Informed consent, medical ethics and more rambling
I appreciate where you're coming from. I'm a nurse and with a very good paying job. Just a little overtime and I make just a little less than my cousin, a primary care doctor. Even with my overtime, she always works more hours than I do since she regularly stays in the office late to do her dictations/charting. For me, it's 3- 12 hour shifts and any extra time on my four days off is overtime. So, she's driving a car older than mine, paying hundreds of thousands in loans, and feeling overworked, underpaid, and unhappy. I recently went part-time to go to grad school to become an FNP. I really like primary care but it's going to be hard to take a pay cut since there's no way they'll be able to match my salary if it's only 20k less than what a MD is making. I'm reading about health care reform tonight. I wish I knew how to fix this situation. I'm not sure but I do hope it gets better for all of us.
I am my own hero...I save myself one day, one meal, one bite, one choice, one challenge, one step at a time...
No one is expecting doctors to be superhuman. Patients do, however, have a RIGHT to be told all of the relevant information regarding a surgery that will permanently alter their anatomy and clearly many surgeons are NOT doing so. Not telling a RNY candidate that the caloric malabsorption is temporary or not telling a DS candidate that their remnant stomach will be removed is VERY poor professional practice at the very least and is, IMO, unethical.
Lora
Lora
14 years out; 190 pounds lost, 165 pound loss maintained
You don't drown by falling in the water. You drown by staying there.
I've been around the business side of the healthcare game for about 10 years now. While I do agree wholeheartedly what what Kelly is saying I think someone needs to throw out that there are some "practical" arguments against it all. As patients it's up to us to be involved in our care. Informed consent is absolutely essential and I want all of the information available to me to be able to make a medical decision. But that doctor isn't a specialist in every single thing in the medical realm. That's just not the way the system works. While it's a negative, it's also the reason that our system is the best in the world. Years ago I had a mentor at a job that always told me to never answer no to a question. Instead, answer "no, but I know someone who does". To me that's what sums up the environment today. As patients we don't just have one doctor to get all of our needs taken care of. I mean, think about it, did we go and see a general surgeon who has abdominal experience for our WLS or did we see someone who started in abdominal surgery and now specializes in the bariatrics side of it?
The money side of the equation is probably the most important side of this as one of the other posters was pointing out. From a business perspective a provider knows they have to see a certain amount of patients in a certain amount of time every day. If they don't like that, then they need to have a small patient load. Which means higher prices, less competitive reimbursements from insurance, and a smaller pool over "overlapping" patients to keep the schedule full. That's why a lot of us are starting to see concierge practices that charge a premium to have them on retainer.
Just to summarize, you're absolutely right that there are situations where the patient is not getting the information they "need" to make a smart decision. Part of it is the provider not being able to spend the time with the patient and some of it is the patient not doing their own homework. Just as we've chosen to go down the WLS road to improve, and actively take part in, our health, so must the "average" patient who just sees a provider for catastrophic care. There is simply too much good information and resources out there today for every doctor's answer to be the if-so-facto final answer.
The money side of the equation is probably the most important side of this as one of the other posters was pointing out. From a business perspective a provider knows they have to see a certain amount of patients in a certain amount of time every day. If they don't like that, then they need to have a small patient load. Which means higher prices, less competitive reimbursements from insurance, and a smaller pool over "overlapping" patients to keep the schedule full. That's why a lot of us are starting to see concierge practices that charge a premium to have them on retainer.
Just to summarize, you're absolutely right that there are situations where the patient is not getting the information they "need" to make a smart decision. Part of it is the provider not being able to spend the time with the patient and some of it is the patient not doing their own homework. Just as we've chosen to go down the WLS road to improve, and actively take part in, our health, so must the "average" patient who just sees a provider for catastrophic care. There is simply too much good information and resources out there today for every doctor's answer to be the if-so-facto final answer.
You already know how strongly I feel about doctors being unethical by using the "soda will stretch your pouch" scare tactic instead of just telling patients the legitimate reasons that it would be BETTER for them to limit or avoid carbonated drinks. Second on my list of surgeons failing to provide enough information for TRULY informed consent are the bariatric surgeons who fail to tell potential RNY patients that the caloric malabsorption is only temporary! In my book that is completely unethical. Even failing to tell them that only about 30% dump also robs the patients of truly informed consent.
Lora
Lora
14 years out; 190 pounds lost, 165 pound loss maintained
You don't drown by falling in the water. You drown by staying there.
I guess I'm really lucky because my doctor here in Virginia, Dr. Moazzez, was always upfront and told me everything, with scientific rationale, from the beginning. He has never misinformed me, used scare tactics, or not been willing to give me actual research studies to explain what he was saying. I was even given an operative report so I could read the play-by-play of my surgery plus pictures of my liver (since it was enlarged). Next time I see him I'm going to thank him for that. I guess I didn't realize how many people weren't getting all the information they needed until I started reading on these boards. Frustrating that there is su*****onsistency but I'm grateful I had good luck and can only hope others will have the same.
I am my own hero...I save myself one day, one meal, one bite, one choice, one challenge, one step at a time...
I think thanking him would be a great idea. You'll probably make his day.
Kelly
Please note: I AM NOT A DOCTOR. If you want medical advice, talk to your doctor. Whatever I post, there is probably some surgeon or other health care provider somewhere that disagrees with me. If you want to know what your surgeon thinks, then ask him or her. Check out my blog.
I had a similar experience and I know that there ARE a lot of excellent surgeons out there. I think my surgeon did a great job of providing information (the only thing she did NOT tell me was how low the percentage was of people who dump... she warned that not everyone would, and that there was no way to know ahead of time, but she didn't tell me it was only about 30%). She has also always been very good about providing more detailed information to patients with the ability to understand a more detailed explanation (the challenge was to let her know that I wanted and could understand more detailed answers).
I am always amazed at how little some people are told about the surgery before they consent to it. Before I came here, I just assumed that everyone was given at least similar info to what I received, but clearly that is not the case.
Lora
I am always amazed at how little some people are told about the surgery before they consent to it. Before I came here, I just assumed that everyone was given at least similar info to what I received, but clearly that is not the case.
Lora
14 years out; 190 pounds lost, 165 pound loss maintained
You don't drown by falling in the water. You drown by staying there.
100% agree with you.
In the 1980s, my husband suffered from debilitating cluster headaches. They were horrible and very disruptive to our lives and his job when they occurred. He was referred to a neurologist and was prescribed several meds. The doctor told him to be aware that one med would cause him to have dreams. So if he began dreaming about pink elephants (his exact words) , he would know why. That bothered my husband, so he decided to not take the med. At least the doctor warned him. His cluster headaches went on for a several years. Then after a series of really bad ones and trips to the ER, WE found the cause.
My husband is extremely sensitive to vitamins....extremely . Unbeknown to me, he was taking large doses of vitamin C. He has always had the idea if 1 is good 2 are better. One night while he was in the midst of a horrible headache. I asked him if he was doing/taking anything. zI asked about his vitamins. He told me the thought had come to him that maybe it was something like that. I told him to stop taking everything. He discontinued all vitamins, and to this day, he has never had a cluster headache again.
Then in 1998 he began taking Total Greens. It is a green mega vitamin for "optimum" thyroid and metabolic health. He began losing lots of weight. His doctor found a growth on his thyroid. When he had the nuclear scan, the radiologist just happened to ask him if he was taking anything. He told him only that particular vitamin. When he described the vitamin, the doctor said he had seen this before in patients who take vitamins, and he told him to stop taking the vitamin. He did, and sure enough the growth disappeared. So in this case it was vitamins again, but the radiologist recognized it.
So after my rambling, what I am saying is doctors do not know every single, itsy bitsy thing about our lives and should therefore give us the absolute maximum information possible when treating us. Now I recognice in the case of cancer screening, etc., there is the right time to divulge facts, but as adults we have the right to know what potentially affects our bodies and lives.
In the 1980s, my husband suffered from debilitating cluster headaches. They were horrible and very disruptive to our lives and his job when they occurred. He was referred to a neurologist and was prescribed several meds. The doctor told him to be aware that one med would cause him to have dreams. So if he began dreaming about pink elephants (his exact words) , he would know why. That bothered my husband, so he decided to not take the med. At least the doctor warned him. His cluster headaches went on for a several years. Then after a series of really bad ones and trips to the ER, WE found the cause.
My husband is extremely sensitive to vitamins....extremely . Unbeknown to me, he was taking large doses of vitamin C. He has always had the idea if 1 is good 2 are better. One night while he was in the midst of a horrible headache. I asked him if he was doing/taking anything. zI asked about his vitamins. He told me the thought had come to him that maybe it was something like that. I told him to stop taking everything. He discontinued all vitamins, and to this day, he has never had a cluster headache again.
Then in 1998 he began taking Total Greens. It is a green mega vitamin for "optimum" thyroid and metabolic health. He began losing lots of weight. His doctor found a growth on his thyroid. When he had the nuclear scan, the radiologist just happened to ask him if he was taking anything. He told him only that particular vitamin. When he described the vitamin, the doctor said he had seen this before in patients who take vitamins, and he told him to stop taking the vitamin. He did, and sure enough the growth disappeared. So in this case it was vitamins again, but the radiologist recognized it.
So after my rambling, what I am saying is doctors do not know every single, itsy bitsy thing about our lives and should therefore give us the absolute maximum information possible when treating us. Now I recognice in the case of cancer screening, etc., there is the right time to divulge facts, but as adults we have the right to know what potentially affects our bodies and lives.
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