Re: About Change: lament about why we need change

[Guest guest]

From Drain,

For patients who are another MD's patient I do not answer their questions in detail. I tell them they must use the system their current physician uses, as this would be conflict if my advice was different than their current MD would want. I simply abdicate if they have abdicated me. I am careful not to imply malice. I tell them they could let their new physician know they want a different way to manage their care, but I let them know that what they ask is impossible, given the current malpractice environment. I would not dream of talking to some other MDs patient about managing their case for 25 minutes, as it would be possilble I was second guessing the current MD, and I could be totally wrong.

At one time I did not do this. Then I had a lesson. One of my previous cases moved to a new MD who used a coumadin clinic rather than doing his own testing. The coumadin clinic changed the dosage on this person's 93 year old parent, based on a single low reading which happened after a single 4 day visit from a sister who cooked entirely different meals for the 93 year old....you know, the kind of thing that makes you say to a patient with an INR of 1.9 who has just been eating salad twice every day because she was harvesting garden to go onto the usual diet and return in five days for another test....which is what I recommended. The coumadin clinic fired the patient for noncomplience, and the primary care MD fired the patient because the coumadin clinic did.....it was a mess. I no longer do these kind things for patients who can not follow up with me.

I keep to myself if I suspect some of the systems are set up make the other medical group a lot more money than my system. After I was told by the ER doc during my residency in Klamath Falls that a 23 year old patient who had just had a tongue piercing and was spitting blood needed to be admitted for a GI bleed "because this little hospital really needs the revenue" I am no longer surprised by those who use protocol to puff up their bottom line.

Joanne Holland DVM/MD Drain, Oregon