• N&PD Moderators: Skorpio

Medical Elitism: Perscriptions and the Patients choice of treatment

auto238367

Ex-Bluelighter
Joined
Aug 2, 2008
Messages
1,094
Why do we still tolerate the elitism of the medical institution in respect to the way doctors prescribe treatment and patience pretty much accept it or leave? Why have we not moved beyond elite medical professionals who are the only people that can choose proper treatment, instead of the patient working with a health professional to live better through chemistry? Do the restrictions on medication negatively impact the lives of legitimate patients in order to mitigate abuse?

* Note I realize that this may not be the place for this, but I can't think of a better one, and didn't want to start this off in a worse one...
 
Sociologists call this reification. The majority of primitive humans accept for a fact that a doctor is the ultimate authority on medicine (and in non-western cultures, on several other things). The medical institution is, along with the court, the most socially-influential of all institutions. After all, it gets the final say in what's real and what is not by drawing the line between schizophrenia and creativity. If, for example, a scientist is labelled schizophrenic by medicine, his findings will likely go unnoticed by most for hundreds of years, even if he had uncovered a huge secret of the universe. If a police man was labelled schizophrenic by medicine, then the court will deem him inappropriate, even if he was that close to capturing a serial arsonist. If medicine deems a prime minister schizophrenic, then he will likely not be PM for too long. These examples and countless others serve to demonstrate that medicine trumps pretty much every other institution.

We tend to underestimate just how much power we give to that institution.
 
Because a doctor is more knowledgeable and infinitely more objective than a patient. That's not to say that there shouldn't be an active discourse between doctor and patient when it comes to exploring possibities and discovering the best path to treatment, but at the end of the day, one of those people has spent the better part of a decade (or more) studying and gaining an expertise in medicine, and it isn't the patient.
 
At least where I come from, patients get all possible treatments presented (including advantages AND disadvantages of each method) and are free to choose themselves what is going to be done. Exceptions include experimental methods, which are not evaluated thoroughly enough. It is considered as a flaw if a physician does not explain all doable possibilities.
This approach is implemented in the jurisdiction of my country, IIRC, and is not just some kinda 'moral standard'.

Either I understood your question wrong or there's just no point in it... Dunno.

Peace! Murphy
 
Because a doctor is more knowledgeable and infinitely more objective than a patient.

Yep!Tough the main part of the people know something about medicine, they still can´t understand the reason for most of their illnesses. Therefore the relationship between the all-knowing shaman and the utterly dependent patient has something mystical to it.

auto238367 said:
Do the restrictions on medication negatively impact the lives of legitimate patients in order to mitigate abuse?
I don´t think so. Not every one who´s got some kind of illness has the mental ability to chose the right medication. Nevertheless your doctor discusses all options with you and at the end you can decide. And if you really need a restricted drug, you will get it in most of the cases(i can only reflect on german doctors, which have an extremely difficult and exhausting education). Imho it would be much more dangerous to leave the decision whether to take that high-potent-XXXXXXX- medicin or not to the patient or some "health professional"(what´s that?). Whereas the doctor should have dealt with it in his education, and has empirical knowledge.

Would you say, that less restriction of abusable meds would improve the lives of "legitimate(who´s that?)" patients ?
 
Because a doctor is more knowledgeable and infinitely more objective than a patient


So is an engineer, a mechanic, a plumber, a electrtican, ect, but people are still allowed to with almost free reign tinker and make gadgets, modify and repair their own car, repair or modify their own home, ect.

why not your own body? I can go out right now and do some pretty damn stupid mods to my motorcycle that would likley leave me as a red stain on the pavement if I rode it after, but I wont do it because I dont want to die. But still, no one is saying I need a mechanic to write down what size wrench I need to buy, and exactly how many turns to use it on a bolt, exactly how often are they?

Should be the same with my own body. I should be able to consult an expert if I want. (and I probably would) but in the end, it should be up to me.
 
rangrz said:
So is an engineer, a mechanic, a plumber, a electrtican, ect, but people are still allowed to with almost free reign tinker and make gadgets, modify and repair their own car, repair or modify their own home, ect.

This is not intended to be flaming, but this statement is complete nonsense. You can't compare these professions with modern medicine, neither with respect to the complexity of the subject nor with respect to the immediate implications on the health of a person. It's just stupid.

And to relativize your comparison with the motorbike to a certain degree: At least in my country your are not allowed to modify only a single screw at your vehicle and then to hit the street, before there wasn't a mechanic who checked the mod... I know that this is probably different in the US and other countries. The point is that as soon as it comes to potential harm either to you or your environment, people should not be allowed to freely choose their options. It will always be a subjectively driven choice. I think that most remedies that need prescription do so for a good purpose!

Peace! Murphy
 
^ I think that some people might think of a car or motorcycle as more complex (ironically!), whereas the human body is simpler to them. Add that to the fact that there's an ad for some medicine to cure your body ills on TV every 10 seconds, and you have a recipe for disaster if people are allowed to prescribe themselves. And when you add the chance of dangerous interactions when people start adding more and more medicines, things get bad. People just want a quick fix, and use a medicine for that. But if they have a bad reaction (because they mixed it with stuff they shouldn't have, took too much, etc) then they blame the pharmaceutical company for making their product 'dangerous'.
 
MC: here at least, once you got the bike/car plated, you can go crazy with mods and hit the streets...if its obviously dangerous, a cop will pull you over and ticket, but if its not, they wont.

and I think an engineer is just as complex as a medical doctor. As is the engineer, say designing the breaking system on a high end vehicle, which you then modify for whatever reasons, and is not longer done by a professional.

at the end of the day, its my body...I should be able to harm if it I want to take the risk of doing so.

Doctors aint magic...I go to walk in clinic, no file on record, have a doctor look at me for 10 minutes and RX me a very generic, common, broad spectrum antibio after asking if I am allergic to that drug or that class of drugs.

this is not quite the same as brain surgery, and I am confidant I could that for my self as well as he did.
 
^ if people could prescribe themselves antibiotics, many many many people would, even when they don't have a bacterial infection. as it is antibiotics are prescribed by doctors too often for simple viral infections, and partly they do this because the patient DEMANDS antibiotics. this would lead to exacerbating the problem of bacterial resistances, at which point it becomes a harm to all of society, and even the world. at this point, it is no longer simply hurting yourself, and you do not have the right to hurt other people with your carelessness.

doctors are there to determine which medicine, if any, is appropriate for your situation. that is why they go to medical school for so long. they have to figure out your illness based on your symptoms (diseases have themes, but do not display the same symptoms exactly the same in every person), and then choose which medicine is appropriate (some antibiotics work better on gram negative bacteria vs gram positive).

i suppose, technically people have the capacity to figure out what's wrong with them, and dose themselves with the information readily available on the internet. but most people don't have the responsibility to do so appropriately, and so i think its a right that they don't deserve. besides, i really don't think its a big deal going to the doctor, and if they aren't willing to listen to you or work with you, then find another doctor. there's more than plenty of doctors willing to work with patients in this world.
 
The point is that as soon as it comes to potential harm either to you or your environment, people should not be allowed to freely choose their options.

Peace! Murphy

This is absolute non-sense. If you are not allowed to make a bad decision then it is no longer true freedom. Ultimately you should always be free to harm yourself in any form you deem acceptable. The role of government should be to ensure consumers are fully informed about the potential harm that may come about by their decision to use a particular treatment product and to ensure it meets QA standards.

Murphy you line of logic above is the crux of the drug prohibitionist stance, that these drugs must be controlled because they can 'harm' the user who is too infantile and stupid to make informed decisions on his own.

Sturnam, although doctors do attend years of education that does not mean they are a better source of treatment than you are. Just think how many times they 'get it wrong'. Most doctors are useful for their clinical experience in diagnosis, IE taking general symptoms and narrowing it to a specifically labeled disorder (often incorrectly I might add). The sad truth is that few doctors understand the mechanism of treatment and because of their patient volume and constant influx of new customers they probably never will take the time to understand that treatments method of action. This is why almost all medical treatment today is pharmacologically based, its much easier to send someone home on drugs than to get a true understanding of a complex problem and its variable solutions. However the patient with a serious interest vested in his health will take this time if his mental abilities permit.

Now you do have a valid point about antibiotics but the truth is that the vast majority of people who are economically endowed will always seek professional treatment, while those who do not have the money will suffer because they cannot afford to have a doctor point out the obvious to them. Allowing individuals to perscribe themselves medications would be a minimal problem IMO, but it is impossible for either of us to speculate because it is a complex phenomenon based on alot of social variables. Ultimately I feel it is better to risk the antibiotics scenario than to perpetuate the current situation where the poor die when they could live for they lack the money to consult doctors when they know what is needed.

I personally do not believe many doctors are willing to work with you. Do you have any idea how difficult it is to get proper pain management by being honest with a US based doctor? How impossible it is for someone with minor anxiety or sleep issue to get benzo, etc the list goes on. Doctors primary concerns are economic, secondary are your health. Yes I believe we put far too much faith in the medical institution in our society, particularly the pseudo science of psychiatry as jamyshad had pointed out.
 
Most doctors in the US are glorified pharmaceutical sales representatives. They don't usually give you any options for treatment either, especially when it comes to prescription drugs. They tell you what you have to take, and you have to try it for a while and then they might be so nice as to switch you to a different prescription when you say that one isn't working right. I've never heard of a doctor in the US asking their newly diagnosed ADHD patient, "There, so, I've laid out all your options for you and explained the possible benefits and downsides of each in detail. Do you want me to write you a prescription for Adderall, Dexedrine, Desoxyn, Ritalin, Focalin, Vyvanse, or Wellbutrin? Or just try one of the diets I compiled here for you: Diet A, Diet B, Diet C, or Diet D?"

Physicians seem very authoritative and pretentious in the USA.
 
Are you guys aware how straightforward the MCAT's are? I would imagine that many people here would not have too much difficultly scoring above a 36...

And while this may be entirely irrelevant, keep in mind that many of these physicians are not highly paid.

If I went to med school only to end up listening to kids complaining about their ADHD (or women complaining about their fibromyalgia --- yes I said it!), I would also be pretty pissed off.

It must really suck to be psychiatrist or pain management physician...
 
Last edited:
well it´s obvious that a underdeveloped,corrupt country like usa can´t offer free health care, as most european countries do. ;) . I think here lies the main problem of our discussion. In central europe you trust your doctor, you get your treatment paid by your cheap health insurance and it´s forbidden, even for the very poor to don´t have that insurance. A DOCTOR.med. has an excellent reputation in society. Of course it´s not near to perfect, as humans always find sth. to complain about 8)
Can you give numbers how often a doctor gave the wrong medication ? You only know what you hear by the media, and i guess it´s not that interessting to report, that today millions of doctors did a good job and saved many lives ...
Michael Moore´s sicko may give you a hint.
 
theWorldWithin said:
This is absolute non-sense. If you are not allowed to make a bad decision then it is no longer true freedom. Ultimately you should always be free to harm yourself in any form you deem acceptable. The role of government should be to ensure consumers are fully informed about the potential harm that may come about by their decision to use a particular treatment product and to ensure it meets QA standards.
Well, this point is indeed complicated. I think it's in fact the responsibility of a government to care for its citizens and this includes that they do not harm themselves, if this can be avoided somehow. The idea that everybody is fully informed and can make up his own decisions is pointless. Maybe YOU are sufficiently informed (btw, I feel that I'm not) but unfortunately the majority of people in Europe and North America (just to stick with these 2 regions) are NOT educted enough to understand anything as complex as pathogenesis of any kind, or neurological issues or even why nose drops are unhealthy in the long term. Tne irony is that I would really like to agree with (and in some special areas I DO agree with you) but this is hardly a viable solution for whole populations.
This brings back the "elite"-attitude, where the well informed and educated could be given more rights to choose than the rest. But such an approach would never be accepted by the majority.
As I said before, even with well educated folks these decisions would be extremely subjective. That is because not even an "Einstein" is free of psychological triggers and emotions and the more or less free access to, lets say amphetamine, would lead to incredible abuse. It's a fact! Lots of substances just have a very high abuse liability. Therefore (but it's of course not the only reason), people should not given the right to choose themselves.

theWorldWithin said:
Murphy you line of logic above is the crux of the drug prohibitionist stance, that these drugs must be controlled because they can 'harm' the user who is too infantile and stupid to make informed decisions on his own.
I'm afraid that the vast majority of drug users would indeed do harm themselves. Informed decisions can be made solely by informed folks and their number is quite small. It's a shame, I admit, but it's unfortunately the truth.

The difference between health systems in the US vs. Germany vss <insert your country of origin> makes such a discussion even more difficult and I will try not to look at those differences in the upcoming posts.

Just to make it clear: Did I get it right that the discussion is about the patients free choice vs. the choice of the physician?? Was this the original question of auto238367? If so, then we can still compare the situations in our countries... Btw, here (Germany) many docs are influenced by the pharma industry as well. To deny this would be foolish. But depending on the seriousness of your sickness, more than one option will ge given by the doc (if possible). When you have an infection, you will get an antibiotic without further discussion. But I expect from every informed doc (not all of them are) to discuss the choice of e.g. an ADHD-treatment with more care. To simply prescribe one med, without further explication, is medical malpractice!

No, you should not be allowed to freely choose your meds. Not YOU personally TheWorldWithin, but "you", the average layperson.

- Murphy
 
Well I certainly think you make a very valid point murphy, the are major feasibility issues (to say the least). I would like to see a system that is more of a compromise of the two. Drugs that pose a significant risk of abuse to others such as the infamous hypnotic benzos implicated in many cases of date rape, or extremely potent hallucinogens should probably be restricted in some sense for the public good. It would be a bad idea to have these things being sold a convenience stores ripe for sociopaths to use them as social weapons. However they should be more easily available with medical consultation than they currently are. Also I see no reason to restict drugs like amphetamines, opiods, etc. There was a significant period in American history when these substances were unrestricted, and yes many people abused them, yet society remained perfectly functional. Other medication that pose little abuse potential but can have serious consequences such as lithium, heart medications, toxic medications, etc. should only come with black box warnings and perhaps specific additive taste and coloring agents to prevent surreptitious administration to others. Most rational individuals will still consult a professional before using such medication but the absolute most needy among us will not have to pay thousands in doctors bills to get what they already know they need. The pharma industry could pay for free consultations with pharmacists to inform people on the risks of medications from an objective standpoint (govt. mandated of course).

To me the stock issue is restricting the freedom of everyone to protect the ignorant from themselves VS allowing these medications to hit the market without being classed as controlled substances thus allowing everyone to benefit from them to the fullest. In my estimation the cost of freedom is casualties but it is still much better to be free and see some suffer than allow all of us to be held in chains to protect fools (who may not need protected in the first place).

Also in response to what you said about most individuals not understanding complex issues of pathology, yes you are absolutely correct! But most doctors do not either, at least not in the US. Even the most expensive (thus more talented ones) tend to understand little and prescribe lots. The medical industry is just that, and industry. The Hippocratic oath is dead, hail the almighty dollar.
 
the hippocratic oath is a completely outdated piece of medical history anyway. sure, people still swear it, but it's sort of in the same league as making someone swear on the bible in a court room.

this 'problem' is actually on the mend. the idea of informed consent is precisely the concept which is designed to remedy this problem. rather than being a guideline, informed consent has now become not only a legal requirement, but a fundamental part of best clinical practices. 99% of the time, no matter how well read a patient is, they are not going to be in a better position than a physician to make decisions regarding treatment alternatives (I don't care what you think, it's a simple fact). that being said, once a physician has presented the alternatives, the patient is going to be the best person to make a decision between them. sure, there are going to be problems surrounding which alternatives the physician is going to present to the patient, especially when there is money involved. but these are enforcement problems which are not representative of policy in the United States and elsewhere. to say that physicians are glorified pharmaceutical salesmen is simply ridiculous. physicians are not permitted to accept rewards for selling particular medication. does it happen? sure, probably. but that does not mean that we simply turn a blind eye to it and accept that physicians are simply going to do it. on the contrary, I think the practice is widely frowned upon by the medical community.

Ideally, this is how a treatment plan should be formed: The physician performs a diagnosis. The patient, in consultation with the physician, establishes their goals. the physician then presents a variety of treatment alternatives along with actuarial data. the patient makes the final decision about which treatment alternative is selected. that's what's on the books.
 
GP's, psychiatrists and some other specialists in the US have it good. They can charge crazy prices for minimal work. It doesn't require 10 years of university education to recognize a strep infection and write "Keflex 500 mg po bid" or to listen to someone whine about how they're bummed and insomniac and Rx escitalopram and temazepam. Most of the time they don't really bother with disciplined differential dx or diagnostic tests more complex than routine bloodwork. And they're living pretty nicely. Where I live, the Hippocratic Oath is old hat because doctors are either businessmen or work for businessmen who care about nothing but profit (I mean this without hyperbole as I see it every day).

If, instead, you had biochemical technicians handling the nonsurgical tasks and the ailments that do not require highly-advanced (e.g. cardiologist- or oncologist-level) knowledge to maintain a patient alive (or healthy), a lot of GP's and psychiatrists would cease to be useful. Does nobody here work in the medical field in the US? Has nobody seen the befuddled look on the average US patient's face when they're explained their medical condition in detail? The average American can't even add fractions or remember if the sun rotates around the earth or visa versa.

That said, I'd love to establish a republic with radically-liberal pharmaceutical laws and shamanesque biochemical consultants, coupled with a highly-educated populace. I nominate Cuba, seeing as Castro's about to (officially) croak and Cuban women have such shapely asses.
 
Top