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Practice philosophies, was JW and Blood refusal LONGFrom: K Dew (kdew@bellsouth.net)Wed Jan 10 04:21:07 2001
I have my patients who refuse mammograms sign a statement outlining their refusal every time they have an annual exam. If I have a patient who uses drugs, I tell them I will randomly test them and if the test comes back positive, they have one week to get into a treatment program or else they will be released. I have them sign a statement agreeing to this. If I have a patient who refuses treatment of any type, I have them sign a statement something like "Dr. Dew wants me to take this course of treatment and I refuse", similar to the one I have patients sign who refuse the triple test ALL of my pregnant patients are tested for HIV, no exceptions. If they refuse, I send them on their way. Likewise, all are tested for syphilis, GC and CT at the first visit. I deliver 25-30 patients per month. I pick up 4-5 CT per month, fully 50% are in "stable" relationships. Patients who insist on using "natural" estrogens/hormones whatever you want to call them are okay by me but they must sign a statement that I have that states that these "medicines" are not regulated therefore yada yada may be unpredictable in potency and content. Also there is no literature about them that is anywhere near as compelling as that concerning "man-made" hormones, therefore benefit to bone/anti-stroke/anti-heart attack/anti hot-flashes is uncertain Paternalistic? hell no! I have spent years studying my craft. I know a heck of a lot more about what I'm doing than they do. Patients don't argue with their heating-air-conditioning person about what they do, they don't argue with their auto-repair person or plumber because "they are trusted professionals", by golly, I'm a trusted professional too. If patients don't like what I have to say they can agree to disagree with me and accept responsibility for this or they can find another MD Kevin
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