bobweiss

As a basic member who is an out-patient, but very much pro-actively involved and self-educated in fields involving my own health issues I find something interesting here. I receive the majority of my care within the VA system, but also have used doctors and hospitals outside that system. I have an observation somewhat similar to many of you nurse professionals and have observed physicians, whom I have respect for because of their knowledge not be curt or abrasive, but dismissive of opinion or even mere suggestion that doesn't concur with their professional opinion. Being outspoken and opinionated by nature I never turn the other cheek and immediately come back at them, but not with anger...with fact/s justifying my stated opinion. In the fields I'm familair with I am able to freely engage with them at their medical jargon level. Good doctors I've observed will politely engage me in discourse and respect my input when they see that I have familiarity and have obviously done my homework, and they realize my motivation for said discourse is sincere. Those of, to put it kindly, a less than competent ability become irritated and red-faced and if they respond in a dismissive manner I engage them as if it were mortal combat as I will not take condescending and/or sarcastic interchange. This comes to the fore much when any reference to a holistic protocol, whether efficacious and proven to so be or not, comes up. Such, usually appears to stoke their systolic and annoy them, but my sentiment is tough sh*t if they think I'm going to tolerate thier sardonic displays they're going to get a rude awaakening. In all things, all individuals deserve to be heard out with a civil manner and behavior, until they give good cause they do not deserve such concession. When they fail to do so I give them a well-calculated albeit polite dressing down and damn the consequences. That ("polite dressing down") may seem a contradiction in terms, but not really and is dependent upon one's technique (HA!!). I then go about making my case about why said protocol should be at minimal, not dismissed out of hand. Until medicine in general sheds the brainwashing effect of big pharma I fear we shall still have to endure the formal practice of medicine being rendered from a narrow-minded perspective. My conclusion, quite expectedly is, I still have great respect for you folks I refer to as the "enlisted troops" who serve within a system rife with abuse in many quarters and where the tendency for closing ranks and covering up (to a degree) is an attitude that needs changing. I sense widespread frustration with it and can empathize with all who must deal with it daily and who take their personal medical mission seriously and with great professionalism.

Understood forrester! It would appear that as is true in many instances of needed reform one must step back and get a perspective of the "overall" system and it's influences to properly address any reformation. I specifically acknowledge your comments regarding litigation which are all too true in this country. It's not unlike the bumper sticker that opines..."We have met the enemy and he is us." Any establishment tends to have those entrenched in power and control close ranks upon criticism/evaluation. It is a near genetic corporate predisposition. Acknowledging such doesn't bode well for addressing health management and dispensation of care issues. It is further complicated by politicians who'll say anything as they whore for the vote. In a manner of speaking..., the patient must cooperate when his well-being is the stated goal.

A quick note. I've been advised by a moderator that in using the doctor reference in my username of "doctorhugo" I've violated rules here. I've changed my profile to reflect a new username of "bobweiss". Hopefully it will be entered soon. Thanks all!

I should note I speak from the perspective of some naivete as an outsider (patient) looking in (upon the system). Regardless of country one thing I always felt would be constructive (if not already in place) is what I describe as an AnonymousPeerReview, which would be step one at the first hint of a formal complaint precursor to litigation by a patient or family member. The "anonymity" would be only that the case would be assigned a number from a registry and the physicians name would never be known to those reviewing. As pertains to the USA, I'd be interested to know if such a formality exists now.

An interesting question indeed and since it may prove related I'll make some comments from a different perspective. First, may I state I am not a doctor. The username is coincidental and has a long, humorous background in my case. I'm a male senior citizen outpatient (cardiology) who is by nature pro-active in all things, not the least of which is health care as it effects me. As I came to realize I had issues I immediately commenced educating myself in the basics of cardiology and ancillary subjects and familiarizing myself with the related terminology so I could interchange with the doctors and nurses at their level. Being relegated to the VA for the bulk of my care I came very quickly to realize that I'd be, in general, dealing with the bottom 20% of the graduating class so I'd best be informed and always make the point to the doctors that any decision on suggested care is a "joint matter" to be decided after a brief medical colliquy between doctor and patient and not an arbitrary decision by a doctor alone. My observation is that competent physicians appreciate a patient who is into his health care regimen and problems (though it irritates some) and don't feel 'challenged' by me. Poor physicians act quite to the contrary and I have little mercy upon them. Whilst a urology patient, on a particular occasion and suffering from a severely distended bladder due to excessive water consumption (as part of protocol between routine catheter removal/replacement) I was given the old medical version of "benign neglect". I finally reacted by grabbing the urology intern by the shoulder as he tried to pass me by one time too many. I instructed him to look in my eyes and note that after having imbibed over 2 litres of H2O that soon I'd be weeping urine from my eye sockets and if he didn't immediately Foley catherize me that I'd sweep his office desk clear, lie down on my back and self-catherize. It took that to get his attention and immediate response. Therefore, from a patient perspective I'd note that benign neglect to be a significant issue with doctors. Even when a patient is obviously understanding of his medical issues doctors tend to be dismissive. They also have a great penchant for being very non-specific and non-commital. I explain that, in many cases, as the side effect of a overly litigeous society and of physicians always seeing the dark shadow of a lawyer behind every patient. Most are grossly uninformed and reject out-of-hand any natural/holistic protocols. The fault there is medical schools. My closing observation would be that those I consider the "enlisted troops", which define all levels of you in nursing from NPs, RNs to PAs et al are those I rely on for more forthright opinion and information and it's how I vette physicians within the VA system. I thank you ALL for your studied dedication. You should know that YOU are the foundational strength of the system. My comment has to do with my observation of doctors from my experience

I think that the current health care system almost mirrors the "average" behavior of it's citizenry when it comes to personal healthcare. That is to say, in a word, it's "dysfunctional". There is something called "responsibility" for the consequences and lack thereof of one's behavior that MUST be taken into account if the health care delivery system is to be reformed. We are inundated with assorted information, all well-intended, via all manner of media outlets on how we may act more responsibly as individuals to insure a better quality of health. Most of the population ignores such and goes about consuming high sugar food and drink, high sodium food products and much other that is marketed, because it's out there and they lack self-discipline. The individual has a responsibiity for one of the two factors that effect his/her health. One, which is a genetic predisposition one cannot effect by behavioral modification, but the other...enviromental influence can be addressed. This country is in the throes of a diabetes typeII epidemic. Health care folks know the devastation that diabetes can wrack upon an individual's health, so why is it that such a large percentage of morbidly obese people can be observed working wihin the nation's hospital systems? It's symptomatic of the greater overall problem and NO health system can be designed that can long endure and compensate for the accumulation of personal neglect and abuse running rampant in this society. In short, we must not put the cart out ahead of the horse. There are very real philosphical considerations that must be recognized as being significant drains upon ANY and ALL health systems. I'm not a 'big government' advocate at all. Politicians have no genuine concern when they voice opinion on health care and are, as may be now daily observed, pandering to segments of the population as they go about whoring for the vote among the intellectually challenged. In short, in the main, they are pathologically disingenuous. The problem here that I've commented upon needs ideas to address it. I'd much rather see serious constructive commentary on how to 'responsibly' deal with the matter of creating an environment that insists upon, not entreats, those of bad behavioral attitude to change or else be left 'out in the cold' so-to-speak. I believe government's responsibility is to be the ombudsman for the public whilst carefully treading that gray line, which when crossed makes them a burdensome, irrelevant, regulatory bureaucracy. We live in times when a spoiled public, for political reasons, has come to expect that the vague Goliath of an entity we call the "federal government" is the provider of all things from cradle to grave. Not yet friends, but the attitude towards rampant socialism is upon us. Government is nothing and it creates nothing...it produces nothing. It's assets and liabilities are the peoples' assets and liabilities. There is no free ride! Allow me to lay the first BET (BehaviorEncouragementTherapy) protocol on the line: 1. Impose, not a tax, but a 25% surcharge at the retail level to the price of a specific approved lists of food and drink products. That money would be collected and deposited in a specific health cost allotment account at the state level to defer the state cost of state-run universal health care. And while were about it...all federal cigarette taxation will CEASE and go to the appropriate states who collect same to go into the same allotment account. The reason for state-run is that a federal plan cannot properly address the varied conditions at many different state levels. States can be more responsive and responsible in maintaining such and MORE EASILY held to account. This knee-jerk attitude of going to the federal government for everything is a destructive process from every view. The federal government should be responsible for setting and applying the basic minimal standards for states to comply with and then step out of the picture. Plans should state that the health delivery system costs, paid for by individual and corporate taxation (as Medicare is phased out as a federal responsibility and changed to a state responsibility), will cover 75% of the "reasonable and customary" charges for procedures. Insurance companies can be revamping their coverages to highlight Major Medical insurance plans to address the bulk of that 25% with varying deductibles for pricing considerations. Just a few thoughts off the top of the old bean......., so LET'S HAVE AT IT!!