Up@dawn 2.0

Monday, April 20, 2015

Should Doctors Give Patients What They Want? (Part 1)

          The question posed is a current concern in the medical field.  Medicare devised a system where hospitals are reimbursed by a score of quality.  30% of this score is determined by patient satisfaction.  Recently, New York City’s hospitals took this idea further and based their physicians’ salaries on patient satisfaction.  This new format was intended to prevent doctors from being rude, not listening, spending little time with the patient, and not explaining things in detail to the patient, but it created a conflict of interest for the doctors giving care.  Instead of providing the patients with care that will help them, the doctor ends up fulfilling patient requests to get paid.
A study surveying 52,000 patients found that “satisfied” patients paid 9% more and had a higher mortality rate, about 26%.  This study shows that a higher level of patient satisfaction does not equal better care for the patient.  The higher costs coincide with the doctor acquiescing to the demands of the patient.  The patients demand a costly procedure or drug because they believe it will magically cure them of whatever afflicts them.  The doctor, wanting to maintain a good rapport with the patient so he or she gets paid, orders the procedure or drug ending in more dollars spent on healthcare.  It may result in the doctor appearing less rude, but this type of reimbursement program is a marketing ploy and in no way provides better care for the patient.

Sometimes there are nice ways to tell patients that they need to lose weight or stop smoking, but other times, situations aren't that easy.  For many people, it is hard to differentiate between the disappointment of a message and the messenger delivering it.  As a volunteer in Vanderbilt University Hospital, I see this type of shoot the messenger mentality a majority of the time.  Many times a patient will ask me to get them food or water.  Before I give the patients anything to eat or drink, I am required to consult the nurse or physician over them.  Nine times out of ten, the nurse or physician will tell me that the patient cannot have anything because they are about to have a procedure done.  As the messenger, I return to the patient and give them the bad news, and instantly, I am shot ... with angry looks.  The patients then treat me differently afterwards most likely thinking I am mean for refusing their request.  Withholding food and water from the patients might not be very pleasing to them, but in the end, it prevents them from having to remain in the emergency room longer.  Materials in the stomach make reading x-rays and other types of scans difficult and also makes surgical procedures difficult to complete.  So in order for the results to turn out well the patients would have to wait for their bodies to process the food and water.  Even after explanation, some patients do not fully understand and still have disgruntled looks on their faces.
... to be continued.



  1. Ethics on GMOS

    Post #1: Pros and Cons


    Food Production: The use of GMO seeds can potentially lead to a higher crop yield. This is through an increased land use efficiency. As our population increases (projected to be 9 billion by 2050), we will need more land for habitation purposes, leaving less land for crops. Theoretically, this is where GMO crops would come in, taking less space and yielding more product.
    Reduce synthetic chemical pesticides: Pesticide producing transgenic crops are engineered to produce Bt toxins. These Bt toxins are protein crystals that rupture the gut of insects when ingested, but are completely harmless to the human gut as well as other wild mammals. Another type, herbicide-resistant crops, are engineered to be resistant to glyphosate. Glyphosate has been rated by the EPA to have low toxicity levels.
    Vitamin Engineering: Crops can be engineered to produce more of a specific nutrient, such as the “Golden Rice” introduced in places where rice was the main staple food. In these areas, thousands would go blind due to Vitamin A deficiency. “Golden Rice” was made to alleviate this problem by containing beta-carotene, a precursor of Vitamin A.


    GMO’s Future Effects: While deemed safe in short term studies, long term effects of GMOs on our bodies as well as the environment are yet to be established. This isn't necessarily a con, but could prove to be one.
    Ecological Impact: The Bt toxin released by pesticide producing GMOs are harmful to some insects that are not considered pests, including the Monarch Butterfly. The herbicide resistant plants, which have allowed the safe widespread use of herbicides, have increased the number of herbicide resistant weeds. These “super weeds” have been increasing in number, prompting farmers to have to use more varied and larger amounts of herbicides.

  2. No! How does a patient even know what they want???