| As physicians, we all strive to practice good | | | | request from the patient. Often the request is |
| medicine. Good medicine means evidence based | | | | granted even though it might not be the best |
| medicine in the patient's best interests. In the ideal | | | | treatment for the patient. Some studies have |
| world this will make patients happy and satisfied. | | | | shown that the perception of the quality of care |
| If you are getting the best treatment for your | | | | improves once the request is granted. |
| condition you should be happy, right? | | | | Some hospitals and clinics are even trying to |
| In the real world, though, keeping patients or their | | | | improve patient satisfactions scores by adjusting |
| families' happy and practicing good medicine might | | | | the physician's compensation and bonuses based |
| not be possible at the same time. This is true for | | | | on the patient satisfaction. Does that encourage |
| both inpatient and outpatient physicians. | | | | physicians to do what the patient wants and not |
| A recent experience that one of my partners had | | | | what the patient really needs? |
| to go through demonstrates the point. The | | | | A study published in the Archives of Internal |
| patient in his mid 80's came with a massive heart | | | | Medicine demonstrated that the request for |
| attack. He had a heart attack at home and, | | | | antidepressant prescription is much more likely to |
| unfortunately, wasn't found until later. He | | | | be granted if the patient asks for the medication |
| developed muscle breakdown that affected his | | | | directly or indirectly. In many cases these |
| kidneys. He had to be started on continuous | | | | prescriptions would be considered unnecessary or |
| dialysis. | | | | even inappropriate by the current practice |
| Despite aggressive medical management, his | | | | guidelines. |
| condition had progressively deteriorated. The blood | | | | Any physician ever practicing outpatient primary |
| pressure remained low despite the high doses of | | | | care knows that patients often expect to be |
| medications. All major organs started to shut | | | | given antibiotics for upper respiratory symptoms, |
| down. The patient was dying. | | | | even though, viral infection is the culprit in more |
| When his condition suddenly deteriorated and he | | | | than 90% of cases. You might say: "What's a big |
| developed a fatal arrhythmia, the responding | | | | deal if the patient takes antibiotics for a few |
| physician refused to escalate care and suggested | | | | days? Even if unnecessary, it might make the |
| to the family that comfort care was more | | | | patient feel like he is actually being treated." |
| appropriate in his case. | | | | Now, imagine on the national level how much |
| The family was unable to make a decision, | | | | wasteful cost it adds to medical care. The |
| insisting on providing futile care. Subsequently, | | | | patients are being exposed to unnecessary risks |
| they became angry with the physician and | | | | of antibiotics. Antimicrobial sensitivity will be altered |
| complained to the hospital administration. This | | | | in the community with emergence of drug |
| caused the physician emotional distress and an | | | | resistant pathogens. |
| unnecessary headache. The refusal to provide | | | | The bottom line is - practicing good medicine and |
| futile care lead to a very unhappy family yet it | | | | having satisfied patients often means performing |
| was the right thing to do. It was the right thing | | | | a balancing act on the part of inpatient and |
| for the patient. | | | | outpatient physicians. The silver lining, according to |
| Things might not be as dramatic in the outpatient | | | | the study mentioned earlier, is that effective |
| world, yet the problem, probably, exists on an | | | | communication with the patient is shown to |
| even bigger scale. Studies have shown that | | | | improve satisfaction even when the specific |
| physicians are more likely to prescribe medications | | | | requests are not being granted. |
| and order tests when confronted with a specific | | | | |