Monday, January 09, 2006

Political Medicine

Medicine has become increasingly politicized in recent years. We see this primarily in the medical malpractice issue, the regulations for medical professionals to contact authorities if abuse or addictions are suspected, and gender-related access to health care, privacy, and medications.

During the campaign season of the last two congressional election years I sat in doctor’s waiting rooms or offices and was taken aback to see political materials, in support of specific candidates, on the walls. In one case the doctor had a campaign brochure tucked under the glass on top of his desk, and facing the patient’s chair. I supported some of these same candidates myself but I found it somewhat alarming. I wondered if the care I received would differ if I said I supported another candidate. In health care matters, and in other professional encounters that could dramatically affect my personal life, I’d prefer that things remain on a nonpartisan basis. It bothers me.

Doctors are required to report suspected child abuse. This is good. Doctors report patients who indicate they have a drinking problem and their driver’s licenses can be revoked on a doctor’s report. I see this as a good thing, too. However, even though neither of these factors apply to me, there are things I don’t say, or downplay, when talking with my doctor, especially when discussing my family medical history, and this could, theoretically, affect their diagnoses in some cases. But I don’t want some information going to my health insurance company. I just don’t trust them and there are significant chinks in the doctor / patient confidentiality pact these days.

I stopped patronizing a local pharmacy years ago when they refused to fill a prescription for prenatal vitamins and told me to buy an over the counter version instead. I went to another pharmacy and the prescription was filled with no problems. I always think of this when there is a discussion of whether or not pharmacists can refuse to fill a prescription based on their religious beliefs. Things like that already happen, and it’s not good.

Alan Sandals has released an ad that illustrates some of these issues. You can see it here. Don’t think this is an exaggeration. In one of my pregnancies there was some indication of a potential problem. Mr. J and I decided against advanced and somewhat risky tests to make a final determination. The docs drilled me about this on every subsequent prenatal visit for the rest of the pregnancy. However, they forgot to tell me I had an iron deficiency until it was too late to take the supplements to correct it. I guess people don’t sue for that. There were definitely more people in that room than just the doctor and me; I think several lawyers and some insurance company executives were in the room, too. In a more literal sense, one of my children was born after an emergency c-section. There were very few surgeries of this nature done at night at this hospital so the doctor allowed 10 or more other people into the room to observe since they seldom got to see the procedure done. No one asked my permission or Mr. J.’s. I’m splayed out like a holiday turkey and a whole slew of strangers are there for continuing education or entertainment. They were not medically necessary. Let’s see something like that happen during a vasectomy or prostate surgery.


ACM said...

I’m splayed out like a holiday turkey and a whole slew of strangers are there for continuing education or entertainment. They were not medically necessary. Let’s see something like that happen during a vasectomy or prostate surgery.

I'm 100% sure that people sit in on any surgery or procedure that is unusual or that takes place in a hospital. Those observers may not be "medically necessary" to your outcome, but they are necessary if you want there to be trained doctors available when your daughter needs a c-section. Nobody learns to be a surgeon (or any other kind of doctor) without getting to watch, and eventually do, every procedure many times.

I sympathize with your desire for greater privacy in all such matters, but the need for medical training (of new doctors, or of old doctors in new procedures) means that we have to find a balance between best care (and privacy) and opportunities for the trainees. We all benefit in the long run, although there are inevitable risks (and indignities) along the way.

albert said...

i've always wondered how people end up on the table in those "Operating Theaters" do you sign a waiver allowing the crowd? do they just knock you out and wheel you in?

would you have consented to have those people present if asked?

and having candidates' material facing a patient's chair seems more than a tad unethical. downright weird. anything to make the patient uncomfortable shouldn't be there in my opinion. that is, unless you're very openly chummy with the doc and s/he has something that may be of interest to you based on past discussions.

AboveAvgJane said...

acm, I think one of the reasons the night crew seldom saw a c-section was that most are scheduled during the day. If the hospital were truly interested in making sure everyone got to see every procedure, they should schedule some at night. Then they could take the time to explain to the people involved who is observing and why. If a c-section is planned there is a greater concern for the personal privacy of the patient, with draperies not only for modesty but also to keep the surgeon focused on the exact area of the surgery. It was also the doctor's first day at that hospital and the additional audience might have provided a greater than usual distraction to her. Most of all, I just wish someone would have asked or at least told us. We didn't know why all those people were there until it was nearly over.

AboveAvgJane said...

Albert, in one or two cases when I've been having a regular check up a doctor has said a student was shadowing him or her in the office that day and would I mind if the student sat in on the exam or did a little poking and prodding for practice. I've always consented. But sure is nice to be asked.

The campaign brochure on the doctor's desk really did bother me. I voted for that candidate but didn't like the aggressive way it was displayed.

LVDem said...

Yeah, a simple request would have been nice. I had surgery a few years ago and the Dr asked if a couple of med students could sit in. I had no problem, but I could see where you would be bit miffed if he didn't ask.