Re: Practice philosophies, was JW and Blood refusal LONG
From: art fougner, md (evsono@pipeline.com)
Wed Jan 10 14:22:18 2001
el -
your local incidence of breast cancer is low?
you don't feel mammography is effective as a screening tool?
you're havin a bad day?
all of the above?
art
At Wed, 10 Jan 2001, Eberhard W Lisse wrote:
>
>Kevin,
>
>In message <LOBBLHDGJEPNIJEICNFLOEDLDMAA.kdew@bellsouth.net>, "K Dew" writes:
>
>> I have my patients who refuse mammograms sign a statement outlining
>> their refusal every time they have an annual exam.
>
>Unnecessary testing.
>
>> If I have a patient who uses drugs,
>
>How do you determine tis?
>
>> 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.
>
>Tests without indication, invasive and involuntary or at best coerced
>consent. Assault and Battery.
>
>> 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.
>
>Invalid. Hardly informed consent.
>
>> ALL of my pregnant patients are tested for HIV, no exceptions.
>
>Assault. In violation of all ethics codes known to man.
>
>And, unnecessary.
>
>> If they refuse, I send them on their way.
>
>Desertion of the patient.
>
>> Likewise, all are tested for syphilis, GC and CT at the first visit.
>
>Tests for syphillis are very common, but still informed, voluntary
>consent is required. How do you test for GC?
>
>> I deliver 25-30 patients per month. I pick up 4-5 CT per month,
>> fully 50% are in "stable" relationships.
>
>Doe they want to be picked up? (Pardon the pun :-)-O)
>
>> 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
>
>Why? Why not just refuse to prescribe it?
>
>> Paternalistic? hell no!
>
>Yeah, right!
>
>> I have spent years studying my craft. I know a heck of a lot more
>> about what I'm doing than they do.
>
>This is debateable, but you didn't take Assault 101.
>
>> 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.
>
>But do they perform assault and battery on them?
>
>> 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
>
>Great choice that is.
>
>My personal oponion of the above is printeable but would consitutue
>crimen injuria.
>
>I can only hope that your patients sue you for all you are worth. And
>some enterprising ambulance chaser reading this goes after a few of
>your patients and through the kangaroo court system takes your Golf
>and Country Club membership away.
>
>greetings, el
>+
--
art fougner, md
A series of 1000 cases begins with but a single anecdote.
