Patient Modesty: Volume 59

Thread visitor APRC wrote the following "I think it is very hard for people who work in health care to accept when a patient refuses care, no matter what the reason. After all, you have devoted many years of study, hard work and personal sacrifice to this endeavor, only to be met with obstinance and refusal. I am sure it must boggle the mind of every health care worker out there and cast patients as little more than petulant children.
However, it is the duty of the health care worker to try to see things from the patient's perspective, and not the other way around. YOU are the fiduciary and I am the entrustor. As such, you have the duty to act in my best interest and I have the right to expect you to do so. You have chosen the role of provider, but I have not chosen the role of patient. [perhaps aside from a handful of purely elective medical matters]". 

One could argue, however, it is not that simple. Trust is not just a one way street in the function of the doctor-patient relationship despite the fact that the patient is the one who is sick.  The physician is the one given the responsibility to reverse that sickness. Trust in the physician by the patient has to be set by the limitations of trust the physician can have in the patient: presenting a complete history, cooperating in the completion of an appropriate workup, demonstrating compliance with the medical advice and treatment.  And just as the doctor will have issues of time, full attention and requirements and limits set by others and the uncertainties of diseases which may affect the responsibility for trust. So too, the patient may have personal financial, social or emotional reasons which cause the patient to fail to meet the criteria that the physician looks for in trusting the patient.  Both the physician and the patient have their own limitations which can negatively affect full trust in the other.

All of this represents important considerations in how smooth and comfortable the patient-doctor relationship and interaction with the medical profession develop. And the limitations experienced on both sides influence how patient's requests for modesty and gender selection of providers is handled.  ..Maurice.

Graphic: From Google Images and modified by me with Picasa3

NOTICE: AS OF TODAY NOVEMBER 27, 2013  "PATIENT MODESTY: VOLUME 59" WILL BE CLOSED FOR FURTHER COMMENTS. YOU CAN CONTINUE POSTING COMMENTS ON VOLUME 60.

Too Much Good can be Bad?:The Issue of Narcotic Prescribing

Ethics is all about sorting out the "good" and the "bad" in various scenarios and perhaps initiating an act which can be supported as meeting an ethical "good". But is there such a thing as too much "good"  and if so could that be considered as "bad"?

The stage, radio and music celebrity of years ago, Mae West said "too much of a good thing can be wonderful."  But is that really true? And, since Ms. West was known for her "double entendres", if it is described as "too much" doesn't that imply that maybe it isn't so wonderful, if wonderful implies something good and still wanted.  Can one repeatedly accept something as considered a "good" actually become a "bad" or if not "bad" then perhaps less good for that individual?

There is current  concern by some in the medical profession regarding the excessive prescription and persistent use of narcotic pain medications for chronic pain which we might see as representing an example of a "good" which appear contrary to Ms. West's declaration. Yes, these medications represent a "good" for those suffering chronic pains.  The  "good" represents the significant reduction of discomfort and suffering provided by these medicines.   But those concerns as expressed in the Editorial of the October 2 2013issue of the Journal of the American Medical Association are that these medications are being over-prescribed and as the pain is eased, not being adequately tapered down or the prescriptions finally  discontinued.  The issue of addiction to prescribed narcotic pain killer medication  by U.S. military veterans poses a similar issue of "good" vs "bad" and is detailed in a presentation October 3 2013 on PBS Newshour.  Rather than provide the veterans necessary personalized non-narcotic therapy it is suggested that doctor-patient time limitations lead simply to the prescription of repeated narcotic refills. And that may lead to addiction as well as unforeseen consequences.  So what was originally  a "good thing" to relieve the veteran's initial pain and suffering has now become supporting a deadly habit. 

One can conclude that Mae West's "too much of a good thing can be wonderful" if not taken as a double entendre, then that statement can certainly apply to the following:  proper, timely, personal attention to all the patient's medical needs understanding the documented consequences of all therapy.  But all this repetition of that "good thing" requires more than some casual approaches to insure that the cumulative results will indeed be "wonderful". ..Maurice.

Graphic: From Google Images