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the corollary is self prescription to overcome physician inertia
Submit responseThere is a mistaken belief that the justification for suspending one's own clinical judgement in favor of the clinical judgment of the physician who looks after you or your family is that "he (or she) knows best". Nothing could be further from the truth when it comes to the management of hypertension. In this context there is an institutionalized inertia towards uptitrating the dose of antihypertensive medication to the goal blood pressure(BP) of optimum blood pressure, namele < 120/80 mm Hg. I know this from personal experience, having been diagnosed with hypertension(BP 170/90 mm Hg) at the age of 55 following identification of hypertensive retinopathy by an optometrist during a routine eye test.
Let us abandon the myth that one's own primary care physician always knows best. When it comes to antihypertensive treatment, the primary care physician is just as liable as all his peers to the institutionalized inertia which prevents acheivement of optimum BP. In fact few primary care physicians would beleive that a 70 year old like myself can have his antihypertensive medication titrated to optimum BP, not only without side effects, but also with the "bonus" of expriencing an improvewment in renal function.
Conflict of Interest:
None declared
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Protecting family members from errors
Submit responseTo the Editor:
The authors provide a wonderful overview of the risks in crossing the line from caring family member to provider. However, asking "what could I do in this situation if I did not have a medical license" begs the question raised by the authors themselves in the vignette "Grateful involvement." Dr. Y noted substandard care being provided to his child and (appropriately) insisted on the correct care being delivered. There are numerous reports of the high rate of medical errors in our health care system (1, 2). As physicians, we are in a unique position to note and attempt to correct these errors. Without a license (or at least medical training), we would probably not recognize those errors. Certainly, we have a goal of reducing errors across the board, but as Dr. Y notes, "...care for our son came first...My family trumped all." We would be less than human if we believed otherwise.
References
1. Schoen C, Osborn R, Huynh PT et al. Taking the pulse of health care systems: Experiences of patients with health problems in six countries. Health Affairs. DOI 10.1377/hlthaff.W5.509, 2005. Accessed December 8, 2008.
2. Agency for Health Care Research and Quality. www.ahrq.gov/qual/errback.html. Accessed December 8, 2008
Conflict of Interest:
None declared
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Self and Family doctoring
Submit responseThis is a very good article that touches on sensitive issues that we all, as physicians, face over and over in our professional life.
What Do You Do When You Are Ill? Self-doctoring is another issue that has some benefits with significant risk. There might be an observation that health care providers, including physicians and nurses, when they got ill, are probably on higher risk for complication secondary to the delay in workup and diagnosis. 52-90% of physicians reported self prescribing medications started even in the medical school. Thomas Percival, an English Physician, wrote the first code conduct regarding physicians caring for their selves and their families in his book, Medical Ethics.
In one study, 23 physician-patients previously treated for cancer were interviewed. Health care-seeking strategies fell on a continuum that ranged from a purely patient role to one that centered on physician activities. Participants identified problems associated with overdependence on either role, suggesting that a balanced approach, one that uses the advantages of both physician and patient roles, has merit.
Refrences:
Doctors Who Doctor Self, Family, and colleagues Krall EJ. WMJ. 2008 Sep;107(6):279-84.
Self-doctoring: a qualitative study of physicians with cancer J Fam Pract. 2004 Apr;53(4):299-306.
Conflict of Interest:
None declared