patient empowerment and the media, and MD respect.

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So I earlier made an entry that touched upon patient respest for m.d., which indirectlly touches upon informed patients. I knew that that deserved follow up but several night calls defeated that intention.

Let me start this message with the extreme opposite of how the “new media, etc” had merely perpetuated the snake oil problem and possiblly made it worse.
I had a patient, L lung FULL of lung ca, metastatsis everywhere, had a spinal met that basically pararlysed him. Was so out of it, couldn’t even comprehend his med situation. So I tried to make the family make him Do not intubate/do not resuscitatate in the event of catastophic event. For days I tried, I will not go into the many details of those conversations. Then, one day, the family member showed me a book by Kevin trudeau http://www.cures-they-dont-want-you-to-know-about.com/. I had glanced at this book before while at barnes and noble, the biggest example of internet snake oil shiester dom you’ve ever seen. (HOnestly I encourage every MD to at least glance this book, as it is a BIG seller and will impact, statistically, every practice at least once and you HAVE to be prepared for it.) She says “you know, you should read this book, it says things that doctors don’t know and should be educated on”. IT WILL happen to you to. I politelly stated, i’ve read it, but declined to comment more.
I think sometimes we think that the proliferation of cheap misleading infor on the internet is harmless/ won’t really effect anyone besides their pocketbook, but believe me, this family was letting him wallow in pain BECAUSE this book/sister internet site states, and I am not exaggerating, you need to read this book, don’t trust doctors, they are undereducated on natural cures cause they get money from drug sales. he literally says, and I QUOTE: “I am qualified to comment on medicine because I am **NOT*** a doctor” There is REAL harm.
By the way, as a consequence, the patient almost died twice, is in the ICU now practically comatose when he is not in pain, and on life support. He is NOW DNR/DNI, but honestly it is too late for that. He will wallow for months/years now.
As you can tell I am still quite livid.
I have no problem with mdconsult type sites that know to edcuate patients to a certain degree but entrust the medical decisions to MD’s. Even then, we all get slightly annoyed when you do your best to meld thousand of review articles/research protocol into a decision for a patient, and when you are walking out they are whipping out their palm pilot/powerbook and when you walk back in they probe your knowledge to see why you didn’t use so and so antibiotic becase a NEJM articel suggested it was better for this bug in this state for this indication.It’s hard to explain that only AFTER four to five years in the field do you understand that there will always be a new article, so it is not a matter of blindly following this month’s jama, or you’d change every month.

Rule number one:
You learn everything you REALLY need to know, that’s striaightforward enough to just follow a book/article, in your first two years-three years in med school
The rest is GRAY (dark black sometimes), and really needs thinking because no one has addressed the unique need of THAT patient ever in ANY research.

Rule number two:
Different MD’s will do different things, and each will be uniquely correct, and each will be uniquely wrong. REmember this when each of your attending gives different advise on how to address so and so disease.

Therefore, you now have the unique problem of people having unlimited access to research articles that, yes they can read and understand, but don’t have any context to place it in. Not cause they are unintelligent, but because it’s not their professsion. In fact, the intelligence factor plays in a different way usually. usually it is high powered, well educated successful people that are the worst candidates. Why? Because they are so successful in one thing, so they figure they can figure out the rest of the world given time. hey, I’m the same way too. the same way that i used to think, when I met a mechanic/accoutant/lawyer/etc, that “hey, give me those books and some time, I could figure it out and save myself some cash. I’m smart and successful, aren’t I”

thus we have patient walking in, having read jama and saying “hey I can somewhat understand this!’
probe the doctor, see he doesn’t use the latest protocol they read about, and have this underlying doubt the whole time.

now don’t get me wrong, the mass education of patients is great, and the majority of self informed patient I met at baylor clinic (our private/self pay/rich folk clinic) is definatly for the betterment, and the mostly defer to their doc for real decisions. But there are negatives, and you too will feel them. Not in the community clinic/hospitals, but in your outpatient clinics for the well off, you have to be prepared.

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this has gotten too long….