When do we draw the money line in medicine? (2 Viewers)

[bangladesh]

the fact that medman is going to be an intern next year scares me lol

 

[Medman]

the fact that medman is going to be an intern next year scares me lol

If you have nothing to add to the debate perhaps you should stop making judgemental comments? Let me guess you stuffed up section 2 in the UMAT?

 

[nerdasdasd]

Speaking of the "money line"... What about the high costs that specialists charge???

Only affluent and middle income people can afford to see specialists and not the average "joe".

I've been to specialists and its crazy expensive (had to give up stuff).

 

[nerdasdasd]

http://www.news.com.au/lifestyle/he...e-financial-pain/story-fneuz9ev-1226687029471
"New parents have been slugged as much as $10,000 by doctors with high-cost structures - and high opinions of themselves."

 

[Medman]

Kiraken is mad. Why are you so mad?

This was a what if debate. I never once said I would disagree with what the patient wanted if I believed they needed it in a real life scenario. This has become a personal attack instead of a proper debate. Perhaps you shouldn't be a doctor because your emotions seem to cloud your judgment for clear reason and respect of other people's opinion. This was a debate to consider the what ifs. You have taken it out of proportion to a personal level. Do you even know me? I thought you didn't judge but you've been judging every single thing I have said. No you don't know shit about me, Kiraken.

I said if the patient wanted to refuse all suggestions by the doctor which will lead them to a path of destruction it is their choice and their death will be at their own hands. How is that a remotely arrogant response? Your inference skills seem to be lacking. Like you said that's patient centred care is it not? Although I would like to intervene, unfortunately I can't because I don't have the capacity and it is their human right to decide not to treat themselves. Is it my job to treat them in their time of need. Yes I would treat them in their time of need. Would I like to deal with them in the future? No, I would feel like I didn't do my job if they continue down their own chosen path. I won't make judgement, just that I think little can be done with my input so I would refer them on after a few sessions. Hence, we have people like you to treat these broken people non-compliant for whatever reasons you can think of. Sorry but I do not have the emotional strength you seem to possess as I am working 20+hours a week+study+social commitments.

Respect my opinion about my own preferences. Why do people choose to go into plastic surgery? Why do people choose to only treat wealthy people? As far as I am concerned my boundaries are well within the ethics of medicine. I still feel for my patients despite their questionable actions. You don't know shit about my thoughts so don't even remotely attempt to deconstruct my mind.

I have lost interest in this debate. Medicine need people like you, Kiraken. I hope your resolve will never be broken.

 

[Kiraken]

Kiraken is mad. Why are you so mad?

I never once said I would disagree with what the patient wanted, I just said what if doctors stopped treatment for patients. This has become a personal attack you ignorant fool instead of a proper debate. Perhaps you shouldn't be a doctor because your emotions seem to cloud your judgment for clear reason and respect of other people's opinion. I said if the patient wanted to refuse all suggestions by the doctor which will lead them to a path of destruction it is their choice and their death will be at their own hands. Like you said that's patient centred care is it not? Although I would like to intervene, unfortunately I can't because I don't have the capacity and it is their human right to decide not to treat themselves. Is it my job to treat them in their time of need. Yes I would treat them in their time of need. Would I like to deal with them in the future? No, I would feel like I didn't do my job if they continue down their own chosen path. I won't make judgement, just that I think little can be done with my input so I would refer them on. Hence, we have people like you to treat these broken people non-compliant for whatever reasons you can think of. Sorry but I do not have the emotional strength you seem to possess as I am working 20+hours a week+study+social commitments.

Respect my opinion about my own preferences. Why do people choose to go into plastic surgery? Why do people choose to only treat wealthy people? As far as I am concerned my boundaries are well within the ethics of medicine. This was a debate to consider the what ifs. You have taken it out of proportion to a personal level. Do you even know me? I thought you didn't judge but you've been judging every single thing I have said. No you don't know shit about me, Kiraken.

lol i do not know where your anger and "ignorant fool" claims in your first few lines came from, for someone accusing others of being mad it seems like you're the only one really losing your temper here.

"Although I would like to intervene, unfortunately I can't because I don't have the capacity and it is their human right to decide not to treat themselves. Is it my job to treat them in their time of need. Yes I would treat them in their time of need."

Funny, that isn't what you have been saying throughout this thread, you literally made this thread with the intent of putting forward the opinion that you should not have to treat patients who you judge as 'retarded" i.e. refuse treatment for patients who are non-compliant. Since you seem to have deviated from your original line of thought i think it is safe to assume this debate is over.

I hardly made it personal, all i said was that if you express a point of view that completely goes against the essence of what medicine stands for by definition and the Declaration of Geneva and by generally accepted medical ethics involving patient-oriented care then perhaps this is not an appropriate line of thought for a future doctor, that isn't a personal attack that is a fact.

Also way to assume you are busier than me lol, i spend close to 40 hours a week in hospital+study+social commitments. I seriously do recommend you try to keep out things about how much "more" you apparently know about hospital out of a debate on an internet forum where you do not know enough about other people to be mentioning such things. This is not a debate about who has talked to more interns or doctors or spent more time in hospital, it is a discussion on medical ethics that anyone is capable of participating in with valid input.

 

[Medman]

I raised the thought of no treatment for non-compliance must like the idea of not giving scarce resources (organs) to certain patients. Also alcohol is not contraindication for liver transplantation, it is the risk the patient will damage the liver with continued drinking. I never once stated I would deny my patient treatment based on their non-compliance because it is illegal. Yet your arguments were directed towards me as not treating patients was what I intend to do. Ignorance at its best.

20+ hours per week working+30 hours in hospital+10 hours of social commitments+10-15hrs of study. Your inference sucks, I am not implying I spend more time in hospital therefore I know more. I am suggesting my patience has decreased for particular patients due to my increased work load. I had more patience when I first started med school but things have changed.

Hospital systems are built to be ethical on the most part but there are some questionable things certain teams do. If you have read the House of God you would be familiar with the term buff and turf. It is still prevalent in our public hospital system and yes it does go against patient orientated care but it still occurs. Despite your altruistic attitude towards patient-orientated care, it is far from perfect in this world.

 

[Kiraken]

I raised the thought of no treatment for non-compliance. I never once stated I would do it myself. Yet your arguments were directed towards me as not treating patients was what I intend to do.

20+ hours per week working+30 hours in hospital+10 hours of social commitments+15hrs of study. I do find I am getting less patient with patients after taking on more work. Am I not busier than you?

so wait, you say that you argued FOR no treatment for non-compliant patients yet suddenly you say "oh no that isn't my point of view"? That is probably one of the more desperate examples of backtracking i have seen. If you don't believe in it yourself, why did you argue so passionately for it?

Not really, as i said, this is not a thread where we discuss who is busier or not busier as you do not know me personally, you do not know how many hours i work in my job or how many hours of social commitments i have or what i do in my spare time, plus as i pointed out repeatedly, it is entirely irrelevant to the thread. Plus the hours you spend on work and social commitments should have nothing to do with your attitude towards patients lol

 

[OMGITzJustin]

my take as a non-med student reader from all of this is that kiraken cant relate to what medman feels, due to the differences in experience

plain old fact is that theory =/= practice (from the transition into a working environment from uni), seems to be a lot of textbook/uni points from kiraken, and real life experiences from medman
you kiraken, are bound to meet idiotic patients who simply dont listen to what you advise, and you think this geneva ethics thing is going to be the first thing that runs through your mind?

it's a little bit like this, but say i'm in the workplace and my boss starts yelling at me. I'm not going to whip out my MGMT1001 textbook and look up "work place conflict and ethics" and see what to do next, you just react and respond back

just like if you were treating a non-compliant patient, you dont just stop treating them, but in your mind you automatically think the patient in front of you in just ignorant(which is what medman is trying to express to you), sometimes you can't always think by the book 100% ethically

 

[bangladesh]

If you have nothing to add to the debate perhaps you should stop making judgemental comments? Let me guess you stuffed up section 2 in the UMAT?

Dude your views on medicine and public health are radical as fuck

 

[Kiraken]

my take as a non-med student reader from all of this is that kiraken cant relate to what medman feels, due to the differences in experience

plain old fact is that theory =/= practice, seems to be a lot of textbook/uni points from kiraken, and real life experiences from medman
you kiraken, are bound to meet idiotic patients who simply dont listen to what you advise, and you think this geneva ethics thing is going to be the first thing that runs through your mind?

it's a little bit like this, but say i'm in the workplace and my boss starts yelling at me. I'm not going to whip out my MGMT1001 textbook and look up "work place conflict and ethics" and see what to do next, you just react and respond back

just like if you were treating a non-compliant patient, you dont just stop treating them, but in your mind you automatically think the patient in front of you in just ignorant(which is what medman is trying to express to you), sometimes you can't always think by the book 100%

but this is all based on assuming i have no clinical experience when i actually do lol

i have actually met my fair share of non-compliant patients and the fact is medman and perhaps yourself do not understand that if you talk to these patients you will find they often have completely valid reasons for being non-compliant and you cannot call them "idiotic"

the problem is one of assumption, as a doctor you cannot just assume that if a patient does not listen to you they are idiotic or retarded or wrong.

not to mention it wasn't his point to just say you can think of a patient that way, he literally suggested not treating patients who were non-compliant. If you read my previous posts in this thread i clearly distinguished between jdging a patient in your head and letting this judgement affect your treatment of them

 

[Kiraken]

i also completely disagree with the theory vs practice point, the theory of ethics is precisely what should be applied in practice, that is basically what ethics is lol, ethics is theory by which you practice. The reason that theory is even there is because of what people have seen in practice, who do you think made the declaration? Not textbook professors but medical practitioners with years of experience

 

[Medman]

What if their reasons for non-compliance are idiotic? What then? I have seen more than my fair share of idiotic reasons even after telling the patient they are false beliefs.

I'm just putting forward an opinion as food for thought. I agree with kiraken that it would not work in our current day and age with our abundance of resources. I doubt we will ever implement something like this unless we become starved for resources, i.e. events such as the great depression or world war etc. In these events you would need to prioritise and give treatment for patients you think will have the best chance for survival and who will be a benefit to the society.

 

[Medman]

Dude your views on medicine and public health are radical as fuck

Thanks! It's for the greater good. I can deal with non-compliant patients but the problem is I feel pretty shitty afterwards because I feel like they are wasting their life away and they could be doing so much better only if they listened. Regardless, you try and try but after a while you realise you can't try so hard for every single patient as you get tired of the whole repetitive process.

 

[Kiraken]

What if their reasons for non-compliance are idiotic? What then? I have seen more than my fair share of idiotic reasons even after telling the patient they are false beliefs.

I'm just putting forward an opinion as food for thought. I agree with kiraken that it would not work in our current day and age with our abundance of resources. I doubt we will ever implement something like this unless we become starved for resources, i.e. events such as the great depression or world war etc.

Even so, that system cannot be applied based on your personal judgement of what is idiotic or not

What is an idiotic reason? A reason that might seem idiotic to u might be of genuine and legitimate concern for the patient

Jehovah's witnesses for example cannot have blood transfusions iirc because it is against their beliefs. This might seem idiotic to some but in reality you have to respect that this is their set of beliefs and you have no right to say it is idiotic when such reasoning is entirely legitimate to them and a part of their identity. Therefore you have no right to refuse them treatment of their illness because u disagree with them, u simply seek a viable method of treatment that caters for what they want

The solution to non compliance is not just ignoring it and giving up on those patients but to get to the root of the non compliance issue and either resolving it or finding methods of treatment that bypass whatever is causing the non compliance

 

[Kiraken]

I understand the frustration you feel and it is completely natural to feel frustrated when a patient does not do what you feel is best for them but you cannot let that affect your treatment or management of the patient nor does it justify ignoring basic medical ethics involving patient oriented care

 

[Medman]

Even so, that system cannot be applied based on your personal judgement of what is idiotic or not

What is an idiotic reason? A reason that mught seem idiotic to u might be of genuine and legitimate cincern for the patient

Jehovah's witnesses for example cannot have blood transfusions iirc because it is against their beliefs. This might seem idiotic to some but in reality you have to respect that this is their set of beliefs and you have no right to say it is idiotic when such reasoning is entirely legitimate to them and a part of their identity. Therefore you have no right to refuse them treatment of their illness because u disagree with them, u simply seek a viable method of treatment that caters for what they want

The solution to non compliance is not just ignoring it and giving up on those patients but to getbto thebroot of the non compliance issue and either resolving it or finding methods of treatment that bypass whatever is causing the non compliance

Good point raised. I'm more alluding to the fact that patient who says "yeh whatever" even after you tell them they could potentially lose their life without taking the medication. Generally younger patients who "think" they are invincible so don't turn up for appointments. The unfortunate thing is they have the most to lose and will cost the most to keep alive because they are young and can potentially live for a long time.

You try your best as a physician to have patience for your patients but sometimes there are ones that you simply cannot deal with but this is all within the bounds of ethical medical care. Then you must realise you may not be the "best" physician for this particular patient so it may be more ethical for the patient to find another physician that suit their needs better.

Thanks for the inputs kiraken, I originally posted this on a pretty bad day. I can totally understand your stance and I do agree with you for our current situation given how fortunate we are in this country. That being said if the situation changes dramatically for the worse then this may be something that should be considered. You will make a fine physician.

 

[Kiraken]

Good point raised. I'm more alluding to the fact that patient who says "yeh whatever" even after you tell them they could potentially lose their life without taking the medication. Generally younger patients who "think" they are invincible so don't turn up for appointments. The unfortunate thing is they have the most to lose and will cost the most to keep alive because they are young and can potentially live for a long time.

You try your best as a physician to have patience for your patients but sometimes there are ones that you simply cannot deal with but this is all within the bounds of ethical medical care. Then you must realise you may not be the "best" physician for this particular patient so it may be more ethical for the patient to find another physician that suit their needs better.

Thanks for the inputs kiraken, I originally posted this on a pretty bad day. I can totally understand your stance and I do agree with you for our current situation given how fortunate we are in this country. That being said if the situation changes dramatically for the worse then this may be something that should be considered. You will make a fine physician.

Thank you, and after you clarified your view I retract much of my doubt as to your ability to be a good doctor, you certainly have the passion for the field that can drive you to great places

I am not sure yet whether I want to be a physician or suegeon, I have not had enough exposure to the latter to rly be concrete on this haha

Sorry to hear.about ur bad day, I hope u feel better now I think we all have ups and downs, both in and out of our professions and studies, and I hope ur ok

 

[Medman]

Thanks Kiraken. Medicine is so competitive these days, people I know are already doing masters, extra credits and research just to get ahead in relevant fields. Also given the long length of training and further education required it's a tough road ahead and without passion you will struggle with many of the obstacles. Also 7 years at uni is way too long for anyone imo.

Something I came across that might pique your interest. Woman with MS was given the go ahead with autologous stem cell therapy only to have the ethics board retract it. Ridiculous, she had to travel to another hospital to get it done. This is unethical conduct.


http://sixtyminutes.ninemsn.com.au/8810871/Russian-Roulette-medical-treatment

A GP once said to me. You shouldn't worry about being deregistered for grey legal decisions, instead you as a doctor should base your decisions on what the patient needs. He was speaking of drug seeking behaviour and even if the patient is registered as a doctor shopper you need to consider giving the medication to prevent serious withdrawal symptoms. Thank you for reminding me of this, I felt this resonated greatly when I first heard it.

 

[Schmeag]

As evidenced by this discussion, caring for the patient over the population may not be as clear cut as it seems. As clinicians, a standard of care needs to be provided for all patients, but it cannot be to the exclusion of the population's needs. In this day and age, the issue is about overtreating them rather than undertreating them, whether it is through CPR/intubation or antibiotic treatment. Antibiotic treatment rationalisation helps the individual somewhat by reducing adverse reactions, and colonisation of resistant microbes, but helps the population more by reducing antibiotic resistance. Vaccination primarily benefits the population--while the individual becomes immune, the chances that they will contract measles is relatively low in this society due to herd immunity, and while safe, adverse reactions are possible.

However, while considering the population, individuals still have the right to refuse treatment (if capable), but we still have a duty to care to inform them of the risks involved. That duty of care continues when they present and consent for reasonable treatment. Medman brings up an ethical dilemma, but as clinicians , we should advocate for the patient and let the higher-ups do the rationalising. In the face of rising healthcare costs, our role as doctors in treating disease is probably lessened and it should be up to the policy makers to institute measures to prevent disease from occurring at a population level. However, this still shouldn't stop us from being advocates for our patients.