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Re: Practice philosophies, was JW and Blood refusal LONG From: Richard Chudacoff, MD (rchudacoff@mylinuxisp.com) Wed Jan 10 07:48:14 2001 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: art fougner, md: "Re: Hypophosphatasia and pregnancy" Previous message: K Dew: "Practice philosophies, was JW and Blood refusal LONG" In reply to: K Dew: "Practice philosophies, was JW and Blood refusal LONG" Next in thread: art fougner, md: "Re: Practice philosophies, was JW and Blood refusal LONG" Reply: art fougner, md: "Re: Practice philosophies, was JW and Blood refusal LONG" Reply: Garry Siegel: "Re: Practice philosophies, was JW and Blood refusal LONG" I take a little bit different approach. My feeling is that I am here to educate, of which I spend a lot of time doing, to consult, to offer options to therapies and treatments, and to discuss the consequences of the options of therapies and treatments. I document well about these discussions. But, I do not make the decisions for my patients, since I do not live with the results of those decisions. Best part of treating adults is that they ARE responsible for their decisions. For example: I have a patient who was pregnant and smoked a pack a day. She was counseled fully regarding the risks of smoking in pregnancy including abruption, PTL, PROM, IUGR and IUFD. She did abrupt at 26 weeks and this resulted in fetal demise. From 8 weeks on I counseled her about the risks, gave her literature, and advised her to quit smoking, making Zyban available and referring her to smoking cessation classes. She rolled the dice. She lost. She learned (perhaps.) Good judgment is based on experience. Experience is based on bad judgment. She had an experience. I lost no sleep. If patients want to take 'natural' hormones, refuse studies, or refuse to follow recognized standards of care, I don't argue nor get upset. I explain the lack of studies, and that I cannot be responsible for adverse outcomes on therapy I do not recommend and have no data to support their use. I offer them the option to seek other, more accommodating practitioners, and have no regrets when these people leave my practice. Above all, I document these discussions, adding that a patient is aware of options, consequences and takes responsibility for action against my medical advice. I sleep better, too. -- Richard Chudacoff, MD -----Original Message----- From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net]On Behalf Of K Dew Sent: Wednesday, January 10, 2001 5:22 AM To: Multiple recipients of list OB-GYN-L Subject: Practice philosophies, was JW and Blood refusal LONG 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 Next message: art fougner, md: "Re: Hypophosphatasia and pregnancy" Previous message: K Dew: "Practice philosophies, was JW and Blood refusal LONG" In reply to: K Dew: "Practice philosophies, was JW and Blood refusal LONG" Next in thread: art fougner, md: "Re: Practice philosophies, was JW and Blood refusal LONG" Reply: art fougner, md: "Re: Practice philosophies, was JW and Blood refusal LONG" Reply: Garry Siegel: "Re: Practice philosophies, was JW and Blood refusal LONG"

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