Letter to an Aspiring Doctor • Hacker News Board

Re: Letter to an Aspiring Doctor

#41

Post by DanBC » Sat, Nov 17, 2018, 4:03 PM UTC

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?

> Should they be legally required to give patients certain drugs

They're not legally forced to do so. They can chose any other job. But if they chose that job then yes, they need to fill the fucking prescriptions correctly.

Re: Letter to an Aspiring Doctor

#42

Post by noddy1 » Sat, Nov 17, 2018, 9:33 PM UTC

evgen wrote: post #37

sethammons wrote: post #36

Earlier quoted context omitted.

Our doctor who delivered our second child some 13 years ago told us he had to deliver (if I recall) 3 babies a week minimum to pay for medical malpractice insurance and he had never payed out on a malpractice lawsuit. The insurance is crazy.

That is because for an obstetrician the consequences of medical malpractice are profound and expensive. They are basically either killing a child or crippling that child for the entirety of their life. If the child survives their malpractice then that child will have a life that is much shorter, or much more unpleasant, than it needed to be if the obstetrician did their job correctly and the insurance company will be…

The constant threat of million dollar lawsuits is a pretty stupid way to ensure good practice of medicine.

Re: Letter to an Aspiring Doctor

#43

Post by evrydayhustling » Sun, Nov 18, 2018, 5:39 AM UTC

daodedickinson wrote: post #31

evrydayhustling wrote: post #28

Earlier quoted context omitted.

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

What empirical studies do you know justify this claim?

Um the experience of waiting in line at the drug store in four states in the last fifteen years? If you think most people have a more involved relationship with their pharmacist, I doubt I'm going to dissuade you.

Re: Letter to an Aspiring Doctor

#44

Post by perl4ever » Sun, Nov 18, 2018, 6:54 AM UTC

evrydayhustling wrote: post #43

daodedickinson wrote: post #31

Earlier quoted context omitted.

What empirical studies do you know justify this claim?

Um the experience of waiting in line at the drug store in four states in the last fifteen years? If you think most people have a more involved relationship with their pharmacist, I doubt I'm going to dissuade you.

It was just over ten years ago, but I had the experience of having an allergic reaction to a medication prescribed to me, and a pharmacist that was knowledgeable enough to warn me not to take the obvious OTC remedy for my symptoms because it would likely make things worse.

Re: Letter to an Aspiring Doctor

#45

Post by evrydayhustling » Sun, Nov 18, 2018, 6:40 PM UTC

perl4ever wrote: post #44

evrydayhustling wrote: post #43

Earlier quoted context omitted.

Um the experience of waiting in line at the drug store in four states in the last fifteen years? If you think most people have a more involved relationship with their pharmacist, I doubt I'm going to dissuade you.

It was just over ten years ago, but I had the experience of having an allergic reaction to a medication prescribed to me, and a pharmacist that was knowledgeable enough to warn me not to take the obvious OTC remedy for my symptoms because it would likely make things worse.

Your comment makes me recognize that my own above could sound fundamentally dismissive of a pharmacist's role, which I don't intend. I recognize that good pharmacists can be a safety check or troubleshooter, and safeguards are valuable even when rarely needed.

However, the fact that your anecdote was 10 years ago underscores the point that the vast majority of pharmacy interactions are transactional: pick up the medicine the doctor ordered in. This is demonstrated in how doctors and insurance treat pharmacies as interchangeable, and the pharmacies themselves advertise discounts and quick pickup rather than diagnostic track record. Per the post further up the thread, it is reasonable for most patients to think of pharmacists as middlemen.

I think this is why many people are shocked that a pharmacist can block a prescription on moral grounds. The lack of a relationship makes the pharmacist overriding you and your doctor's judgements seem entirely out of the spirit of the transaction. It feels like a neighbor you barely know using a moment of economic leverage to have a major impact on your life, for which they will have no accountability.

I'm personally sympathetic to the idea that a pharmacist, or anyone, shouldn't have to act outside their moral principles. But that should come along with clearly advertising what transaction is being offered -- "We fulfill prescriptions" is a different service offering than "we fulfill prescriptions that we agree with", and a patient needs to know in advance which they are sending their order to.

Re: Letter to an Aspiring Doctor

#46

Post by perl4ever » Mon, Nov 19, 2018, 10:57 PM UTC

evrydayhustling wrote: post #45

perl4ever wrote: post #44

Earlier quoted context omitted.

It was just over ten years ago, but I had the experience of having an allergic reaction to a medication prescribed to me, and a pharmacist that was knowledgeable enough to warn me not to take the obvious OTC remedy for my symptoms because it would likely make things worse.

Your comment makes me recognize that my own above could sound fundamentally dismissive of a pharmacist's role, which I don't intend. I recognize that good pharmacists can be a safety check or troubleshooter, and safeguards are valuable even when rarely needed. However, the fact that your anecdote was 10 years ago underscores the point that the vast majority of pharmacy interactions are transactional: pick up the medi…

I think it's possible things have changed in the last decade, but I don't think it was accidental or the natural evolution of things. Unlike the situation years ago, today I am required to use a particular pharmacy (CVS) by my insurance company. So I think that anything other than filling pill bottles must be crushed by the way the market is currently working. There is simply no point in providing any expertise or extra service when your audience is captive. I used to prefer Rite-Aid, but it's not an option now.

Re: Letter to an Aspiring Doctor

#47

Post by lliamander » Tue, Nov 20, 2018, 7:00 PM UTC

aidanfindlater wrote: post #38

lliamander wrote: post #15

Earlier quoted context omitted.

I do not believe the author was trying to be coy, but you are eliding the paragraph which gives the correct context to the latter statement: > Moreover, though we pay lip service as a society to diversity and tolerance, we increasingly demand uniformity. 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 unethica…

The actual debate among physicians is about the ethics of denying patients care to which they have a right. There is no law or legal fiat that forces physicians to do things they object to. We are instead held up to a standard of care by our professional regulatory bodies, which define how a physician should act in order to be considered a member of the profession. Most of the rules are around ethical behaviour. With…

> The actual debate among physicians is about the ethics of denying patients care to which they have a right. There is no law or legal fiat that forces physicians to do things they object to.

I agree that is the status quo. The linked article is not necessarily talking about what the medical field currently looks like, but what it may look like over the coming decades. The author is concerned that law may one day override an individual doctor's conscientious objections.

I should also note that author lives and practiced in the U.K. and so if you are writing from an American context (as I am) then it may be that the state of medical ethics is somewhat different over there.

Re: Letter to an Aspiring Doctor

#48

Post by nkrisc » Tue, Nov 20, 2018, 9:14 PM UTC

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.

Perhaps my language was too dismissive. I regret that. Are you suggesting that pharmacists who refuse to hand over drugs that they disagree with for whatever reason are doing so because they have the patient's wellbeing in mind?