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Letter to an Aspiring Doctor

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Re: Letter to an Aspiring Doctor

#21

Post by nkrisc »

nradov wrote: post #16
lliamander wrote: post #13

Earlier quoted context omitted.

Although a possible interpretation, I consider that unlikely. Immediately preceding the section on abortion we have the following comment: > There is nowadays a tendency for rights to spread, like ink through blotting paper. And then immediately following: > A recent article in the New England Journal of Medicine argued that doctors should not be permitted to opt out of performing procedures that they considered unet…

It's not just physicians. There have been issues with pharmacists refusing to dispense legally prescribed abortifacients. Should they be legally required to give patients certain drugs which conflict with their personal morals?

Perhaps not required but instead prohibited from abusing their role as a middleman in interfering with another's treatment.

Re: Letter to an Aspiring Doctor

#22

Post by nradov »

nkrisc wrote: post #21
nradov wrote: post #16

Earlier quoted context omitted.

It's not just physicians. There have been issues with pharmacists refusing to dispense legally prescribed abortifacients. Should they be legally required to give patients certain drugs which conflict with their personal morals?

Perhaps not required but instead prohibited from abusing their role as a middleman in interfering with another's treatment.

Pharmacists aren't middlemen. They are licensed healthcare providers with a critical role in patient care that goes beyond just handing over pill bottles.

Re: Letter to an Aspiring Doctor

#24

Post by MRD85 »

tastythrowaway wrote: post #19
classichasclass wrote: post #3

Earlier quoted context omitted.

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.

respectfully, what remotely well-trained doctor _didn't_ realize that part about an opiate being only a minor addiction risk was obviously bullshit?

The doctors were getting shown a whole host of studies which all said that there was only a minor addiction risk. You need to be able to put trust into what the studies are showing.

Re: Letter to an Aspiring Doctor

#25

Post by MRD85 »

srinivgp wrote: post #6
msla wrote: post #4

Earlier quoted context omitted.

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 n…

I had a post viral illness this year after glandular fever. The post viral illness is related to chronic fatigue and if it hadn't resolved I would have been diagnosed with chronic fatigue. I had every test the doctors could think of and I was seeing specialists, yet every test said I was a bill of health. It's incredibly frustrating to have medical practitioners not believe you when the illness is ruining your life.

Re: Letter to an Aspiring Doctor

#26

Post by weliketocode »

nickpsecurity wrote: post #2

This 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 also was a very strong emphasis on pain treatment as part of standard-of-care.

When pain management is legislated, it becomes a lot easier for doctors to accept it as necessary.

Re: Letter to an Aspiring Doctor

#27

Post by cco »

tastythrowaway wrote: post #19
classichasclass wrote: post #3

Earlier quoted context omitted.

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.

respectfully, what remotely well-trained doctor _didn't_ realize that part about an opiate being only a minor addiction risk was obviously bullshit?

I'm shocked to the point of disbelief on this as well, this does not pass the smell test for me. Anybody, especially doctors, should have been well aware of the risks, this was not a surprise to anybody with as much as a toe in the public health sector.

Re: Letter to an Aspiring Doctor

#28

Post by evrydayhustling »

nradov wrote: post #22
nkrisc wrote: post #21

Earlier quoted context omitted.

Perhaps not required but instead prohibited from abusing their role as a middleman in interfering with another's treatment.

Pharmacists aren't middlemen. They are licensed healthcare providers with a critical role in patient care that goes beyond just handing over pill bottles.

That may describe the professionals training and intended role in the ecosystem, but it does not describe most patients' experience of the pharmacist.

Re: Letter to an Aspiring Doctor

#29

Post by jmalicki »

tastythrowaway wrote: post #19
classichasclass wrote: post #3

Earlier quoted context omitted.

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.

respectfully, what remotely well-trained doctor _didn't_ realize that part about an opiate being only a minor addiction risk was obviously bullshit?

The book Dreamland[1] chronicles a lot of this history... but a belief in science means that if scientific studies challenge some of your preexisting beliefs, you accept that evidence.

[1] https://www.amazon.com/Dreamland-True-Americas-Opiate-Epidem...

Re: Letter to an Aspiring Doctor

#30

Post by siberianbear »

toastermoster wrote: post #23

I'm surprised there was no mention about insurance and billing requirements, etc.

Yeah, that surprised me, too.

At one time in my life, I considered becoming a doctor, and had even started to take some of the required undergraduate coursework required to apply to medical school (organic chemistry, biology, etc.)

I started to talk to doctors about my choice, and nearly all of them advised me not to go into medicine and often went into a long rant about dealing with insurance companies, billing issues and being told how to practice medicine by people with only a high school diploma at an insurance company.

I might be a doctor today if it wasn't for them. I think it was for the best: I found electrical engineering in Silicon Valley to be interesting and highly remunerative.

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