> Sonja van Baardwijk-Holten wrote:
> >Deborah Harrell wrote:
> >>Sonja van Baardwijk-Holten wrote:
> >>I've found that the weakest link in treatment is
> >>always the patient.
> >>I've been a patient on a number of occasions and
> >>have more then once
> >>found that a lot of physicians rellish that feel
> >> of being a god in white.
> >Hmm, I wasn't actually thinking of the patient as a
> >link in the _delivery_ of healthcare, but certainly
> >the patient is a link in the _consumption_ of
> >healthcare. And it's true that a patient who does
> >ot participate in their own care weakens the
> >effectiveness of treatment.
> What about the issue that you get new carers all the
> time while in
> hospital. One doctor that doesn't trust the opinion
> of another and runs
> all his own tests just to be on the safe side or
> just because results
> were done to different standards then his.
<sniplet>
> In Germany...
> the land of the specialist treatment. Never known my
> mom to go to a
> general practitioner, if they at all exist in
> Germany that is.
There is technically one doctor in charge of a patient
while in-hospital, and any others are consultants who
offer opinions, but usually do not write their own
orders unless they have discussed it with the
admitting doc. Exceptions are very complex cases as
in the ICU; then specialists or consultants will
usually write their own orders. However, many
hospitals here have de facto 'gatekeeper' personnel
who would notice repeated expensive tests, and speak
to the offender(s) about unnecessary costs. And when
doctors disagree about the handling of a case, it is
usually in polite terms...until somebody gets *really*
hacked off. When that happens, we call it 'chart
wars,' and lawyers love to have such documentation,
should the case wind up in a malpractice suit...
HMOs are big on having a 'primary provider' (no,
that's not one of the bettors of quatloos on whether
Jim Kirk will beat his drill-thrall, that is what they
have labeled physicians in primary care: family
practice, GP {which hardly exists anymore},
pediatrics, internal medicine, GYN, and geriatrics)
who is supposed to coordinate care and prevent overuse
of specialists. I actually don't object to the
concept, but when it is corrupted by adding financial
incentives to keep a person from seeing a specialist,
or the primary physician doesn't have enough scheduled
time to do a full work-up (even though s/he knows how
to handle the problem/investigation), the patient is
not served well.
> >Twenty or thirty years ago I'd agree with you that
> >many (probably most) doctors took the paternalistic
> >view, and basically dictated what the patient was
> >to do.... <sniplets>
> >In very rural and 'backwards' areas....there is
> >still quite a lot of that 'godlike' approach, but
> >even there it is slowly eroding....
> Most elderly still are too polite imo....In
> Belgium the physician still is the god in white. I
> gave one of them a
> real scare when I started asking all them pesky
> questions...
How dare *you* - a women as well! - question a learned
professional?! Whose body is it, anyway?!
<evil smirk>
> The other physician tried to convince me that I
> needed to go on a diet
> urgently or else.... I did 5 times a 1 km swimming
> session a week plus
> two very intense sessions of badminton each week at
> that time. He was
> sitting acros me with his belly draped over his
> trousers....
<snort> Thread crossover into Hypocrisy!
> >I....have a British client who, after working in
> >the US for 3 years, is _still_ surprised....
> >that, as a woman, she can -without offense- give
> >orders to many of the men in her firm, yet....
> >back in GB, "I'd have a riot on my hands!"
> Yep, you have to be 'one of the lads' to be able to
> commandeer them
> around....So I adjust....I'm
> usually the other lad, stick my hands out of my
> sleeves to shift my
> weight and we get along just fine after the initial
> stuttering. ;o)
<grin> I actually _did_ know one gastroenterologist
who got away with the 'dainty' approach: she had the
presence of Julie Andrews at her most elegant, and I
never saw her challenged by student or colleague in
any but the most polite and respectful way...the rest
of us just projected 'brass ovaries.' ;D
Debbi
Molly Mule Maru UU ;)
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