Jeesus... I'm really, really glad I'm not one of your patients. I understand
how someone might not be able to keep up with all the literature about this
or that medication or procedure, but to be so totally lacking in
understanding of the real costs and problems of the healthcare profession by
someone who claims to be a physician is truly beyond belief.

--
"j" ganz @@
www.sailnow.com

"Maxprop" wrote in message
nk.net...

"Donal" wrote in message

You all have an inflated view of your knowledge. Most of you seem to
think
that it is acceptable to take a guess. I'd like to give you a wake-up
call.
If you are not 100% certain, then you should admit that you don't know.
Your confidence is somebody's bereavement.

I really didn't care to get into this discussion, but it's obvious you
have absolutely no concept of how medicine is practiced. 100% certainty
is exceedingly rare in medicine, as in virtually anything where the human
body and mind are concerned.

Example: A patient comes to me with a painful, red eye. I can generally
determine from signs and symptoms whether it is an infection, or from some
other cause. Say, for example, that it's an infection. Once again via
signs and symptoms I can usually determine if the causative organism is
viral, bacterial, or parasitic. If viral, I'll prescribe an antibiotic
prophylactically (viruses tear up tissue like a rototiller through a
garden) and advise palliative measures. If a bacterial or parasitic
infection, I may culture it, if it is severely acute, and prescribe a
broad-spectrum antibiotic. If subacute, I'll simply prescribe an
appropriate antibiotic regimen and have the patient return in a day or so.
The reason is simple--if one waits until the results from a culture and
sensitivity return from the lab, one of three possible outcomes will have
occurred: 1) the eye will have gotten worse, 2) the infection will be
unchanged, and 3) the eye will have gotten better on its own. The first
two are unacceptable, so an antibiotic is prescribed as a matter of
routine. And 95% of the time, the antibiotic will clear up the infection.
I can't recall the last time I had a patient return with an infection that
failed to respond to what I prescribed. Yes, it has happened, but rarely.
The point is, most medicine is practiced in a similar manner,
i.e.--without knowing 100% of the facts. But that professional knowledge
you seem to have no respect for actually allows us to make a very educated
guess, and far more often than not, it is the correct one.

Another example: A patient presents with abdominal pain. The
differential diagnosis points to, say, two possibilities: a simple
irritation to the bowel from some unknown causative agent (toxin,
hypersensitivity to something ingested, etc.) or perhaps, say, an
infectious agent of some sort, like an enteric virus. So the doctor
prescribes something to make the patient feel better along with something
to neutralize the irritant or kill the infective agent. 90% or better of
patient will be treated successfully by this method. But say, for the
sake of discussion, that the patient has a bowel obstruction, a
potentially fatal condition, and that the physician missed the diagnosis.
When 8 hours or less pass and the patient is still suffering, he will call
the doctor who will then order further testing, such as lower-GI X-rays
and/or and of a number of scans, bloodwork, and further physical
examination. So why, you'll no doubt ask, did he NOT order them in the
first place? Because of cost, plain and simple. To order such tests on
every patient that walks through the door with a belly ache would bankrupt
the third party carriers overnight, or at least end medical insurance
coverage as we know it. Such tests aren't generally needed by competent
clinicians with good differential diagnostic skills for routine belly
aches. And in most cases the patient won't expire before the necessary
tests are done. Occasionally doctors misread the symptoms and signs and
miss the keys that might have saved a patient's life. That is medicine in
a nutshell--it isn't perfect. As I said before, it's an inexact art. A
physician's confidence in his knowledge is his #1 tool in the diagnosis
and management of illness. Many tout technology as the savior of the
human race, w/r/t medicine, but without doctors with good diagnostic
skills, technology is useless.

Another aspect to this is that if tort reform or some sort judicial review
of medical malpractice cases does not become reality, the day might
arrive when a physician must order up every possible test for every
sniffle and belly ache that comes through his door in order to keep his
ass out of court. In that event, health care will reach astronomical cost
points, possibly hundreds of times what it costs today. And it will NOT
be any more effective in saving lives than it is now, only more expensive.

It's really your choice. Do you want reasonable health care costs, or do
you want 100% assurance that nothing is ever missed? You can't have both.

Do you have 100% assurance that every time you board an airliner you will
reach your destination alive? Do you have 100% assurance that your next
trip to the park with the kiddies won't result in a random, drive-by
shooting, killing your or your child? Do you have 100% assurance that
when you buy a bottle of Tylenol that one of the capsules won't be filled
with cyanide? Of course you don't. But the odds are overwhelmingly in
your favor for a favorable outcome. The same is true with medicine,
despite what the yellow journalistic anti-medicine press and websites
wrongly profess.

Max