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Let's Face It: Medicine is Business

Category: Bedside Manners

Will Technology Replace Pharmacists?

Maybe it can. But there are aspects of healthcare that can never be automated.

Yes, I worked in healthcare and consulted for one of the stakeholders, and I have seen the benefits of automation – reducing human errors, improving delivery efficiency.

But healthcare is a human profession, dealing with human beings and usually human beings who are sick, in pain, hurt, scared, and suffering.

Pharmacists are a member of the healthcare “human care team”, just as physicians and other healthcare professionals are part of that whole unit of caregivers and experts whose job is to focus on that one patient in front of them who is sick, in pain, hurt, scared, and suffering in some way. They know that one day, just like you and I will were we to live long enough or old enough, they and each one of us will be a patient one day.

So the point of pharmacy as a profession is the same in its foundation as the point of medicine as a profession, medical science (that branch of PhD research science dealing with human beings and human bodies in some way) as a profession, and any applied healthcare related business as a profession (regulators of industry, manufacturers of drugs, devices, and diagnostics) –

To care not just the human body but the human being.

Yes, you can get a machine to query for medicines that the patient is taking, whether there are supplements or drugs that may pose adverse interactions. You can print out sheets of information to get the patient to know how to take the drug, when to take it, what to watch out for… But the pharmacist with the human touch can get the patient to feel like he is being cared for, that his health and life are important, and that he matters. That can go a long way in gaining patient compliance and having a positive experience in healthcare.

This is something that we may improve with technology – but can never replace.

Other people’s take on this issue

Most Doctors Don’t Recommend Their Own Profession

Dan Abshear

Lately in the media, others have said and expressed concern about the apparent shortage of primary care doctors, most notably. Typically, the main reason stated for this shortage is lack of pay of this particular specialty compared with others chosen by potential physicians.

Yet considering the additional attention of shortages of students in some medical schools, one may ask the question as to whether or not people want to be any type of doctor in the first place in the United States. About one third of their lives are spent achieving the requirements of this profession. Reasons for not choosing to enter this profession are several and valid.

There is the issue of long hours- with primary care in particular because of the apparent lack of doctors of this specialty. Such doctors may be over-worked without an expected pay reflecting the work they do. Furthermore, those doctors employed by health care systems are required to see a certain number of patients a day, and receive a monetary bonus if this expectation is exceeded. It seems that most doctors are members of such health care systems. So burnout certainly may occur. And I consider such a requirement mandated by health care systems demeaning to this profession, and leaves the doctor without the control that the doctor is entitled to due to their training and experience.

However, the recent increases in hospitalists, who are those doctors that are usually Internal Medicine doctors who specialize in patients presently under hospital care, and they have lessened the load for all doctor specialties for the work they do that the admitting doctors would have to do without their presence. This in itself makes a doctor possibly more effective and efficient in their practice outside of the medical institution.

All doctors, I presume, face a high degree of emotional and physical stress associated with their profession, as stated in the previous paragraph, for example. And this is not to mention the incredible stress associated with patient care in the first place, with some patient cases causing more stress than others

Doctors, due to the changes that have occurred recently in the U.S. health care system, not only have the issue of money to deal with, but also a loss of autonomy regarding patient care combined with loss of respect that may be due in large part to others dictating on how they practice medicine. Ironically and often, these others are not as qualified as the doctor in the first place. This is complicated by the perception that the public, with some who view doctors as having the easy life with their pay and profession, which does not seem to be the case presently.

There are also reasons of malpractice insurance, which is why doctors choose to join health care systems, it is believed, to pick up the tab for this necessity, along with eliminating the concerns of running a practice in a private manner, which historically has been the case, as their offices are owned by the health care system as well.

Up to 90 percent of malpractice cases against a doctor are baseless and without merit, so they are unsuccessful for the plaintiff, yet this still affects the rate the doctor has to pay for malpractice insurance. I understand that simply filing a lawsuit against a doctor, as frivolous as it may be, still increases the malpractice premium of that doctor. This is combined with the amount the doctor has to spend to defend themselves in such cases, which approaches about 100,000 dollars over the course of about 4 years for such cases. A tort reform in Texas in 2004 resulted in annual malpractice premiums reduced by about a third of what they were. Soon afterwards, claims against doctors remarkably dropped by about 50 percent. Some specialties of doctors pay more premiums for malpractice than others. For example, OB/GYN doctors have been known to pay around 300 thousand dollars a year for this insurance. Certain types of surgeons experience a similar high rate of malpractice premiums.

Also, about a third of the U.S. is insured by Medicare, which progressively has lowered what they will reimburse a doctor for regarding the care they give a patient they treat. This fact is recognized by other insurance companies who will eventually follow the recommendations of Medicare, usually, regarding the reimbursement issue, so it seems. This will lead to a doctor having to see even more patients in order to make it financially with their profession, as this has resulted in the overall income of a doctor experiencing a decline of about 10 percent over the last decade.

Furthermore, doctors normally have to pay off the debt acquired from attending medical school, which averages well over 100,000 dollars today after their training. About 20 years ago, that debt was only about a fifth of what it is today. Paying this debt off is typically about 2 thousand dollars a month that doctors on average have to pay in order to eliminate this debt in a timely fashion. There are some who believe that doctors in the U.S. are over-paid. This may be true, but they are not absent of financial concerns as with any other profession.

Most doctors do not recommend their profession to others for such reasons stated in this article, and perhaps others not mentioned. This is somewhat understandable, yet extremely unfortunate for the health of the public in the future, especially. There have been cases where doctors do in fact change careers, and get into vocational fields such as medical communications or corporate medical companies. Also, expert witnessing is another consideration for those who choose to leave their profession. Finally, other choices considered include consulting and research. The training of doctors fortunately leaves them with options not involved directly with the flaws of medical care, but this is bad for us as citizens, overall.

No all doctors are saints. Like others, some are greedy and corrupt, which complicates others in this profession. Personally, I believe that the intentions of most physicians are bona fide. Yet in time, due to the nature of the current health care system, doctors frequently become cynical and apathetic, and this may be considered a significant concern to the well-being of those in need of restoration of their health.

Not long ago, the medical profession that has been discussed had honor and an element of nobility. Such traits are not as visible anymore, which saddens many intimate with the profession needed by many.

“In nothing do me more nearly approach the Gods then in giving health to men.” — Cicero

Disclosure: The author was formerly an employee of the pharmaceutical industry (sales) and is currently seeking employment in the same industry.

British Doc Pisses People Off by Calling Out Fat

Dr. Hamish Meldrum is the head of the British Medical Association and has upset a lot of people because he wants to stop sugar-coating the obesity problem and start some serious prevention. Meldrum’s view is that obesity is not always a “medical” problem, but a behavioral one, and when doctors are too quick a write a prescription for a pill for a patient who should be best helped with dietary modification and behavioral changes around food, this prevents overweight people from taking personal responsibility about their weight problems. (more…)

Why We Like the Doctors We Like

I’ve visited with many doctors in the past – primary care docs and specialists, both as a patient and years ago as a professional. I’ve come to really appreciate the importance of bedside manners and compassion in medicine.

Because of some of the behaviors I have seen from doctors when I worked in the pharmaceutical industry, it’s made me highly distrustful of physicians. So in writing this, I already have had bad experiences that had made me biased against how some doctors “practice medicine.”

As a patient, I’ve met doctors who have been dismissive or judgmental, and who came across as barely caring about my wellbeing as a patient because I was just another body shuffling through the office in a highly managed care environment.

For example, a primary care doctor my husband and I went to had given us both annual physical exams and never bothered to call us about the blood test results. His office staff said that we would only get a call if something was “wrong.” I found this ridiculous especially when the doctor had made my husband take a 2 hour glucose tolerance test for his blood sugar levels. The doctor also made recommendations that ran counter to a world-class endocrinologist even when we told the doctor about family risk factors, etc.

This was a young doctor, and maybe that’s where his arrogance came from. (more…)

Suicide and SSRI When Medical Legal Risk is High

By Robert Lamberts, M.D.

I had a tough situation in the office yesterday.

One of my patients is a 17-year old who went to the ER on Sunday for shortness of breath. They said she had a panic attack and should follow-up with me as soon as possible.

When I saw her, she was clearly distressed, but not to the point of needing to be hospitalized. I asked her what was up and she told me that she had been kicked out of school recently because she stabbed someone with a knife – apparently only after that person grabbed her forcibly. She lives with her mother and her father is a homeless alcoholic. Her mother tells her not to talk to him, but he calls regularly and tells her that she is all he has. He also says that he might kill himself. She knows that he shouldn’t say this kind of thing to her, but it puts her in a hard situation. On one hand, she knows that it tears her apart to talk with him. On the other hand, she fears that if she does not talk to him, he will kill himself.

I asked her if she ever thought of killing herself, and she said she had – especially after talking to her father – but was not at this time suicidal. She had a real good friend with her who was very supportive.

So I am stuck in a dilemma. On one hand, she is clearly depressed and needs both medication and psychological counseling. On the other hand, since there is a black-box warning for using SSRI’s in teens, putting her on one would put me at huge risk for a lawsuit should she follow-through and kill herself. I think she is at very high risk of doing that in the long-run, and don’t really have a longstanding relationship with her as her doctor. I did what I could to tell her to talk with either her friend or me if she should feel she is close to killing herself, but I don’t really know her that well. I am trying to reach one of the local child psychiatrists, but most of them are several months out for new patient visits. (more…)

Here To Fight or Here To Die?

When I was a graduate student, a senior student teacher (scientist or professor in training?) got up to address the the group of college students and graduate student teachers. The senior student glossed over the usual orientation-related information. At the end, he became very solemn and said, “Please show some decorum around here. Remember that people come here to die. It’s necessary to show decorum.” It wasn’t until months later that I realized what bothered me about the comment. What disturbed me was that no one seemed to be offended at the senior student’s comment – for them it made sense.

Cancer patients do not come to die. They come to fight for their lives.

How many students did the teaching assistant influence with that perspective – those students who didn’t bother to question what he said, or didn’t see there was anything to question?

There is a widespread disconnect in perspectives of those who study cancer and those who live it. I had no clue what living with cancer is about even though I’ve scurried along the same hallways as emaciated, hairless patients who were wheeled around the hospital. I’ve seen children fighting cancer and felt as removed if I was watching a television. How many basic science (preclinical) students go through school wondering whether their project would make a difference at all?

Perspective on cancer matters not only to people living with cancer and to clinicians treating patients, but also to everyone else – graduate students researching on various aspects of cancer, individuals who influence social perspective (teachers, community leaders.) Perspective affects our decisions to to detach and become indifferent, or to increase awareness of and appreciation for individual courage in the fight against cancer.

From a breast cancer patient: “…having cancer has changed me for the better, I wish I could have changed a different way, but I’ll take this way if necessary. Cancer is a disease of LIFE, not just a disease of the body. And though others want you back to normal, normal is different now. It’s not about being strong; it’s about being grateful for every second.”

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