Bad Medical Decisions

Thought I would share a patient story to illustrate a point. I had seen a five year old child last year with recurrent ear infections and after failing numerous courses of antibiotic therapy the recommendation was to insert tubes in the child's ears. The child was covered by medicaid, the health insurance for the poor. The patient was scheduled for surgery but for whatever reason failed to show for the appointment. I am not sure why the child didn't show up but it was never re-scheduled. About one year later the child shows up with the parent and it appears that permanent damage ensued since the problem was never dealt with and the parent didn't pursue the appropriate treatment. What was an easy problem to fix last year has become a much more difficult problem and perhaps not fixable with a permanent deficit.

My initial reaction was that the nanny state can give the poor all the benefits they want but ultimately an individual or parent still needs to take some individual responsibility for their health care. I blamed the parent for stupid decision making which results in their child having a more serious problem. But after watching 60 minutes last week regarding Steve Jobs it seems that stupid decisions regarding ones health are not limited to a certain segment of the population or income level. It seems there was a chance had he taken care of his tumor when it was initially found he could have beaten the disease. Probably out of fear, he decided to wait and try alternative treatment and that may have cost him his life.

Why do people fail to pursue the recommendations of their doctors? Is it just fear or is there something else that influences their decisions? I put part of the blame on the media. There is so much negative media attention paid to the medical profession that people question the recommendations of their doctors. You hear so many times on the TV the vast number of deaths that are caused by medical errors. You hear how American health care is rated low compared to other nations (totally ridiculous, just look at cancer survival in the US vs. anywhere else). Even BO promotes this skepticism towards doctors when he questions doctors/surgeons motivations when they perform operations. Specifically he questioned the motivations of doctors who perform tonsillectomy in children as well as the greed of doctors who perform amputations only to line their pockets (as if this community organizer has a clue about the indications for such surgery). This environment of suspicion regarding the motivations of doctors has an adverse effect by allowing patients with serious problems to justify putting off needed interventions. On a similar note, there are so many false claims by alternative treatments (which are legally permitted) that the public buys into it. People don't realize that medical treatments go through rigorous trials to ensure efficacy and safety whereas alternative treatments do not.

In no way am I advocating for people to blindly follow any doctor's recommendations as I have encountered many a patient who I believe were advised incorrectly. Similarly, I am sure I have had patients who have seen me and then went elsewhere for another opinion that was different and may have been correct when I was wrong. Doctors are human and can make mistakes or overlook something which is why I always encourage second opinions in my own patients. I never look at it as a threat to my abilities but rather what is in the general welfare of the patient which is the ultimate goal. I believe most physicians feel similarly.

Whatever one may think of a doctor it is imperative that if an individual does not believe or trust the recommendations of a specific doctor that he/she seek another medical opinion.