Letter to an Aspiring Doctor
firstthings.com
Letter to an Aspiring Doctor
1–10 of 48 posts
Re: Letter to an Aspiring Doctor
#2This is a great letter. I do want to pause on this, though, about doctors prescribing opiates:
"The epidemic would have been avoidable if doctors as a whole had adopted a more critical and thoughtful approach"
He could be totally right about causes of that problem in that time. Currently, though, drug companies offer all kinds of financial incentives anyone that will increase drugs use in ways ranging from BS studies to incorrect info in textbooks to actual prescriptions. I've also read they give free samples.
Examples I found in quick DuckDuckGo:
https://www.bostonglobe.com/opinion/2016/04/11/medical-resea...
https://www.nytimes.com/2004/06/27/us/medical-marketing-trea...
http://content.time.com/time/health/article/0,8599,1883449,0...
This stuff could've been going on a long time. Maybe back when the push to use addictive drugs started. Or maybe that was just bad science like author says with the current push involving massive amounts of corruption. I say don't forget what's going on in any current debate about drugs, though.
Re: Letter to an Aspiring Doctor
#3This is a great letter. I do want to pause on this, though, about doctors prescribing opiates: "The epidemic would have been avoidable if doctors as a whole had adopted a more critical and thoughtful approach" He could be totally right about causes of that problem in that time. Currently, though, drug companies offer all kinds of financial incentives anyone that will increase drugs use in ways ranging from BS studies…
No, we didn't get free opioid samples. I can't imagine many docs got paid, either (I certainly got neither, nor would I have accepted them). What we actually got was a tsunami of alleged literature that said we should be doing more about non-malignant pain and that addiction was a minor risk. And, well, most of us bought it. Of course, look at who turned out to be behind it.
Re: Letter to an Aspiring Doctor
#4This is a great letter. I do want to pause on this, though, about doctors prescribing opiates: "The epidemic would have been avoidable if doctors as a whole had adopted a more critical and thoughtful approach" He could be totally right about causes of that problem in that time. Currently, though, drug companies offer all kinds of financial incentives anyone that will increase drugs use in ways ranging from BS studies…
There was also a push to have pain as a fifth vital sign:
https://www.medpagetoday.com/publichealthpolicy/publichealth...
> In 2001, the Joint Commission rolled out its Pain Management Standards, which helped grow the idea of pain as a "fifth vital sign." It required healthcare providers to ask every patient about their pain, given the perception at the time was that pain was undertreated.
My parents have complained about this; my mom's an RN, who's been everything from a home health nurse to an ICU nurse to a clinic nurse in a podiatrist's office, and my dad's a CRNA, and they talk about people who are likely drug-seeking and people who just don't like any discomfort, even stuff that, if you felt like that on a normal day, wouldn't cause you to take anything for it if you were a normal person.
So you have a mandate to Take Pain Really, Really Seriously. You have someone in a clinic, or on a table, groaning about how it hurts even though there's nothing, objectively, wrong with them. What do you do?
Re: Letter to an Aspiring Doctor
#5This is a great letter. I do want to pause on this, though, about doctors prescribing opiates: "The epidemic would have been avoidable if doctors as a whole had adopted a more critical and thoughtful approach" He could be totally right about causes of that problem in that time. Currently, though, drug companies offer all kinds of financial incentives anyone that will increase drugs use in ways ranging from BS studies…
No, we didn't get free opioid samples. I can't imagine many docs got paid, either (I certainly got neither, nor would I have accepted them). What we actually got was a tsunami of alleged literature that said we should be doing more about non-malignant pain and that addiction was a minor risk. And, well, most of us bought it. Of course, look at who turned out to be behind it.
[deleted]
Re: Letter to an Aspiring Doctor
#6This is a great letter. I do want to pause on this, though, about doctors prescribing opiates: "The epidemic would have been avoidable if doctors as a whole had adopted a more critical and thoughtful approach" He could be totally right about causes of that problem in that time. Currently, though, drug companies offer all kinds of financial incentives anyone that will increase drugs use in ways ranging from BS studies…
There was also a push to have pain as a fifth vital sign: https://www.medpagetoday.com/publichealthpolicy/publichealth... > In 2001, the Joint Commission rolled out its Pain Management Standards, which helped grow the idea of pain as a "fifth vital sign." It required healthcare providers to ask every patient about their pain, given the perception at the time was that pain was undertreated. My parents have complained…
> You have someone in a clinic, or on a table, groaning about how it hurts even though there's nothing, objectively, wrong with them. What do you do?
In practice, living the years I have with my wife, the answer seems to usually be "assume that you, as a doctor, have much more knowledge about your patient's experience and that because no test you know how to do dings 'yep, a problem', that the patient in fact _does not_ have a problem, that their claims of being in enough pain to want to die at least a few times a week are made-up, that they've lived this long with their 'must be just in their head' problem that surely it's not so bad and they can keep doing so".
From a purely probabilistic standpoint, they might be right.
From my wife's perspective, they are torturing her, hopefully not to death.
What _do_ you do?
Re: Letter to an Aspiring Doctor
#7If you detect a stealth agenda between the lines, it's not your imagination. From wikipedia: First Things is an ecumenical, conservative and, in some views, neoconservative[1][2][3][4][5] religious journal aimed at "advanc[ing] a religiously informed public philosophy for the ordering of society".[6] The magazine, which focuses on theology, liturgy, church history, religious history, culture, education, society and politics, is inter-denominational and inter-religious, representing a broad intellectual tradition of Christian and Jewish critique of contemporary society.
Re: Letter to an Aspiring Doctor
#8If you detect a stealth agenda between the lines, it's not your imagination. From wikipedia: First Things is an ecumenical, conservative and, in some views, neoconservative[1][2][3][4][5] religious journal aimed at "advanc[ing] a religiously informed public philosophy for the ordering of society".[6] The magazine, which focuses on theology, liturgy, church history, religious history, culture, education, society and p…
This jumped out at me.
"Abortion was originally intended to be performed in limited circumstances only, but now has become an inalienable right in any circumstances whatever—into which, indeed, it is impermissible to inquire."
followed coyly a paragraph later by
"This, of course, would have the corollary that mass murder by doctors would in theory be permissible, or even obligatory."
Re: Letter to an Aspiring Doctor
#9If you detect a stealth agenda between the lines, it's not your imagination. From wikipedia: First Things is an ecumenical, conservative and, in some views, neoconservative[1][2][3][4][5] religious journal aimed at "advanc[ing] a religiously informed public philosophy for the ordering of society".[6] The magazine, which focuses on theology, liturgy, church history, religious history, culture, education, society and p…
Yeah I could see it was a conservative from the website url, the abortion thing, and the mass murder bit.
Re: Letter to an Aspiring Doctor
#10This is a great letter. I do want to pause on this, though, about doctors prescribing opiates: "The epidemic would have been avoidable if doctors as a whole had adopted a more critical and thoughtful approach" He could be totally right about causes of that problem in that time. Currently, though, drug companies offer all kinds of financial incentives anyone that will increase drugs use in ways ranging from BS studies…
No, we didn't get free opioid samples. I can't imagine many docs got paid, either (I certainly got neither, nor would I have accepted them). What we actually got was a tsunami of alleged literature that said we should be doing more about non-malignant pain and that addiction was a minor risk. And, well, most of us bought it. Of course, look at who turned out to be behind it.
Yep. The fifth vital sign and all that.