Should patients have a say in the medication they take?

March 7, 2013 in Random stuff, Rants, Science, Skeptical

A century ago when you called a doctor he came, if necessary wrote you a prescription and left with the expectation you would immediately rush out to have the prescription filled no questions asked. Today we do things a little differently; healthcare has become a true business and duly its consumers demand choice, but is this a step in the right direction?

But I’m getting slightly ahead of myself, let us, for but a moment; return once more to the doctor of old and measure his worth. A major part of any society, this highly respected individual spent years studying medicine and was thus trusted in his opinion regarding illness. But more than simply objectively treating illness, the doctor was often a friend, confident and indeed even aided in upholding the peace.

The Doctor, by Sir Luke Fildes (1891)

The Doctor, by Sir Luke Fildes (1891) (Photo credit: Wikipedia)

In a time when the only way to understand an element of medicine was to formally study the subject, this individual was an apex member of society. As we move forward to today however, whilst still generally respected in the community the doctor isn’t the infallible apex member of society s/he once was. In a time when information can be summoned to your fingertips regardless as to where you are, the ill want control and power over their treatment.

This new way of doing things has some obvious draw backs, the most obvious of which of course is that people whom lack a medical degree, or essentially any real medical context are left making decisions about their healthcare based; at least in part; on word of mouth and what they find on the internet (regardless of source). To compile this problem even further these very same people all too often lack anything remotely resembling critical thought and this leads us, as a society to some pretty major problems indeed.

Because the internet is a free zone where anyone can write anything and not need to back themselves up, the internet has seen rise to some pretty strange ideas catching on with more than a couple of people, and these sorts of ideas seek to reposition a very well disproven method of healthcare in place conventional, evidence based medicine all in the name of the almighty dollar. Worst still they seek to do so by attempting to sow seeds of distrust towards doctors, the very members of our society charged with keeping you alive.

Let us take vaccination as an example, in the old world people trusted the doctor so that when s/he said they needed to vaccinate their children, guess what families did? Because of that fact we managed to get rid of polio from western societies, we rid ourselves of deadly diseases like smallpox, measles and mumps. Our child mortality rate dropped, it dropped so far that, along with changes in the economic landscape, we were given the luxury of being able to come up with the concept of the “right to a childhood” and gave it innocence.

But more to the point, we were given the luxury of being able to delude ourselves into thinking now that when a child dies, they have died “too soon”.  Flash forward to today once more and the anti-vaccination movement threatens to bring the days of high child mortality back, only this time by what should be preventable disease. These are people whom lack any understanding of medicine, of science or critical thought, they are persons whom have no medical context to place their argument into and lack evidence to back it up away; and yet they feel they are have a right to spread their misinformation. And whilst it may be easy enough to some to palm them off as harmless conspiracy theorists, the recent outbreaks of diseases such as measles and whooping cough around the world tell a very different story about these groups.

English: A doctor examines a female patient.

English: A doctor examines a female patient. (Photo credit: Wikipedia)

But it isn’t only growing conspiracy theorists that are the problem with too much consumer choice in health, patients also now feel, without really knowing anything about the medication that has been prescribed to them, that they are in a position to choose whether to take it or not. Indeed some patients shop around until they can find a doctor whom is willing to give them the medication they desire, because they saw an ad for it, or perhaps internet based word of mouth made them think it appropriate.

This sort of behaviour is, I feel, inappropriate. There is a reason not just anyone can put up a sign and call themselves a doctor, there is a reason it’s a highly regulated career path and there is a reason why doctors spend 6 years studying medicine and another 4 years on the job training (residency). These are well thought out systems designed to ensure when we visit our doctor they provide us with the best medical advice possible, including any prescriptions (or lack thereof). To consumerise, to democratise such an interaction and defend it with a feeling of entitlement to uneducated opinion is well, disturbing to say the least.

I mean we’re not talking about buying a sweater here, we’re talking about your health. It’s complex, it requires knowledge, context and understanding; it isn’t something that is readily based on opinion.

Now with all that said, I will be first to admit that if left with all the power there are some doctors whom will utilise it wrongly, and there are some people whom should just never be doctors; so I’m not suggesting we do away with the consumer choice system all together, what I am saying however is we should, as individuals and a community, look to restore the doctor to a position of respect, to restore them as a confident and a trusted friend. Someone consistent in your life, whom knows how your body works and how to best treat you as an individual.

They’re my thoughts on the matter and I’m sure there are many whom will disagree with me, so please I invite you to leave a comment now telling me your thoughts on consumer health and whether patients should have free roaming control over what medications they take.

EDIT: It turns out I’ve forgotten to mention my main argument, indeed the argument which first inspired me to write this post; And that is economic cost.

For most western countries some form of universal healthcare scheme is a reality, here in Australia we call it medicare but I could just as easily be talking about the NHS or another of the healthcare schemes around the world. I mentioned briefly above about patients whom shop doctors until they find one willing to prescribe the medication they desire, regardless whether the medication will actually be of benefit or not.

Let’s be optimistic (or pessimistic depending on which angle you look at it from) and say in a hyperthetical situation a patient shopping for a particular type of medication or diagnosis sees 3 doctors before they are successful, that’s 3x your tax dollars have been spent on the same diagnostic, for the same condition with the same patient. Now pretend there are a conservative 1 million patients a year that engage in such an activity, starting to add up isn’t is?

But why stop there? When patients come in to my clinic, around 35% are complete and utter time wasters. That’s 35% of patients whom for various reasons have decided before they even come in that they’re not going to accept the treatment recommendation and 50% of those whom come back after their initial study for CPAP with the mindset they won’t be using CPAP. Those patients cost tax payers over $1000 ea, and there are around 25,000 of them nation wide each year. Look at those numbers climb.

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