decision about what to do. While I believe this SHOULD be done, I don't believe it should be a law and that it should be illegal to not do it, or illegal for a health care professional to exercise individual discretion as to what is appropriate to give patients and when."
So, I can only guess that borderline is an imaginary construct that psychs bill for and for which they medicate/hospitalize patients. I do think that that in the case of breast or prostate cancer, doctors, do give up to date info about resource and what to do. You can see a cnacer on a scan. Find me anyone who can see can see a scan that shows borderline. Yet, I don't believe in the flawed dichotomy of Axes 1 v. 2 disorders as per JH.

Dinah said...

The legislation is to require health care providers to give information about Down's Syndrome. They count the chromosomes, it's a pretty precise diagnosis there. "Borderline" was the handle of the commenter I was responding to. There is no legislation proposed that would require therapists, car mechanics, or anyone else to distribute up to date pamphlets on Borderline Personality Disorder. Perhaps there should be?


Borderline said...

LOL. Every time I post, I think I ought to use a different name just because this is a shrinky blog and people might get the wrong impression. It's a little confusing for this blog.

Anonymous said...

Borderline, I used to work on a floor where it was standard to order pregnancy tests on every female of child bearing potential. It's not that they didn't believe the patient, there were just a standard set of labs that were drawn on all patients. It does seem sort of ridiculous to ask you, and then order it anyway, though. I even saw quite a few pregnancy tests ordered on male patients. All the men had negative pregnancy tests, by the way. I don't know what insurance did with the pregnancy tests done on men.

There is a lot of waste, but a pregnancy test is probably going to be the least of it, sadly.


Joel Hassman, MD said...

It seems you have a whole chapter for your book placed perfectly on your lap regarding the Justina Pelletier matter going on now. CPS believed putting a teenager on a psych unit for a year was appropriate and responsible?

And people wonder why I stay the hell away from CPS cases as much as humanly possible. A couple of interesting links to read?

And something I walked into about 6 months after it happened and then watched the florid mismanagement of another case that had no real overt issues of abuse/malfeasance CPS tried to make of it for almost a year before a judge finally threw it out:

Gotta love this in the latter link:

"The grand jury report was prompted by the case of 8-year-old Shamir Hudson, whose bloody, beaten body was discovered in a mobile home outside Berlin. Police have charged his adoptive mother, Catherine Marie Hudson, in the killing. The boy died in March after multiple warnings to social workers about suspected child abuse in the home."

Forget making docs nice, how about a little work on the judicial and Social Services agencies across this country first!

Anonymous said...

Dr. Hassman, thank you for mentioning the Justina Pelletier case. By the way, she is now at this place, and not getting any medical treatment even though the Judge ordered on March 4 that her medical care be coordinated by Tufts. Ironically, that is where the parents wanted to take her last year when Boston Children's Hospital got CPS involved and she ended up on the psych ward.

Anyway, your link once again proves that CPS steals kids from loving families as in the Pelletier case and does nothing about taking them from abusive families.


Anonymous said...

As usual, I enjoyed reading your post, but I'll admit that information like this sends my cortisol levels into orbit. Just what we need - the prospect of further legislation that sucks the joy out of practicing psychiatry and reminds us of how unempowered we are as a profession. It's precisely because of nonsense like this that I'm not encouraging my children to apply to medical school. Seriously - how many other professions would tolerate so much proverbial sand being kicked in their faces?

Okay, Okay - I'll take a few cleansing breaths and Google the keywords, "Yoga" and "Tai-chi."

--Anonymous Newcomer