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Re: Practice philosophies, was JW and Blood refusal LONG From: Garry Siegel (garrys@mindspring.com) Wed Jan 10 11:35:06 2001 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: J D Stewart,MD: "Fetal Intestinal obstruction at 31 weeks-" Previous message: ainsron@msn.com: "Re: flying" In reply to: Richard Chudacoff, MD: "Re: Practice philosophies, was JW and Blood refusal LONG" Next in thread: Eberhard W Lisse: "Re: Practice philosophies, was JW and Blood refusal LONG" 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. snipped >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 > snipped > >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 > What a good thread and good comments by Kevin and Richard. FWIW, Art's comment about not being reimbursed for education rings true--i.e. it may be easier to just say "hit the road" or "sign this refusal" than to educate when the ultimate outcome (the patient is still going to do what she wants) isn't in doubt. Kevin, I like what you said with respect to your "professionals" comment, and that you've (all of us) studied for years and know more than the patients. You do, but the real beauty of being a good physician (that means teacher)is combining your clearly superior knowledge and experience with your good listening and people skills in order to practice. Add to that a dash of self preservation, be it documented disclaimers a la Richard (that's what I do) or signed disclaimers as you do (seems a bit strong to me, but I would rather have that piece of paper if ever challenged), and there you are. Most importantly, we have do to what we think is best for the patients and what we can live with, and hopefully those two goals are in agreement. You can't please all of the people all of the time, either. Garry BTW, business is pretty good, but not *that* good, so we don't kick folks out if they decline voluntary HIV testing when pregnant. We do tell everyone that it is recommended, not required. -- Garry E. Siegel, M.D., F.A.C.O.G. Roswell, GA Private Practice Next message: J D Stewart,MD: "Fetal Intestinal obstruction at 31 weeks-" Previous message: ainsron@msn.com: "Re: flying" In reply to: Richard Chudacoff, MD: "Re: Practice philosophies, was JW and Blood refusal LONG" Next in thread: Eberhard W Lisse: "Re: Practice philosophies, was JW and Blood refusal LONG"

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