Re: Practice philosophies, was JW and Blood refusal LONG
From: art fougner, md (evsono@pipeline.com)
Wed Jan 10 09:24:02 2001
pity the reimbursement rate for education is somewhat less than ample.
art
At Wed, 10 Jan 2001, Richard Chudacoff, MD wrote:
>
>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
>
--
art fougner, md
A series of 1000 cases begins with but a single anecdote.
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