I get copies of all my clinic notes regularly, even those from mental health. Yes, I have found errors and pointed those out to doctors. I have also found a couple uncomplimentary statements such as, "Patient appears older than stated age." I called out my doc on that!

We must read over our medical charts regularly to ensure that there aren't any important mistakes or mis-interpretations. I'm fortunate that military hospitals (Medical Records) give chart notes out freely and with no hassle. Free, easy, and no questions asked. I can also get copies of lab results, imaging tests, and ER/ICU notes. Just got some today, in fact.

"older than stated age" is a common medical phrase. I can understand being offended by it but don't take it personally. Its not meant as a insult; rather, people who appear older may be suffering from some chronic disease. It also lets others know who may be reviewing the chart but didn't see the patient that the treating doc thinks they may be frailer than their age otherwise suggests

My policy has always been to allow the patient, or a family member in the presence of the patient, to review the record. In fact, if a patient is moving away or going for a second opinion I make a copy of the record for them to hand-carry to the next doctor. This is because records mailed to major medical centers often get lost and then my nurse has to stop what she is doing an FAX a copy of the record. This has even happened with records to the Mayo Clinic and M.D. Anderson, so I don't mail them anymore. This also allows the patient to review the records and help me by pointing out errors in it. I have to say however, that I have a detailed questionnaire that I ask patients to fill out before I see them and then yearly thereafter. Many (over 75%) patients complain about this and do not fill it out accurately. I recently had a patient who did not list ANY operations but when I examined his chest and asked about the scar, he told me he had open heart surgery to repair a VSD. Another patient, who was a medical records librarian, came to be because of an elevated white cell count, abnormal red cells and an elevated platelet count. She thought she had leukemia. When I examined her abdomen she had a big scar that she told me was from a car wreck. She had her spleen removed in that operation and that turned out to be the cause of her elevated blood counts. She had not mentioned this to any of her doctors and because she had not, she also had not been given the pneumonia vaccine which is very important if you have had your spleen removed.

For the record, fill it out completely and do not get irritated when you are asked to do it again later. You may have left out something vital. Also, feel free to ask to see your record. If your doc writes in it that he thinks you are a nut-case, either get another doctor or think about it from his perspective.

I think my doctors should be more interested in what I'm writing about them.

Half of them are a bunch of closed-minded nitwits operating out of 30 year old medical textbooks not knowing anything about changes that have happened in the past 10 years.

.

for the record, drs must complete a certain number of continuing medical education credits per year. They must also retake and pass their boards every 10 years to maintain certification

So I think your comment is probably a bit inaccurate

eric-2573068, it sure does not show with some of these doctors.

My last appt I had to stuff an NIH article under their nose and say "READ" to get my point across finally.

yeah, its definetely hard to stay completely up to date on all things in medicine...new advances daily and that kind of thing

I try at least to maintain current with my field.

Well, if you ARE 'Hot' perhaps there are reasons you don't get unflattering comments. ;)

I can understand docs being a bit nervous, sometimes honest opinions may be hurtful to someone, if they are unrealistic about themselves, but it's MY health, and those records are mine as far as I'm concerned.

actually, wrong. the government or your insurance company paid for it. So by your logic, I could look at any medicare patient's chart because Im a taxpayer

That being said, I agree with the other posters. There's nothing in there except at most some euphemism for a difficult patient ie what mike p101 said. Or maybe something along the lines of "drug seeking behavior"

are we going to spar here eric?????

Some of us actually pay for our own insurance and make copays.... or pay out of pocket. The record legally belongs to the patient... That's why when they change medical providers you have to foward the entire thing, not just a summary.

As to you looking at ANY patients record that you are not the DR on the case or of record would be a blatant violation of HIPAA and you know that... quit with your scare tatic and god complex before you start. It would also be against federal law for you to access PII unless again you are the DR of record.

If you feel as a PROFESSIONAL it is appropriate to put euphemisms in a patient record you need to change professions. You're supposed to be a professional that is there for the patient and their medical CARE, not cracking jokes or talking behind their back or poking fun at them in the record.

Doctors are fighting tooth and nail to keep the public from having access to doctors professional records, malpractice suits, and general screw ups. They get bent out of shape if a patient writes a poor review of the treatment they got on a public blog/board and sue to have it taken down and claim damages of liable. What right does a DR have to make a permanent entry into a patient file that has little to nothing to do with patient treatment?

Reply to Eric-2573068: I saw the notes my primary wrote when I asked for a referral to a specialist and it was really bad, even to the point she suggested I needed psychiatric help. She couldn't find the source of my pain so I wanted a second opinion after two years, and she resented it. The specialist DID find the source of my pain, and I was referred to another specialist who has been able to give me the medical treatment that helps reduce my pain. I have also seen other notes from other doctors and the theme I see running through them all is that if you challenge a diagnosis or want another opinion they label you a "difficult" patient when all you are trying to do is get help or are trying to understand what is wrong.

may I ask what they diagnosed you with?

Also, the problem with chronic pain patients is a little clearer if you look at it from the doc's view. The average primary doc sees so many people who complain of constant pain, and I promise you the majority of them are narcotic-seekers. Another large percentage are people with psychiatric issues that manifest in physical symptoms of pain. It ruins it for the minority who do have true chronic pain, but this is the nature of people and the practice of medicine

So its not that doctors care when people question diagnoses, it is specifically directed to those patients who complain of pain without objective findings.

I am sorry if you are one of those patients who truly suffers from pain. I have met a few, and I know its not pleasant

sticking to your direct quotes I've and will paste them so you can read what you wrote... and I love the personal attacks calling me a liar or making words/things up.... When one can't argue facts they attack the messenger

Im well aware that people pay premiums and copays. But go back and carefully read what the first poster stated. She said that she pays "For every test and every minute of the dr's time"...that's not true. A copay or premium wouldn't cover that

you AssUMe that they didn't pay out of pocket. you are aware that over 43 million people do NOT have insurance or insurance that covers all the tests they may need?

That being said, I agree that a patient can ask to look at their chart. I just don't see it as automatic and their property, especially through that poster's faulty logic

Faulty logic? It is a record about that patient. Much like a DMV, criminal, credit record. At least the those 3 can be reviewed to a certain degree and corrected... The medical/insurance records are held as proprietary and even if wrong can't be reviewed or corrected for some reason. Why shouldn't the record be automatic... on request... during normal business hours.. without the need for a doctor or other assistance if all they are doing is VIEWING the records or perhaps a copy. I can see a small fee for copies just like the government charges for making copies. Yep make them sign their HIPAA release so you are covered but don't make it near impossible to see what is written about them... What are doctors trying to hide? Did they mess up and write a note to themselves that they cut the wrong part off?

Please stop with you ad-hominem attacks or I will report you. This is your last warning

ooooo I'm shaking in my boots with that warning (threat?) It is your OPINION that her logic is ridiculous.

Not all euphemisms are pleasant... many read that as "code". I agree you can put a note that in your opinion someone is "insert phrase here" but as noted by others not all doctors find an actual cause for pain and attribute it to "drug seeking" I for one would prefer the straight words in my medical files as it is a record of FACTS. Facts are not always pleasant but there is no questioning the straight facts rather than trying to guess what the "euphemism" / "code" means. Instead of "appears to be drug seeking" how about backing it up with WHY you see things that way. Patient presented with symptoms XYZ and specifically requested Rx ABC. In DR opinion they appear to be drug seeking as when offered DEF they declined and insisted on ABC. Of course the patient could have just read an advert in one of your magazines in the lobby or seen a drug on TV... but at least clear it is why you are putting that in their record.

I hope I've quoted you correctly and stuck to the facts without making you feel like I am attacking you personally.

Please do realize that even before the internet age some patients cared enough about their own health and well being that they actually picked up books and read or knew whom to ask besides their specific doctor about medical treatment. With the advent of the internet there are plenty of resources to assist patients (or confuse/mislead them granted) in understanding BIG words that the medical profession uses, out of necessity, to list symptoms and diagnostics.

If I didn't pay the insurance company, would the insurance company pay you? NO. Common sense.

I was in a terrible car accident 10 years ago, and no doctor has made any effort to figure what the issue is. My back hurts every day, and yoga is the only thing that helps. I refuse to take drugs. There is a problem, and no doctor I've met knows what it is.

You're telling me that just b/c YOU don't know what the problem is, I'm a narcotic-seeker? LOL, are you one of the idiot doctors? LOL, that was meant to be a joke, right?

sticking to your direct quotes I've and will paste them so you can read what you wrote... and I love the personal attacks calling me a liar or making words/things up.... When one can't argue facts they attack the messenger

Youre not doing a very good job so far. I never called you a liar...i've said youve lied about what Ive posted in the past. Theres a difference. Try harder

you AssUMe that they didn't pay out of pocket. you are aware that over 43 million people do NOT have insurance or insurance that covers all the tests they may need?

Faulty logic?

Its a safe ASSumption considering the majority of people in this country ARE covered. But Im not sure you understand my point. Even if someone paid for the entirety of their care out of pocket, I don't think that ALONE gives them the right to claim the chart, the test results, etc, as their property

That point sailed way, way over your head. The faulty logic is in saying "i paid for it, therefore it is mine". Lets take a few examples, shall we? Lets say an insurance company pays for your LVAD (artificial heart). Then you fail to subsequently pay your premiums. Can they take it back since "they paid for it?"

What about a young girl, 22 years old, who is still on her parents' insurance. She goes to the dr for birth control pills, which are prescribed. A week later her mother barges in demanding to see the chart to see if her daughter is taking birth control, as the mom has a religious objection to it. Should she be allowed to see the record "since she paid for it?"

You see where this logic takes you? Thats my problem with it. Whether patients should be allowed to see their charts for other reasons I think is up for debate, but probably they should have access within reason

ooooo I'm shaking in my boots with that warning (threat?) It is your OPINION that her logic is ridiculous

Again, you missed the point in question. It is not opinion that offends me; it is statements like this:

quit with your scare tatic and god complex before you start

Again, last warning. Do not post any more ad-hominem attacks. Start acting like an adult

Not all euphemisms are pleasant

I don't know how much clearer the definition could be. I got it straight from the dictionary. Admit it; you didn't understand the meaning of the word. Its a less offensive phrase meant to stand in for one that may offend. You can try to wriggle out of it, but its pretty plain to anyone that reads it that you didn't know the proper definition

Instead of "appears to be drug seeking" how about backing it up with WHY you see things that way

umm..duh. You really think the chart says "drug seeking" and thats it? A two word chart? You don't think there is a negative physical exam in there, as well as negative CT, chest x ray, and a history that does not correlate with any known pathology? Come on...you need to stop assuming

dctrtuba,

Slow down. Im assuming you are responding to post 4.5?

You're telling me that just b/c YOU don't know what the problem is, I'm a narcotic-seeker?

Did I ever say that? Ive never examined you, I don't know the history, and I do not have access to any test results. How on earth could I come to a conclusion about YOUR case??

In my post, I was speaking about what doctors encounter in practice. As I stated earlier, there are many people who are drug seekers who feign symptoms to get narcotics. This is a fact. Don't kill the messenger.

If you don't believe me, just google it. Or ask any ER doc. I could never practice emergency medicine purely because of the drug seekers

Did I ever say there were people in pain who AREN'T drug seekers. YES. I explicitly said so...unfortunately, there are so many addicts the true sufferers often get lumped in

I sense your frustration with medicine. I wish you the best of luck.

P.S.

It is my opinion that people who say physical therapy, water aerobics, or yoga really helps are the ones who are telling the truth, because they are trying to avoid narcotics.

humorous

There's such a word as "general". Common sense says that you weren't talking specifically about me. Stop debating. There are numerous problems with medicine. Don't play the BS education game with me. You'll lose.

@eric

You also pay that insurance company to pay your claims so in essence the consumer has paid for the information plus you also pay TAXES to the government which makes that YOUR information not the insurance companies or the government... I am never going to argue with you because I am ALWAYS RIGHT!

eric glad to see you aren't off pouting and maybe got some sleep... not that it seems to have helped

your response to jerri just goes to show your ego... you post in a public forum and it's all comers not just the person you are attempting to belittle.

I'm sorry you don't understand my paragraph that per you is all hot air. I'm asking you what is reasonable to YOU? And do you feel it is reasonable that if YOUR patient has the right to ask questions about what is in the record? I'm not saying CHALLENGE you but ASK why something is there and perhaps in lay terms what it means.

ethel,

I don't know what your point is

trust,

I am happy to talk to anyone as long as they conduct themselves in a adult manner that invites mutual respect. Jerri did not, so I asked her not to talk to me until she is capable of conducting herself in an adult manner. If that is not reasonable to you, then I don't know what to tell you

I understood your last paragraph fine..its not all that complicated. My response is posted. If you want to respond to it, feel free, and I'll be happy to answer any questions

eric this was your response:

Your last paragraph is nothing but hot air and nothing of value to discuss. Again, you missed the point. I do not disagree with patients access to records, I disagre with ownership being tied to the payer because of the inherent problems that would create in a third party payer system like we have in this country.

so calling my last paragraph is "adult"? I'm looking for you response to what is reasonable.

here is that paragraph again

Patient records again are factual documents, or should be. What do you define as reasonable access? I review my credit reports annually or more frequently if something might be inaccurate. You are NOT a god. It should not be up to YOU whether a patient has access to their records. I'm not saying you should have your office open at midnight xmas eve. I am saying that you shouldn't be preventing a patient from reviewing their OWN records. You also should not be AFRAID of what the patient might read if it is FACT. You should be prepared to answer questions at their next PAID visit. Questions like what does something mean or why did you put that statement. Or do you feel any or all of that is unreasonable?

Please define what you feel is unreasonable or define your view of reasonable. Yes I emphaiszed OWN records as those regarding that patient, or someone they are responsible for of course like an adult reviewing their dependents records. I agree to disagree about ownership but lets leave that question behind us, or does the review go back to ownership? Short and sweet.... does a patient have the right to review their medical records and ask questions about what is in it?

According to HIPAA, the patient has rights regarding access to his or her medical records:

“Health Insurers and Providers who are covered entities must comply with your right to:

Ask to see and get a copy of your health records”

http://www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html

There is also this:

“The Privacy Rule gives you, with few exceptions, the right to inspect, review, and receive a copy of your medical records and billing records that are held by health plans and health care providers covered by the Privacy Rule. “

http://www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/medicalrecords.html

It is NOT debatable. It’s not a matter of opinion. You either know the law or you don’t.

If Erik really is a doctor than I'm the Pope

i assume you are talking to me...no one is debating the legality. I guess you missed that

well, since you can't even spell my name tom, when its written all over this thread, I don't doubt you are incorrect in other things as well

Any specifics that lead you to your opinion?

Eric,

Don’t assume. The post was directed at ANYONE in this thread that is questioning the patient’s legal right to access his or her own medical records. I provided a link to clarify that issue because I think that is of far more value to Newsvine readers than trading angry posts.

Don’t try to read between the lines in my post.

trust,

so the term "hot air" offends you, but you are allowed to say I have a god complex, that I am "throwing a tantrum", and all the other rude comments you have made this thread

How do you not see the hypocrisy? Really? Its quite obvious. but that's not a rhetorical question. I would really like to hear your excuse

I said patients should have access to medical charts within reason. One big caveat is that example I gave above that you continue to dodge. i don't think parents should have access to their non-minor children's medical records without express permission of the patient

I also think dependent children of parents who have no decision making capacity should have to obtain a power of attorney before looking at files. Whether those patients without decision making ability should be able to look at their own charts I'll leave up to the hospital ethics committee and lawyers, but that may be another potentially sticky situation

But in the vast majority of cases, there is no reason for a patient not to look at their own chart

Your basic problem is you have misinterpreted my very first post. Never once did I state patients shouldnt see their records. Never once. In fact, multiple times I explicitly stated the opposite

The difference is I can forsee some problems with tying access to payment, which was my point in that first post. But you either skimmed my post, or flat out misinterpreted it, and ran with it without looking back. I've noticed that pattern with you

junicon,

Honestly?

you said that anyone "who doesn't know this shouldnt be a doctor". (you have since removed that) Since I was the only physician commenting, and your post was in reply to one of my posts, it was a safe assumption

eric-2573068

i assume you are talking to me...no one is debating the legality. I guess you missed that

Your basic problem is you have misinterpreted my very first post. Never once did I state patients shouldnt see their records. Never once. In fact, multiple times I explicitly stated the opposite

I didn't think we were debating the legal nuances either... your posts lead MANY including myself to believe you felt patients had no need or right to their record. The ownership debate came up over title to the record (if there is such a thing) and thus entitlement to see, review, question the record.

Seems we are on the same page as far as WHO has the right to access their own or dependents records. The only challenging area I can see is where a parent has a college age person on their insurance. My book would be, presuming no diminished capacity, that once someone reaches the age of 18 they control who has access not who is paying the bill. The challenge at that point is the primary on the insurance receives statements regarding use of insurance.. but that's not really medical records other than those pesky billing codes that indicate treatment for STD, drug dependency, pregnancy. A medical facility would be WISE to refer the primary insurance holder to a legal adviser about gaining access to their depends records who is no longer a minor. Oh sorry you don't want me giving advice so take that as a general statement to the medical profession at large and not directed at anyone in particular.

I;assume you are talking to me...no one is debating the legality. I guess you missed that

that was not directed at you.  My fault for not being specific

your posts lead MANY including myself to believe you felt patients had no need or right to their record

I can't help other's unfounded conclusions. I never said it. The only thing I said even remotely close to it was I thought other reasons were debatable, but that I believed they should have access

If people want to take my words and form their own conclusions, i have no control over that. That is something you have done time and again when responding to my posts

eric --

Here's something I've learned in a long life:

When you find yourself fighting with everyone around you due not to an unpopular opinion but personal attacks, the cause can be found in the nearest mirror.

If you truly are a doctor -- which I seriously doubt but can't know, so I'll give you the benefit of the doubt -- I hope you'll get some counseling. Your level of hostility and aggression is obvious, and surely not healthy for yourself or your patients.

Good luck to you.

jerri,

look at the title of this article. Also, look at the tenor of the comments that I have nothing to do with. They are very anti-doctor. That is easily the reason for the unpopular opinion and personal attacks

Its like the yankees playing at the red sox

As far as hostility, your post was certainly one of the more hostile I have encountered. In fact, you'll notice it has been collapsed by the community, due to its hostility and lack of any value

Your opinions on whether Im a doctor or not are really meaningless, as you do not have enough information to make that determination. And you definitely could not know whether I'm a good one or not. Also, frankly, you are in no place to judge as you know nothing of medicine

As far as looking in the mirror--well, thats the best advice for yourself

In fact, you'll notice it has been collapsed by the community, due to its hostility and lack of any value

Maybe you don't hang out here much. Comments get collapsed all the time, and they are often starred comments, meaning at least 5 people felt strongly enough to vote for them. As was mine.

How do you know I know nothing about medicine? Because I question your knowledge?

I know something about human nature. You don't add up as a doctor. Not even close. I think you're a troll, loving the attention.



How do you know I know nothing about medicine?

The same way you think that you know what I do for a living. Gut intuition. If Im wrong, then maybe you are too.

But its not really what you believe I do for a living that I find interesting. This is the internet--I could be a homeless guy in a library or the president; there is no way to tell. Any attempt to do so is foolhardy. I can tell you to look back at my posts, and see that I've always answered that I am a cardiologist practicing in a large city; take that for what it is worth

My bigger point of interest with you is your hypocrisy. You claim that I am overly hostile. Allow me to repost your collapsed post:

You are trying to give the impression that you're a doctor. ROFLMAO God help your patients if you are.

You're the one who needs to grow up.

would you describe that as a mature post? You try to ridicule my attempt to tone down the rhetoric on here by saying "please don't tell on me" like we are children on a playground

I for one have moved past that stage in my life. You seem to be stuck in it. Yet then your next post calls me hostile, where in your first post you ridiculed my attempt to quell the hostility

Does the hypocrisy not astonish you? Seriously? Im interested in your response

earl,

may I ask what the genetic condition is, and what blood test diagnosed it?

Thanks

Earl - don't answer. HIPPA protects you.

yeah, cause earl-113767 is a common name.

Gimme a break

Eric don't you think as a DR you should be discussing PATIENT information in PRIVATE? You could EMAIL earl rather than discuss his case for all to see and record.

Fireopal... HIPPA (actually HIPAA) doesn't protect someone from disclosing their private information it only is meant to keep others from gaining access without permission or medical necessity. If some individual of their own free will or carelessness discloses their own information it's on them not those who view it or request it.

trust,

you are not qualified to give medical or legal advice. And no offense, but I don't find much value in your opinion. Not trying to be mean, but just being honest. If you want to keep wasting your time trying to give me advice, go ahead.

This is an ANONYOMOUS board...i discuss priveleged information all the time WITHOUT patient identifiers, ie Mr J with the broken leg, etc. That's allowed. NOt to mention that earl volunteered the info, and I asked him, not forced him to reveal more. Its his choice--HIPAA is voluntary on the side of the patient

go back and study HIPAA before you try and tell other people about it

Eric because of my job function I am REQUIRED to KNOW HIPAA, PII SOX and many other regulations. But I know you don't value my or for that matter anyones opinion except your own. I'll refrain from wasting my thoughts on advising you since you know it all. Fair enough? or is that faulty logic?

Good grief, guys, get a grip. If Earl doesn't want to answer, he doesn't have to. If his panties aren't in a bunch, yours don't need to be, either. eric was politely asking a question for clarification on an anonymous forum. It's up to Earl, nobody else, whether he shares that information.

sandy,

thank the lord you are here...im getting killed here! Not a dr friendly thread at all.

I promise I will never say another ill word about dentists again! You know, I still feel so bad about that, weird as that is.

eric-2573068

"It is faulty logic
I value other peoples opinion...just not yours"

You seem to love the Latin ad hominem and the English version, "faulty logic." Man, if you can give me three other Latin/Greek arguments -- translated -- I might take you seriously.

(HA. HA, just kidding -- anyone can find them on Wikipedia!)

Seriously,

WOW. I'm amazed (sarcasm) you don't value someone else's opinion... (again, I say SARCASM!) especially since you so often use ad hominem as your "argument"!

A lot of very intelligent people here see you for what you are. They may not be necessarily as "educated" in the rules of logic, but they question anything Latin (as well they should!)!!!

By "rhetorical" (ancient Greek...) understanding, ad hominem is an argument that attempts to counter the other person's claims (or conclusions) by attacking the person, rather than addressing the argument itself.

And yes, I can spell arrogance... can YOU?

eric, I await your rebuttal. And many people with plain old common sense do, too!

Arrogant eric, bring it on!

Lol, eric, I'm over it, so feel free to forgive yourself!;)

IMO, if Earl brings up a genetic disorder as an example of what was apparently difficult diagnosis, he invites further inquiry. As this is an anonymous forum, there is no patient identifying information in his post - we none of us have a clue who Earl is.

And, he is perfectly free to decline to answer. Nobody is twisting his arm. I do find it presumptuous, though, to tell him what he ought and ought not to reveal. eric was polite in his REQUEST for further info, but someone else pretty much TOLD Earl not to answer. Perhaps Earl would have been interested in any insights eric had to offer, and it's nobody else's place to tell him to share or not.

eric, I await your rebuttal

Boris, trust me, if there was something approaching a coherent thought in that steaming pile you call a post, I would surely find something to say

I have a terrible time with getting diagnoses - it ended up being endometriosis and adhesions. I was called a drug seeker and given NSAIDs, which promptly ruined my digestive system. This last year I had severe headaches, went round and round - dentist, 2 ENTs, neurologist and finally the ER in desperation. Had an abcess. Many, many months of pain. No painkillers; can't take NSAIDs. Got one more mystery and going for 6th CT scan (I say it's from more adhesions).

Even with insurance, the last 6 years sucked thousands of dollars out of me. Thankfully I could afford it. I don't know what would have happened if I did not have the money. My biggest gripe is that specialists cannot get together or communicate with each other. I have had soooo many different opinions from the best (university) specialists but I don't get how they were so varied.

Consequently, I am back in school alongside the pre-meds.

My biggest complaint is doctors who just tell you your labs are "normal" and assume you can't understand or don't care about the numbers and will neither tell you nor give a copy of the written report without a fight. I had a very hard time getting labs from my previous doctor, turned out I was at the bottom of "normal" in multiple things, all of which different labs have slightly different cut-off points for.

It SHOULD make it easier. Mine have been digitized for the past two years and all I've had to do is show up and sign a request/release and the non image stuff is mine on the spot... the imaging (x-ray, ultrasound, CAT scan) takes a bit longer as they have to "order" the cd/dvd.

The down side to electronic goes back to the old adage ... to error is human, to really foul things up requires a computer. It takes about six months to remove erroneous information (not mine but the next patient seen by the DR entered into) the record.

It takes about six months to remove erroneous information

Gee, it only took 6 months for you?

My chart says I'm allergic to a prescription drug I take every day. I've been trying to get it off my chart for 2 years. Interestingly, (and somewhat disturbing), various people renew the prescription regularly without ever asking about my "allergy," but when I see someone new they always mention that I'm allergic to this drug.

Their excuse? "(mumble, mumble) It's hard to get information out of the system once it's in the records."

No big deal in my case, but I can imagine scenarios that would lead to tragedy and I can't imagine it's a good thing to be unable to correct allergy information.

As for my records, I have all of them. I even have CD's of my scans. I had a problem with a hospital in Pennsylvania once, but I spoke to a patient advocate and made it clear that they could give the records to me because I asked for them or because of a court order -- their choice. That clarified matters for them and they complied.

Because with a patient, a little bit of knowledge can be dangerous....

People decide that with 20 minutes on WedMD, they're more knowledgeable on a subject than a Physician. It's like me coming to where you work and telling you how best to do your job...

It's like me coming to where you work and telling you how best to do your job...

I think that depends on the patient. I could also say that I've lived in this body for more than 50 years and I know when something isn't right. A total stranger who has known me for 10 minutes doesn't have that insight, to say the least.

I'm fortunate though in that I FINALLY found a REAL doctor. It took decades and I nearly died 3 times, but I found her, bless her heart. She couldn't care less about titles or whether she's the smart one in the room, she's 100% focused on solving the mystery, and she sees me as an important part of the team.

During my last visit she rushed into the room with papers in her hand and said, "Okay, this may sound a little weird, but look at this and tell me what you think." She handed me the papers and started explaining where she was headed and why.

I have my own ideas, and she agrees they are also possible, so we're following up on both leads.

In the meantime I had a severe UTI, treated it with homeopathy, told her so and asked for a culture to be sure the infection was gone. She didn't bat an eyelash, but instead asked me how long it took for the symptoms to disappear. (The culture was clean, the symptoms stopped in 2 hours.) She carefully wrote down the name of the remedy I took. I suspect she's going to do some research on it.

Now THAT is a doctor.

DirtyJersey, so a question for you. A family member had a doctor tell them while being treated for septicemia that a course of treatment was needed to be made more aggressive based on blood results that were taken more than 48 hours prior and before any antibiotic therapy had begun. I called the doctor out on this insisting that the blood that had been taken just two hours before his recommendation should be used for the treatment decision. Who was right here, the doctor or the person with "20 minutes on WebMD"? I'll give you a hint, that particular doctor was not back in the hospital room for the remainder of the treatment after a brief talk with the Chief of Medicine.

Oh, and to add a little more detail, the most recent blood draw had shown that the current antibiotic course had already dropped the WBC count from more than 48,000 on admission to about 17,000 (normal for a person is around 5,000 to 10,000). So, DirtyJersey, was the doctor right with his recommendation based on outdated information or do you still insist that patients blindly follow without questions?

wow, so youre actually dead wrong on this (pun intended)

Actually, blood cultures taken after antibiotics have been started are unreliable. Even if the blood cultures clear, that particular antibiotic may not be effective enough, ie, the MIC might not be high enough and you won't get a complete clearance of the blood infection

He was right to use blood cultures before initiation of abx for that reason.

I'll take the information that the Chief of Medicine at the hospital gave me over the opinion of a random person on a website any day of the week. The Chief of Medicine specifically stated when I talked to him that the doctor was incorrect to order a change of the initial medication ordered after the blood cultures were taken on admission without reassessing the current situation. A doctor evaluated the infection based on admission testing and made a prescription, another doctor without any updated information or cause attempted to change the order and was told he was wrong to do so by his supervisor. Now a random person on the internet thinks they know better with no specific knowledge of the situation, now that's comical. What makes your comment especially comical is that the original course of treatment that this doctor attempted to change without reason resolved the illness in the exact time frame the first doctor had estimated.

take any information you want, that is definetely your choice

But blood cultures drawn after antibiotics have been started are almost universally unreliable. True no matter how comical you find it to be

IF you don't believe me, maybe you will believe UPENN

http://health.upenn.edu/bugdrug/antibiotic_manual/infctl%20blood%20cult.htm

Blood cultures should be drawn prior to the institution of antibiotics whenever possible

Or the institute for healthcare improvement:

http://www.ihi.org/knowledge/Pages/Changes/BloodCulturesObtainedPriortoAntibioticAdministration.aspx

Collecting blood cultures prior to antibiotic administration offers the best hope of identifying the organism that caused severe sepsis in an individual patient. Failure to check blood cultures prior to antibiotic infusion will perhaps affect the growth of any blood borne bacteria and prevent a culture from becoming positive later.

Maybe there is more to the story than you realize or are telling, and that's why the chief of medicine got involved.

Just because the patient got better, it does not mean the right thing was done. For example, if he was maintained on a broad spectrum antibiotic instead of a more limited one, he would get better but may be at risk for future infections (c diff) or resistant bacteria

Maybe you're having a challenge with comprehension so I'll repeat. The original doctor drew blood for a culture and prescribed a course of treatment based on the results of the admission collection (prior to the initiation of any treatment). Then, 48 hours later, a different doctor attempted to change the treatment based on no new information being presented, with no consideration for the already ongoing treatment. The Chief of Medicine removed him from the case and the original doctor on return from his weekend didn't seem all that pleased either. Like I said, I'll take the opinion of the Chief that the doctor was wrong over the opinion of a random person on the internet. No matter how qualified the profession as a whole is there's exceptions and having patients question their doctor is never a bad idea.

in fact, I have no challenges with comprehension. Allow me to quote your original post with the relevant portions bolded:

A family member had a doctor tell them while being treated for septicemia that a course of treatment was needed to be made more aggressive based on blood results that were taken more than 48 hours prior and before any antibiotic therapy had begun. I called the doctor out on this insisting that the blood that had been taken just two hours before his recommendation should be used for the treatment decision

Now here's your most recent post:

Then, 48 hours later, a different doctor attempted to change the treatment based on no new information being presented

Those two statements are in direct conflict. I have two questions

1. Was or was there not a second blood test?

2. Was the second blood test a culture?

If so, then my above point stands

There was a second blood collection taken two hours before the second doctor attempted to change the treatment, it had not been processed at the time. Your point is still invalid, the doctor attempted to change a treatment plan without a specific reason given and was told by his boss after being questioned that he was wrong. There is no conflict in the statements, blood had been collected but the doctor not only ignored the treatment plan set forth by the primary doctor but didn't even have the most current information to base the decision on. You still seem to be having comprehension issues, which is exactly why I'll stick with the opinion of the Chief of Medicine that the second doctor was incorrect (and that my questioning of him was correct).

I think I understand your area of confusion...

blood cultures can take up to or longer than 48 hours to grow, and then an additional 24 hours to get sensitivities.

Those may have just come back from the first culture, which is why he was recommending a change to therapy

it had not been processed at the time

See, Im not sure what that statement is trying to say...blood cultures require some time. In essence, you are trying to grow enough bacteria to identify the species. That can take a day or two

I hope that clears it up for you

The culture can take 24-48 hours to grow (in this particular case the strain was isolated after about 28 hours of growth), this had already been accomplished with the first blood sample taken on admission and the strain of bacteria had been isolated by the lab, hence the treatment plan set forth by the first doctor. The follow up samples were not to culture a strain of bacteria, they were to monitor progress of the treatment plan. The second doctor didn't come into the equation until long after the strain had been grown, isolated, and identified and the treatment based on the bacterial sensitivity had begun, there's no confusion on my part. Once again, you appear to be the one that needs to have things cleared up for you since you're continuing to act as if you have any clue what the specifics of the case at the time were. The only thing you need to know is that the second doctor involved was told by the Chief of Medicine (and the primary doctor) that he was wrong in trying to make the treatment change he attempted. If the doctor hadn't been incorrect would the Chief have intervened and removed him from the case while leaving the original treatment exactly as prescribed? The original treatment remained in place and your insinuation of a follow-up infection hasn't come to be since the incident more than 5 years ago. Whether you're a doctor or not, I'd hope you know better than to make random guesses on cases that you have absolutely no direct knowledge of.

Coracii, you were quite clear, so relax. Sometimes preconceptions can interfere with a person's reading comprehension. I see it happen all the time with my elementary students, although they usually make the mistake based on pictures in the book rather than from trying to show off their "intellect."

I'd hope you know better than to make random guesses on cases that you have absolutely no direct knowledge of.

Im just trying to get a straight story from you...its a little difficult. Let me repost again what you have said:

A family member had a doctor tell them while being treated for septicemia that a course of treatment was needed to be made more aggressive based on blood results that were taken more than 48 hours prior and before any antibiotic therapy had begun. I called the doctor out on this insisting that the blood that had been taken just two hours before his recommendation should be used for the treatment decision.

Thats just simply incorrect. The blood culture before the antibiotics were started should be used. Further testing does not change that

My whole point is that the initial blood culture should be used for all treatment decisions. Your story is now changing; you are saying that in fact the first test WAS used to guide therapy. So what were you calling the doctor out on? Why, if appropriate therapy was initiated based on the first test were you insisting the doctor wait on the second?

My guess is that the chief decided it would be best to change drs and try to appease a clearly angry patient and avoid a lawsuit. He may have been telling you what you wanted to hear to make you happy.

I may be wrong here; like you said, I wasn't there, and Im not getting a clear story from you. But something seems awfully fishy

eae,

do your elementary students inject themselves into conversations they were not a part of only to then make an insignificant, immature remark?

Because that seems VERY consistent with the behavior of a child

The only thing you've managed to get correct so far in this entire thread is that you are wrong in this case. You have absolutely no clue of the details in the case and yet you continue to act as if you have even the slightest bit of knowledge. If the Chief of Medicine was trying to appease me you're insinuating that he would put the life of a patient at risk by not backing up the second doctor in changing the treatment without merit. Instead, he and the first doctor continued the treatment as originally prescribed through the entire duration? You just seem incapable of understanding details, the second doctor was attempting to unnecessarily change the treatment plan without a specific reason. If you truly are a physician I hope for the sake of any patients you tend to that you're less likely to randomly guess based on limited information when you're actually treating a patient. Here you seem to be suffering from the God complex that infects doctors on occasion, you're not all-knowing.

you know, for some reason this case is sticking in my head. Ive read and re-read your posts and this is what I can come up with for a timeline

Day 1: Patient admitted, blood cultures drawn

Day 1-3: antibiotics started by doctor #1 with respect to culture and sensitivities, patient improves

day >3: doctor #2 covers for the weekend, sees *something* on the initial blood culture, and wants to change therapy. You are not happy with this decision, as the patient is improving, and you would prefer to wait on a 2nd *blood test* which you believe is necessary to properly guide therapy

Monday: doctor #1 returns, doctor #2 taken off case after chief intervenes

I guess this is plausible. I still have questions though, that you may not have the answers to. What was the *something* seen on the initial blood culture by dr2? What was the *blood test* that was so crucial to guiding therapy in a patient on appropriate antibiotics who was improving?

You probably don't care about my honest opinion, which is fine and I don't blame you. But im going to say it anyway. I don't believe the above sequence of events.

Your first post clearly demonstrates an anger for dr2 for relying on the initial blood cultures, and instead insisted that he wait for this mysterious 2nd blood test. It is very obvious that you are judging dr2 quite harshly for using information on a blood culture drawn before antibiotics are given, as you believe this to be bad medicine. After I pointed out the error of this logic, your story changed and suddenly you know that relying on a culutre drawn "before any antibiotics were started" as you clearly and at first, disparangly, pointed out is obviously the right thing to do.

It just doesn't add up. But I think we both know that maybe next time you won't be so quick to judge

as far as any complex, I have already said there is a chance I am mistaken. I do not have all the details, and quite frankly, your story is quite difficult and lacking in details, as I pointed out in the above post, so any definite conclusion from my vantage point would be impossible

both you and I at least agree on that

I think any god complex requires a belief in infallibility--i mean, that really puts the god in god, right?

So, if i freely admit I might be mistaken, thats not very god-like of me, is it? Unless you know some very humble deities?

But your story as told has holes; our friend EAE is a bit out of his element and so cannot properly discern them, they same way I could not do his job as well as he could do mine

As far as putting your patient in danger, maybe the first treatment plan was also fine. Maybe the second one was more appropriate, I have no idea. What I do know is very rarely is there just one answer in medicine, and I doubt that this decision was as truly life and death as you seem to think it was

Its very possible both antibiotic choices were acceptable; in fact, a good part of antibiotic choosing has to do with thoughts of society as a whole, and creating resistant strains, as well as healing the patient in front of you. So, in actuallity, there may have been no danger to that particular patient regardless of antibiotic choice

Like I said, if you truly are a physician I hope you're better with patients in person then you are with comprehension on the internet. You're so focused on pretending that you know the situation that you're incapable of understanding what's being presented. Not worth my time, I'll stick with the decision of the primary doctor that handled the case and the Chief of Medicine that removed the second doctor and continued the original treatment. According to the other doctors involved the second doctor was incorrect. They don't care what some unknown person on the Internet claiming to be a doctor thinks any more than I do.

hey, clearly I offended you and that was not my intention. I truly apologize if I did.

I don't think im focused on "pretending" anything. I freely admitted repeatedly that I don't have all the details, and in fact, almost all of my posts were focused on eliciting more details from you

I also looked back through my posts, and I can't find anywhere I claimed to be a doctor, and least not to you. Maybe you saw it somewhere else

my point in all of this was to really see if the doctor was at fault here or not. From your first post it wasn't clear. HOwever, all of the other drs involved seemed to think so

There is just so much anti-physician sentiment, I was hoping to maybe change it one person at a time. I guess I failed

If, however, you have some free time and feel like answering some of the questions in my last couple posts, that would be great. I am still curious to why you were so against that doc relying on good culture data, and what this second test was

Thanks.

eric lets clear the air once and for all

I also looked back through my posts, and I can't find anywhere I claimed to be a doctor, and least not to you. Maybe you saw it somewhere else

yes or NO are you a DR? Don't float doubt, it takes from your credibility. You've stated residency and in prior posts (which everyone can review by clicking your name here) you've stated cardiologist. You've also stated things are slow at the hospital this time of year. You've implied you are involved in doing a cath (unless you are doing a urinary cath we presume a heart cath). You also claim to have patients... if that isn't saying you are a DR then I'm not sure what is.

so Im going to address this in two parts

The first part is easy; am I a physician? Yes. I finished residency awhile ago, and I am a cardiology fellow.

The second part of my answer is a bit more complicated; specifically, why Im not obvious about it on this board. I see some other posters, like VADOC and kizmd who make it fairly clear. Im not like that for a few reasons

The biggest is that that point always turns into this hot topic of conversation. And with the anti-doc sentiment that permeates these threads, it just turns into a bunch of personal attacks. Anytime I post anything, its met with

a)arrogant

b) god complex

c) greedy

or "i would hate to be your patient" Or "i feel sorry for your patients" or some combination thereof that I don't think would be dished out if people didn't know I was a physician. So I intentionally try to hide it, but people often catch on because of the nature of my posts

And then a majority of the posts are like the ones from jerri-1 or some joker who posted awhile ago that if i was a doc he was the pope. Debating my occupation online is like arguing about the existense of G-d. Pointless, impossible to prove, and ultimately a personal thing.

So really, i try to hide it so we can focus on the topic at hand instead of my biases (which may or may not affect the validity of my points) or whether im a doctor really (irrelevent) or how good of a dr am I (also irrelevent and essentially impossible to tell from my responses on a message board)

Moving on, my computer is acting up so I don't want to do a whole seperate post, but i did read your response to kizmds post and do agree that she used some big words that most people (including myself with one of them) would not know.

They tell us in school to avoid jargon, but we get so used to it that its a tough habit to break. But Im not sure why she chose such a obscure word to describe her notes. Your point is well taken

When multiple people seem to think you are arrogant, perhaps it is time for some self-reflection and self-examination.

Anytime you have a public forum like this, you will have many different opinions. Mature people do not take the opinions of annoymous strangers personally, nor do they see it as a private conversation between themselves and another poster.

The topic was about patients seeing their records. Seeing my lab reports, enabled me to make educated decisions about my health, which involved seeking out a doctor with more background with a particular health problem I have, and my current doctor actually encourages me to see my lab reports and be an educated involved patient. In my field, parents are entitled to view their children's permanent school records, and it keeps us both honest and cautious about what we put in them. Just as teachers are to treat parents respectfully, and use our expertise to inform and educate parents rather than dictate, so doctors today need to learn to communicate, educate, and inform their patients these days rather than dictate, except in dealing with emergency situations.

Most of us will admit we have had good doctors and bad doctors, just like in many other professions. Sometimes a doctor who is good for one person is not for another person, for reasons as varied as expertise in a particular area, communication styles, and just plain old personality. Ultimately, people today are not only better educated, but we have access to more information than ever before. And in general, people today react very negatively to being dictated to. Ironically, I have even heard a couple of doctors complain about the arrogance of a few of their colleagues, so I do not think that perception is merely the imagination of patients.

thanks for proving my point

You clearly have a bias against doctors shown by your previous post complaining about lab work, as well as saying directly that you know even other drs think that some are arrogant

So of course, I'm arrogant to you and others who share your view even before I open my mouth. Its a self-fulfilling prophecy

The reason drs are hesitant to show you lab work is you are not as educated as you think you are. I have no idea what your labs showed, but what may be high or low on your test may be either normal for you, or a normal variant. But you got your panties in a bunch when you found out, which is ironically exactly what your doctor was trying to prevent

Trust me, in my workplace there is not one person who thinks Im arrogant. Im a few things, definetely, but arrogant is not one of them. I have multiple patients and nurses and other staff compliement me multiple times on my attitude and behavior

As for YOU, your comment to me was TERRIBLY arrogant. You denegrated my reading skills and compared me to a schoolchild for chrissakes!!

Your hypocrisy is frankly mindblowing

But you want to take the opinion of some random people who hate doctors on a liberal leaning site on a thread who's very title bashes physicians and use that as some kind of evidence???

Hahah...that's like asking the KKK what they think of the civil rights movement

Thanks for your opinion, but no thanks

Great post, EAE-886609. I don't appreciate someone who takes over a board and thinks they know it all.

Besides that, I don't know of any physician who has the time to sit and argue with people on a internet forum such as this.

I did have some input I was going to add to the discussion, but since a certain someone hijacked it, I'll just save myself the time and effort.

you should really stop being so passive aggressive

Kai, I don't know any real doctors with that kind of time either. I was curious, and there are massive posts by Eric on other medical topics this month. No, I didn't read them, probably more of this kind of stuff.

I clearly said there are good doctors and bad doctors. Can't figure out how that is arrogant.

As for my earlier comment about labs, I will not use a doctor ever again who does not let me see my thyroid labs. After changing doctors, my new doctor immediately changed my dosage and then pointed out multiple other areas in which I was just barely at the bottom of normal where I needed to start watching my diet, taking suppliments, etc. Things like vitamin levels, kidney function, etc. Her attitude is that an informed patient will actually follow medical directives, take needed medicines, etc. better than an uninformed patient.

Well, I am on vacation for a few days, so I'm off to finish wrapping, decorating, and baking; and no I do not share my recipes, they are more secret than our medical records!

Folks, take a look at how eric has been treated. He stated that paying the bill doesn't give you the right to see the chart, else anyone who has Medicare or Medicaid would have a chart accessible to any taxpayer. And then trust_verify jumped down his throat. His logic was sound - if paying the bill gives you the right to see any chart you want, you could see the records of your grown children (over 18), so long as they are financially dependent on you and are covered under your insurance. You can't. The law is clear on this - you can't look at the chart of any other mentally competent adult except by their permission or court order.

eric never said a patient had no right to see his/her own chart. He feels there are reasons against it, but agrees they are legally entitled to see their chart.

Every time he posts, no matter how innocent, someone here jumps his case, and if he defends himself, he is accused of being arrogant, or of hijacking the thread. I notice no other posters with similar numbers of posts are accused of hijacking. I see Boris accusing him of trolling, then stalking out his posts on other threads just to throw out trolling accusations.

We don't have to agree with each other, but if you engage in personal attacks, you should expect the person attacked to defend themselves.

EAE-886609,

Are you sure that I couldn't squeeze just one recipe from you? LOL

We've been blessed with a great doctor, one who takes the time to really listen to what we have to say. It means so much to us knowing he genuinely cares about us. We love him, and yep, we tell him so.

We have a very high level of trust with our doctor. That comes from a relationship built over 12 years.

He never leaves us hanging, lab results are always sent to us after being reviewed, and highlighted with notations on relevant results. (and I appreciate his consideration...a LOT!) He's a keeper. I don't know what we would do without him.

I hope your holidays are filled with much joy, and love.

thanks sandy,

I really appreciate it. Im not too concerned over how things played out on this board...real life is pretty good to me

I just thinks its kind of humorous that EAE makes a statement that says:

Sometimes preconceptions can interfere with a person's reading comprehension. I see it happen all the time with my elementary students, although they usually make the mistake based on pictures in the book rather than from trying to show off their "intellect."

And then plays stupid (or is just that dumb) when I call him out on his hypocrisy over this arrogance. I don't think I was ever that arrogant without provocation over this whole thread. But whatever--people like that are all over the place. If he needs his heart fixed, or his teeth fixed, im sure he'll be singing a much different tune

I wasn't even trying to play "all knowing" with the original poster. He/she just seemed to be bashing her doctor over something that seemed to be his/her mistake that she couldn't understand. I wasn't claiming to have all the answers, just asking her to re-examine her position. Instead, she stuck to the fact that there was some sort of disciplinary action, as if that proves wrongdoing.

As for trust, she followed me over from another thread where she claimed drs made 1.2-1.8 million a year. As a fellow doc, Im sure you know thats a bit outside the average. There were some strong words, but we have made a truce for now

Again, as I stated earlier, thats really the reason I hate to bring up my job here. I work hard, but to imagine I don't have 1 or even 2 hours to spend to myself each day is ridiculous. Of course I have free time--im not jailed to the hospital No person, not even a doctor, would work a job like that. Its just not reasonable.

Anyway, thanks again for your support

eric GROW UP.

And then plays stupid (or is just that dumb) when

you splash your "wisdom?" all over these threads and WHINE that people need to act like adults not children then drop that bs?

claimed drs made 1.2-1.8 million a year.

I never claimed you EARNED 1.2 to 1.8 million I showed calculations that a medical office GROSSED that kind of money. made implies you put that in your pocket.

As a fellow doc,

interesting choice of words as you are ONLY a fellow. The fact that you are in RESIDENCY tells me that you do NOT have your own practice and are still learning. Yep you may have earned your piece of paper, but as you are under fellowship at the VA implies you don't have your own patients.

As for trust, she followed me over from another thread

LOL talk about an ego!!!!!! It's a public forum "DR" there was no following. Feel free to keep making AssUmptions. Now you think I'm an angry woman? You did state I needed anger management didn't you?

im not jailed to the hospital No person, not even a doctor, would work a job like that. Its just not reasonable.

nope, a normal person would not work those hours... an over worked DR with patients of their own would be busy with their patients during the day and resting at night. Then again you did state all the HOURS a DR in training works... wasn't it 80 to a 100 with some days being 36 or 48 hours long? Then claiming that no other profession does that? Obviously never been in the service or worked in a mill or industrial setting but that debate is over.

Anyway, thanks again for your support

That seems to be what you are doing here Eric, seeking support and attention... you seem to lose your ego over time becoming friendly and reasonable, until someone blows smoke up your backside then it come ROARING back.

The two threads, this and the previous one, have devolved from the topic at hand to eric making a grab for attention. It will be interesting to see what happens in the next thread that "trust follows eric " into if you do the same thing... I don't feel like checking other threads you've been in right now but maybe I will in the next one if it digresses that way.

wow, all this hatred. I thought you were past all this

I am in fellowship, but I am done with my general cardiology fellowship, and am in a sub-fellowship. I have all the training of a general internist, as well as a cardiologist

Residency and fellowship ARE NOT interchangable by the way

My fellowship is NOT at the VA, although I rotate through there

As for the rest of your post, I was going to take the time to respond, but its not worth it.

Happy holidays!

eric

wow, all this hatred. I thought you were past all this

Hatred NO. calling a spade a spade YES.

As for the rest of your post, I was going to take the time to respond, but its not worth it.

Cant' refute the truth. You may be all you claim on paper but you are a wannabe still. You might have all sorts of learning from books done but you have a LOT to learn about people still. That's something one can't learn from a book.

peace of the holidays be with you.

listen,

I think ive heard everything I need to from you. If you see me post anywhere again, just ignore it.

Thanks

eric

I think ive heard everything I need to from you. If you see me post anywhere again, just ignore it.

Seems I stepped on your ego, which wasn't my intent, but you just keep laying it out there to be tripped over. No one, contrary to your egotistical self, made you a god. I'll choose who and what to ignore, not you. It's a public forum. If we happen to end up on the same thread so be it. If you don't like my comments, for what ever reasons, feel free to use that ! button at the lower right here and choose Ignore this Author. I'll either comment, or not, favorably or against any posting I choose based on my knowledge and opinion as is my right, and yours.

May the Great bird of paradise....... (pick what you will to complete that sentence.)

wow. I was pretty nice to you earlier, but that was before I read this post.

The doctor of medicine has to be the easiest doctoral-level degree there is. When I was busy busting my [expletive] at one our country's top schools, I was busy learning how to think, and how to work extremely hard.

I would love to hear what school and program that was. I could then compare it with medical school and show you how much more difficult it is to gain admission to medical school

Did your "top school" make you work 100 hours a week, many of them overnight with multiple 30-36 hour shifts operating on NO sleep? Did you have to do this for 8 years, the sum of my post medical school education??

I doubt it.

All these doctors do is rely on a simple "poke and puke" formula -- matching a set of symptoms to a set of pills. Seriously, I bet I can train an animal to do that......or hell, I can use WEBMD :)

See, you are part of the problem, and now I can see why your doctors gave up on you. If you told me you disagreed with me because webmd said something different, I would politely suggest that you take my advice, or find another doctor. There are too many sick people that I need to help to waste my time with people who think the internet can do a better job. Im sure people will disagree with me, but I promise most drs feel the same way.

Honestly, lets put your webMD to the test.

You are called to see a patient who suffered an MI 4 days ago treated with TPA and salvage PCI. The patient had previously been doing well but now complains of recurrent chest pain. EKG is unchanged. Stat CBC and BMP are unremarkable. Exam reveals a diaphoretic male in moderate distress. There is a soft 2/6 holosystolic murmur heard best at the apex with no obvious radiation.

Your diagnosis and next step, doc?

lol - this is why I don't go to the doctor. I have plenty of evidence to show that you medical doctors aren't making any effort to treat the patient.

Nowhere in my post did I say that webMD is a better solution. But these days, people are reading for themselves, and fixing their own problems the holistic way -- because they get results. If you worked that hard for your education, you should making a much more concerted effort to correct patients' problems.

Based on what you said, yes, my major was much tougher. And why isn't your treatment effective, if you've worked so hard? This is pointless. If you can't admit that medicine has many problems, you really don't need to be talking.

So to you, I say WOW.

Dude -- if you can't admit that traditional medical doctors are part of the problem, you need to go see a psychiatrist.

Oh, and now who's assuming? Is that what you do in your medical practice? We can go all night dude, or you can admit fault and go about your business.

@eric

There are too many sick people that I need to help to waste my time with people who think the internet can do a better job. Im sure people will disagree with me, but I promise most drs feel the same way.

See there's that you know better than your patients ALL the time. You won't even discuss alternatives from the sound of things. You feel that a patient can't possibly do a little research and that asking a question is a waste of time.

We are all so SORRY you CHOSE to become a DR and had to put in long hours learning(?) your skills. I bet you look down on your auto mechanic and feel they are as dumb as the car that broke down because they spent 2 years at a trade school and the last 20 working on cars. THAT is why people don't like the likes of you.

I'm not playing into your garbage man.

I have plenty of proof. Go find it for yourself. I don't have time to stroke your ego.

If I posted my major, you'll just come up with more BS....I've put plenty of facts out there. Judging from what I've seen from doctors, there's no way that they could even get through the undergraduate courses. I'm not posting research on here, and letting you fly off the handle on me, lol....neither do I have time. Go to bed & give up.

Here's one tip to get you started: I see an Atlas Orthagonal Specialist. 10 years of migraines (taking pills the entire time)....3 visits = no more migraines. Why don't you find one of those doctors. You'll quickly be humbled, by the big hole in your education. I'm not explaining why you're misunderstanding what I'm saying, so forget it.

Here's a fact that you can stroke your ego with: I took several different pills for a long period of time, for my acid reflux issue....I'd say about 10-12 years. My natural specialist recommended aloe vera juice.....and hola! No more reflux. Oh wait, I should shut up b/c I'm part of the problem. Oh, and don't forget to tell all of your patients that you could get in trouble for discussing natural treatment, unless the patient brings it up.

Thanks for finally admitting that medicine has problems. That's all I wanted. I actually like you dude, but I am going to state my opinion, regardless of how offended you get.

please solve my patient example to prove your point about webmd being able to do the job of a physician

Thank you

whatever....games again

you call it games, but it is actually central to your argument. This patient will die within hours if the correct treatment is not followed.

Yet you completely put down medicine, state that a dog could do it, and yet you yourself are not up to the task

If indeed, a doctor could save this person's life (and did), what does that say about your entire point on this thread? What does that say about the value of webmd when the fit hits the shan?

trust,

your last post was nothing but a thinly veiled ad hominem attack against me. I have no idea why you have so much anger bottled up inside you but I suggest you seek professional treatment

I will be happy to respond to adult level discussions, but from this point forward I will completely refrain from responding if there is more of the same from you

eric where did you get that whole "ad hominem" and faulty logic thing from? I see you have used that on quite a few threads. you do know that they are synonyms of each other? I also see you are a god er um cardiologist so that explains your whole ego thing.

I have no idea why you have so much anger bottled up inside you but I suggest you seek professional treatment

So now you are a shrink? You can read my words and get inside my head and figure out everything about not only myself but everyone on here who doesn't agree with you?

your last post was nothing but a thinly veiled ad hominem attack against me.

You must have a bruised ego or are paranoid to feel I and others are "attacking" you. You must be sleep deprived from all that high and mighty schooling you did. How's that for removing the veils?

Are you really a cardiologist or one of those web quacks that you have such disdain for? I guess we'll never know the answer since you are going off to sulk. NOW THAT is an attack your high and mighty lordship.

Had to reply, especially when you mentioned the "they don't know what they're doing" thing. I recently had to allow my 81 yr old father be taken to the hospital as he was presenting with signs of congestive heart issues, he already has a pacemaker/defibrillator combo in his chest, OR possible onset of pneumonia, as he had trouble breathing and couldn't get warm, there was a circulatory issue going on somewhere and his demeanor was deteriorating fast. Once they got him in the hospital, they start their poking and tests....I call the next morning, "Well the Dr. wasn't sure so he was doing more tests to rule out PE (pulmonary embolism)." At no time did my Dad ever complain of pain, except when they were jabbing the hell out of him to do more tests....eh..ok. Three days in, I call, and wonder why I haven't heard anything from any doctors. After the course of a week and ONE test that said he MIGHT have had a PE, the rest showed NOTHING for the following 8 days, while they put him on COUMADIN...of all drugs. EXTREMELY debilitating for a person who already has a struggling immune system, keeping him in a hospital where there are so many MORE bad bacteria than there are in his own home. The WORST part of the whole affair....EVERY time I called the floor nurse, the first full phrase I got was I DON'T KNOW.....that is the worst three words you can say when being paid to take care of my family member. Also, the Dr. parading into my father's dimly lit room in a filmy gown....sick people in bed see them as angels when they come in like that. It worked on my Dad....didn't work on me, I nearly laughed out loud. Sure wear your filmy gown...but don't patronize me and my dad into feeling sorry for you working such long hours. You're getting paid quite well to do it. My Dad went into the hospital walking, eating...doing fine, and came out near invalid in less than two weeks...and all they could say, EVERY TIME, was I DON'T KNOW, and ...now that his regular DR. got him OFF the coumadin he never needed....and he can walk again, but must use a walker now. They STILL don't know if he had a PE or not, yea R I G H T. I hope to God, my family are as diligent about my care when I am old and can't control it all myself. I was pretty appalled and won't soon forget the experience.

@11.1 is the answer, Mitral regurgitation?

rick,

yeah, thats it...specifically, severe MR from a ruptured papillary muscle, a well known and very fatal mechanical complication of acute MI.

@eric-2573068

You wrote:

"wow. I was pretty nice to you earlier, but that was before I read this post.

The doctor of medicine has to be the easiest doctoral-level degree there is. When I was busy busting my [expletive] at one our country's top schools, I was busy learning how to think, and how to work extremely hard.

I would love to hear what school and program that was. I could then compare it with medical school and show you how much more difficult it is to gain admission to medical school.

Did your "top school" make you work 100 hours a week, many of them overnight with multiple 30-36 hour shifts operating on NO sleep? Did you have to do this for 8 years, the sum of my post medical school education??"

eric, why did you not point out immediately that an MD is not a "doctorate" i.e. not a PhD?

An MD is a professional degree, akin to a JD or MBA. And like JDs and MBAs, an MD is a skill set, NOT some measure of theoretical knowledge or understanding. An MD is nothing like a PhD.

And MDs wonder why so many people believe physicians have huge egos.

well, since the D stands for doctorate, I disagree with you

I got my degree at an institution that awards PhDs as well

But since there is no definitive answer, its mostly opinion

The "D" stands for Doctor, not doctorate.

As you say, you got your MD "at an institution that awards PhDs as well" (emphasis added)

So you clearly know the difference.

P.S.

Why didn't you refute my comparison of an MD being just a skill set like a JD and MBA?

Hit too close to home?

The "D" stands for Doctor, not doctorate.

You might be right about that...ive heard medical doctor and doctor of medicine. To be honest, it was one of those things that never mattered to me

Why didn't you refute my comparison of an MD being just a skill set like a JD and MBA?

Hit too close to home?

I did address it. I said its really a matter of opinion. A doctorate is by definition the terminal degree of any program. So a JD is a doctorate. An MBA is NOT a terminal degree though, one could get a PhD in business.

That being said, I understand people who decry the dilution of degrees. Now you have doctors of physical therapy, of pharmacy, of nursing. Not saying those people don't deserve the title, its just given to more people than it used to. I also understand people who think the PhD is a more purely academic degree than the other more technically focused degrees

But that does nothing to refute my original point to which you were responding. The doctor(ate) of medicine, and required minimum of 3 years post graduate residency is one of the most challenging educational roads ever conceived. It is truly brutal

And Im sorry, but youre in no place to comment on that unless youve been through it

Eric, I know you're not speaking to me, but I'm scanning your posts faithfully. :)

You mentioned something as a rebuttal to another post that is one of my deep concerns about the medical industry:

Did your "top school" make you work 100 hours a week, many of them overnight with multiple 30-36 hour shifts operating on NO sleep? Did you have to do this for 8 years, the sum of my post medical school education??

Do you believe that any person -- regardless of how much experience or training -- should be treating patients under those conditions?

Isn't that more a form of hazing, with the patient viewed as just a piece of expendable meat?

If not, please explain the purpose.

I have a second question, too, and it might seem quite offensive, but it's a real question. It seems to me that medical school consists mostly of memorizing huge amounts of information. You know more about the brain than I do, so could you tell me if there is any reason to believe a person who is talented at memorization would also have a talent for, say, extrapolation?

I have always wondered if being able to memorize large amounts of information means a person is smart. My ex-husband had a prodigious memory for historical facts, but the guy was actually dumb as a rock. To be more specific, he could regurgitate stuff he'd read years ago, but couldn't plan ahead one week.

dctrtuba -

How much education does it take to act like you're superior, be arrogant, and come up with BS phrases to mask the FACT that you don't know what you're doing?

I can't say I agree with everything in your post, but I had to LOL at that remark. It's one of the funniest things about medicine, IMO.

Doctor (looking learned and serious): You have gastritis. That will be $300.

Patient: I happen to know that -itis means inflammed. I knew that when I came in here. You want $300 to tell me I have a tummy ache?

Doctor (nose in the air): So where did you get your medical degree?

Medical terminology often serves to mask the fact that the doctor is telling you absolutely nothing.

Then he'll add insult to injury by prescribing an expensive drug with side-effects when you could have solved the problem with a swig of Pepto-Bismol.

jerri,

Im very glad you asked that question. Let me address the hours question first

To some degree it may be hazing...older docs went through it, and see no reason their younger colleagues shouldn't do the same. However, i really see that as a minor reason, if it all. Mostly, you need to see that much volume in order to be a competent physician. Keep in mind that residency training is essentially when you learn to be a doctor, as well as learning your specific field. And that training has to last the rest of your life. Sure, you do continuing education, but the strength of a physician's residency training is huge

Is it safe to see patients under those circumstances? Its probably not optimal, obviously. And in fact there has been a push recently to limit trainee's work hours, which have been restricted now twice in the past 10 years or so.

But that brings up a big problem that is often ignored. By restricting a doc's work hours, essentially making him a shift worker, you drastically increase the number of "patient handoffs"; ie, when you transfer the care of your patient to the oncoming doc. Now, I will tell you from experience, that you never, ever know the handoffs as well as your own patients that you admit. You can try and be thorough, write things down, but inevitably, a problem will arise that you did not forsee and the next doc is not as well equipped to handle due to his relative lack of knowledge of the patient

So don't be fooled by the idea that decreasing a doc's work hours is some magical solution for patient safety without its own inherent problems

eric

Now, I will tell you from experience, that you never, ever know the handoffs as well as your own patients that you admit. You can try and be thorough, write things down, but inevitably, a problem will arise that you did not forsee and the next doc is not as well equipped to handle due to his relative lack of knowledge of the patient

so you are admitting you are not infallible? Or are you stating that the DR handing a patient off to you made mistakes? do you think that a patient, in that situation, has the right ask question of the receiving DR? Why aren't the NOTES correct in the patient record? That is why a patient NEEDS to review their records.

jerri,

second question I get a lot. There is a HUGE amount of memorization needed in medical school, compared to law school, where they work on critical thinking. That's because the medical decision making is taught in residency, not medical school. Its actually a better system than law, for example, because new medical graduates aren't just thrust on the job--they are put into a system of graduated responsibility and are monitored with decreasing levels of supervision until they are capable on their own

A good example of medical problem solving is the gastritis example above. Sure, you can take pepto and mask the symptoms, but a REAL doctor would probably check the patient for H pylori, or treat for that empirically, since it is responsible for the majority of ulcers. If ulcers are present, not just gastritis, you would also want to biopsy them because there is a chance they are malignant

Finally, you would address the risk factors this patient may have for gastritis (heavy alcohol use, smoking, NSAIDS) to see if they could possibly be managed without meds

In addition, if ulcers are present elsewhere in the GI system, and there is no obvious reason why the patient has ulcers, it may be worthwhile to look for a rarer cause, something like Zollinger ellison syndrome

In summary, the best doctors I have worked with pick up all relevant information from the patient by asking the right questions, take a very thorough physical exam, and order tests judiciously to avoid side effects and cost.

Thats what truly seperates an average doc from a great one

trust,

ignoring the obvious sarcasm, I'll ask you a simple question: did you ever play the game operator as a kid? the one where you sit in a circle and whisper along a message, and see if the last person is close to the original message?

How often was he so off that everyone laughed?

thats how medical handoffs are. Its not that the notes are incorrect, per se, but there is something that you pick up from actually doing an H+P rather than reading one. Its hard to explain, but it would be like seeing a movie compared to reading a synopsis. Does that make sense?

Its not that anyone is doing anything wrong. And there's a lot of research on how to improve handoffs in medicine right now...just google the topic and Im sure it will come up

Your point about that being a good reason for patients to look at their charts is a good thought. Its usually too late by that point though

To add a point about the critical thinking thing - most science majors, including premed students, are pretty good critical thinkers before they enter med school. Yes, all those science classes involve memorization, but solving physics equations or doing stoichiometry also involves a fair amount of reasoning ability, as well. So, while med school involves a lot of memorization, it is not at the expense of critical thinking - it provides the basic knowledge from which to proceed with a well-thought-out diagnosis and treatment plan.

eric-2573068

Honestly, lets put your webMD to the test.

You are called to see a patient who suffered an MI 4 days ago treated with TPA and salvage PCI. The patient had previously been doing well but now complains of recurrent chest pain. EKG is unchanged. Stat CBC and BMP are unremarkable. Exam reveals a diaphoretic male in moderate distress. There is a soft 2/6 holosystolic murmur heard best at the apex with no obvious radiation.

What seems to be missed in this thread is that Rick 854092 nailed the diagnosis using the power of the Google (and/or WebMD). Guess that does shoot a bit of a hole in the "patients can't possibly be informed about their own treatment" theory. In my entire life there's been only one doctor that didn't exceed my expectations for their profession and that doctor was dealt with accordingly. The difference between him and all the other doctors is that he didn't take the time to listen to a question and refused to provide any explanation as to why he wanted to change the order from a primary doctor already treating the case. He had piss-poor patient relationship and a superiority complex and that's something that will come back to bite him time and time again if it's not corrected. Treat patients like intelligent humans and they'll respect doctors much more.

couple assumptions there on your part

1)Rick used google. He could be a health care professional for all we know

2)Rick got the answer exactly right I was being a bit generous when I said that was right. It was close, but acute papillary muscle rupture is different than run of the mill mitral regurgitation. The former is a surgical emergency, whereas the latter can be asymptomatic and clinically insignificant. I also didn't press him on the next step, which was immediate surgical evaluation, and likely milrinone or other inotropic agent. I didn't mention all this because the point was not to embarass people, but just show that medicine is a bit more difficult than was being discussed

3)One correct answer destroys my argument Even if he did get that question exactly right, that doesn't prove anything conclusively. Its like you sinking a 3 pointer and then saying youre ready to take on the miami heat singlehandedly. Slow your roll there pal

You can try back-tracking or doublespeak as much as you'd like, or put more examples and I'd be willing to bet that answers can be found on the internet just as Rick did with your first challenge. The answer may not be 100% but that's part of the conversation that a good doctor would have with their patient, or the part a mediocre doctor would ignore. The point of the matter is that patients are more informed regarding their care then they ever have been in the past and dismissing their questions or concerns (except in the case of immediate medical intervention for a life-saving procedure, there are rare cases where a patient or family member needs to just stay out of the way) doesn't endear doctors to their patients.

I'm under no assumption that I know as much as a doctor does about their field of expertise any more than I don't believe they would be fully knowledgable about my field, however just as I treat people with respect while performing my job a good doctor will do the same. You're obviously still young based on the answers you've given to the various probes into your biography, hopefully you'll eventually understand that patients have every right to question why you're recommending a treatment or pharmaceutical and not decide for yourself that they're beneath you and not worth your time. Unfortunately that's the impression that you're giving off here.

its not back tracking. Google both "mitral regurgitation" and "acute papillary muscle rupture" and see if the descriptions and treatments are exactly the same. Its plain as day, but if you are too lazy to do the research, don't blame me

I'm under no assumption that I know as much as a doctor does about their field of expertise

Your statements show the opposite. Your first example where you argued with your doctor you were dead wrong. Then YOU backtracked and made up some other stuff to make it seem like you were really right all along. It was unsuccessful

You're obviously still young based on the answers you've given to the various probes into your biography, hopefully you'll eventually understand that patients have every right to question why you're recommending a treatment or pharmaceutical and not decide for yourself that they're beneath you and not worth your time. Unfortunately that's the impression that you're giving off here

I may be young, but experience wise you are not even close to me. I have no problem with questions, but if I encountered someone with your attitude I would politely ask that you can follow my recs or find yourself another doc.

As long as we're trading impressions, my impression of you is that you are not nearly as smart as you think you are, and have a lot more to learn about medicine until you can make some educated comments

Same old BS, sorry to say. I'm starting to wonder if you really have any idea how bad you're making your profession look here on the boards. There's way too many good doctors out there to be brought down by doctors that very obviously are not up to the task of patient care in addition to the medical aspects of the profession. This is definitely a case where the little "!" in the corner will come in handy since you provide absolutely no benefit to this forum. Your comprehension skills seem to be lacking in that you only read what you want to and ignore the remainder, hopefully you keep that trait here on the internet and don't let if affect your medical decisions. I hope for the sake of your future patients you grow up and learn that you're not the only intelligent being on the planet.

put more examples and I'd be willing to bet that answers can be found on the internet just as Rick did with your first challenge

I accept your challenge:

A 68 YO M with ischemic cardiomyopathy and EF 28% s/p BiV-ICD returns to clinic for f/u. He complains of palpitations occuring frequently over the past few weeks. These are not associated with dizziness, loss of consciousness, or chest pain. However, they are frequent and quite bothersome

Interrogation of his device reveals frequent episodes of tachycardia of a HR of 180 bpm. His device settings are as follows:

VT1 zone 120-140 with ATP x 3 followed by shock x 1

VF zone >140 with ATP x1 followed by shock x 6

lower tracking rate of 40 with upper rate of 175

His pvarb period is somewhat shortned. His atrial lead is sensing and pacing appropriately. There are spikes on his a lead electrogram following the surface qrs complex His ventricular lead is also functioning normally

What is your diagnosis and treatment hotshot?

Eric-

This is sad. How many of these do you think you have to put out there before you "win"? A person's perception is their reality, whether it's true or not. Those with negative doctor views on this forum are not going to change their opinion because of you and these "try and be as good a doctor as me with google" scenarios are doing nothing to improve peoples perception of you or doctors in general. The only thing you are doing is re-enforcing the negative attitudes of people towards the profession you love. Let it go. Enjoy your holidays.

Thank you pathforlife. Sometimes doctors just don't seem to get that they are treating people.

for the record, i'd love someone involved in this thread, other than rick and eric himself, to come up with the answer.

2 and a half months, and no takers...

if anyone cares about the answer, its pacemaker mediated tachycardia

i probably screwed up a little by making his heart rate greater than his upper tracking/sensor rate though...

Dctrtuba.. I hope you are never in a motor vehicle collision and placed in an ICU. You'll find many an MD or even DO but very few naturopathic practitioners there. When your guts are hanging out on the table and your intestine is perforated you'll need a good surgeon and strong antibiotics along with follow up by one of those MD's you so dislike.

I do agree that not all physicians are qualified to be practicing medicine but to say that all physicians do not appropriately treat or care for patients is an over-generalization at best.

As far as med school to become a physician goes, an MD/DO is one of the most academically challenging degrees to obtain. I've pursued/obtained degrees in numerous fields so can legitimately state that claim.

Mike --

I hope you are never in a motor vehicle collision and placed in an ICU. You'll find many an MD or even DO but very few naturopathic practitioners there.

True. That's because the AMA -- that unelected branch of our government -- successfully suppressed all other schools of medicine so that they cannot learn or practice surgery. Did you know the AMA was formed for the express purpose of suppressing homeopathy?

And while I'd want the only trained person in the room if I required surgery, I would also want the best-trained person in the room if I had a chronic disease. That almost certainly would not be an allopath. It is in my lifetime that they were hooting at the crazies who believed diet had anything at all to do with health.

It's not either/or.

The problem is we have no convincing evidence of the efficacy of homeopathy. there is lots for allopathic medicine

I know what you are going to say; bias, pharma, money, yada, yada, yada

Maybe true, maybe not. But the bottom line is that the evidence for your POV is lacking

This is by far the most intelligent post on this thread so far.

I LOVE patients like this--people who obviously care about their health, have all their records, and want to work as a team with their health care provider

Im not suprised your dad is a veteran--I have worked in the VA hospital in the past and I adore taking care of veterans.

lol - I'm a veteran, and I bet you'd hate me....since I actually will challenge what you have to say and prove your diagnosis with facts. I'm a very pleasant person to talk to, but am extremely serious about my health.

I will think for myself, and if you say something questionable, I will ask you about it.

My wife has an obgyn who admits all of this stuff that I've said anyway....and what I said has nothing to do with my treatment. And no, I don't care what kind of doctor you are.

There's a lot of things that my students wouldn't be able to get on their own. Experts should be able to produce results that has a large amount of the population upset. It's a rare case that my students question me. When they do, it's not a problem. I listen to them, and we come to a solution. I don't get defensive. NO, I didn't say that YOU specifically get defensive. ....just trying to quell your BS "assumption" statements. Oh, wait, I'm part of the problem. You haven't made too many intelligent statements on here, so you're really wasting your breath here trying to speak with me.

The real problem here, is that people take what you say, and don't think for themselves. I'm not saying that you're always wrong, or anything. But yes, there would be less suffering if people would think for themselves.

I know several doctors who would agree with everything that I've said in this discussion. There's no such thing as an incurable condition, for instance. Someone who is "screwed" by the medical industry enough times will get just as upset as me, and speak up. I'm sorry you have a problem with it. There are plenty of doctors out there, who are OUTSTANDING at problem-solving....and will research their tails off to figure out the cause of the patient's issue. That's a doctor who cares about his/her patients. That's how I treat my students. I don't give up on a problem until it's fixed. I don't care if the patient is irate, they still deserve help. I don't care if the patient is cussing me out. I'm still going to bust my tail for them.....b/c I'm the person with the education. You see, we get education to help people. That's the sole purpose. Money and all that other stuff takes a distant second.

You haven't made too many intelligent statements on here, so you're really wasting your breath here trying to speak with me.

There was neither an intelligent statement or a fact in that entire post, so I tend to agree with your conclusion

If your student had an honest question, im sure you wouldn't get defensive. But if he told you he read the cliffs notes on a book youre trying to teach, and he insists that your literary theory is flat wrong, Id bet you might get a little peeved

Lets compare apples to apples, shall we?

There you go again eric.. putting the messenger down with that "You haven't made too many intelligent statements on here, so you're really wasting your breath here trying to speak with me."

translation... I think you are beneath me and I won't listen to a thing you have to say. That may not be what you intended to say but that is how I and perhaps a few others see those words.

Maybe I would....but as a professional, I would get a handle on my emotions and work with the student.

There was neither an intelligent statement or a fact in that entire post, so I tend to agree with your conclusion

lol, so that makes us both dumb, I guess. whatever, so does that make you feel better. Like I said, just go do some research and look at results and patient satisfaction (for starters). If people are constantly coming back, how successful are you being? Here's a tough pill to swallow -- the Gerson therapy cures cancer :)

I'm not trying to be your worst enemy dude, but like I said, I'm going to state my opinion. People judge the quality of your education, by the results. You have to consider all angles.

There you go again eric.. putting the messenger down with that "You haven't made too many intelligent statements on here, so you're really wasting your breath here trying to speak with me."

Youre a pretty selective quoter, arent you? Did you even see that I was only repeating his remark to me? Shall I quote you and all the ways you've put me down on this thread?

What does that say about you? That its ok for you to make disparaging comments to me, but not ok if I do it?

My problem with being an “active participant” in my health care is my doctor. I am informed about my health and I know that there are some tests that can be done at physicals that I do not need. But when I tell the doctor that I am refusing the test and exactly why I am refusing the test, he waited until I was in a compromised position and did the test anyway, while calling me a whore and a liar.

Please don’t misunderstand me, I’m not painting all doctors with this brush. My point is that some doctors don’t allow you to participate in deciding your health care. I will not be going back to this doctor.

harder than you

right, lol -- based on the results of medical doctors, it doesn't look like it.

yeah, penicillin, polio vaccine, AIDS research and the jump in our life span over the past century....that's nothing

good night - this is pointless.

feel free to post another smart comment. hopefully some people on here will see my point, and go read for themselves. the information is everywhere, regardless of what you say.

@eric-2573068

"yeah, penicillin, polio vaccine, AIDS research and the jump in our life span over the past century....that's nothing"

They were the work of PhDs, not simple MDs. Please stop confusing the two -- one (the MD) is just a skill set like a JD or MBA.

it is extremely embarrassing for you not to know that Jonas Salk was an MD.

Wow, im honestly shocked....i thought that was common knowledge

Somewhere, your 2nd grade teacher is ashamed of you

An MD working with PhDs...

Please gloat somewhere else.

BORIS STOP wasting eric's time. Since you don't agree with him he does not value your opinion. Feel free to blow smoke up his backside and he will smile.

Thank you, trust_verify.

Good advice!

Since you don't agree with him he does not value your opinion. Feel free to blow smoke up his backside and he will smile.

You see what I mean trust? You constantly LIE about what i have said. Go ahead, try and find that statement from me anywhere.

You can't

Dont whine next time I call you out on your lies

There that calling me a liar is...

li·ar/ˈlīər/

Noun:

A person who tells lies.

Synonyms:

fibber - storyteller - fibster

so you at least agree you lied. That's something

boris,

by the way, here is your quote in reference to the discovery of the polio vaccine and other medical advances:

They were the work of PhDs, not simple MDs.

Again, Salk was as MD. This is definitive evidence of your ignorance

here is your second statement:

An MD working with PhDs...

Your two statements are in direct conflict. You are changing your tune

Please gloat somewhere else.

No. Im going to gloat right here IN YOUR FREAKING FACE!

Eric --

God, you'd be easy to bait. And attractive to bait, too.

But I'm actually starting to hear that little voice telling me to stop it, someone is in real pain.

I don't think you're a doctor. I do think you've had some exposure to the study of medicine -- perhaps a personal fascination, perhaps one of those people who become "fans."

Get some help. Just get some help.

@eric... so finally you admit to CALLING me a liar? I haven't lied. I simply provided the definition for you. My statement was reading between the lines when you stated your employees performance was such that you had to go behind them and do their jobs because you didn't trust them to do it correctly. You stated you had a medical assistant doing your insurance work and felt you could do a better job than them.

I'm just curious. I've given you the benefit of the doubt that you are a DR and a Cardiologist at that. If you are posting online all day and night, how do you have the time and energy to see patients? I'll be back on schedule first of next year but unless you are on vacation surely your patients aren't coming first if you aren't at your best.

God, you'd be easy to bait. And attractive to bait, too

Thanks! Oh, I see, you messed up your english. You mean baiting me is fun. Well, ive never heard of anyone so proud of themselves for being annoying, but I guess we all have to have reasonable goals for ourselves, so congratulations I guess...

don't think you're a doctor. I do think you've had some exposure to the study of medicine -- perhaps a personal fascination, perhaps one of those people who become "fans."

Get some help. Just get some help.

Get help for what? For thinking Im a doctor when you don't think I am? Im not sure thats in the DSM-IV anywhere

At any rate, you are OBSESSED with my occupation. You have mentioned it in at least 3 posts, always absolutely sure of yourself that Im not a doctor without any real evidence either way. Ive asked you to provide some and you havent

Anyway, I couldn't care less what you thought. Because it is completely irrelevant. I could be the guy cleaning out the hospital room, or not work in the medical field at all

In case you didn't notice, the topic of the article we are discussion is NOT "Is eric-2573068 a physician?"; its about patient access to med records. Whether Im a doctor or not does not change the validity of my points. Again, I could be a janitor but if I make a persuasive argument, then who cares?

Wow - such venom against doctors!!! Why??? I read this at the hospital on a break today, and afterwards I looked around for the PhDs in the ICU with me saving kids lives....and what do you know, never found ANY! And I actually have a Master's degree in addition to my MD, and I somehow managed to do the work, write my dissertation and defend it ON THE SIDE while a resident - so much for other disciplines being more difficult and demanding than medicine!!! If as some of you have stated a dog could be trained to do what we do then where are all the people training the dogs???? I find it amazing that so many people feel that somehow a little internet research gives them as good a grasp of medicine as years of training - I would NEVER think that about most other professions that are not mine! I respect the time and training that others spend to try to excel at their fields and simply expect the same courtesy from others.

As with any profession their will be variation in the level of competency and skill, but do you simply say nasty things about all teachers or mechanics, say, based on a single anecdotal experience???? I think I am pretty good at my job, the nurses that I work with seem to like and trust me, but there are people that I have interacted with that I would not wish on an enemy. They are rude, unreasonable, nasty and demanding, demeaning to the hospital personnel for no real reason, and overtly LOOKING for ANYTHING that they can use both to bolster their own negative opinions of medicine and to personally enrich themselves. It seems to me that several of those people (or perhaps their relatives!!) are on this forum!!!

Sure you can read my notes - but then do not fault me 1) if you do not understand what you read and think I am prevaricating when I try to break it down to your level of understanding or 2) if you don't like what I say about you in those records. The record is kept for the benefit of the caregivers - yes you are entitled to it but it is NOT designed to keep you happy!!! Yes there will sometimes be errors, but many times what you feel are "errors" are based on behaviors observed by the staff but denied by you. If you lie continually and undermine your care or that of your child IT WILL BE IN MY RECORD!!! And I really don't care if your feelings are hurt by that - my job is to PROTECT THE PATIENT, in my case the child, and my records will reflect that.

thank you for the best post on this thread by far!

You have successfully said in 1 post what I have attempted to convey in many posts here, with I think less than stellar results

I could have used you earlier!!

(Happy holidays -- been gone a bit!)

@eric-2573068

You said: (15.8)
"boris,
by the way, here is your quote in reference to the discovery of the polio vaccine and other medical advances:
They were the work of PhDs, not simple MDs.

Again, Salk was as MD. This is definitive evidence of your ignorance"

eric-2573068

Oops, I made a typo.

And to all, it was not a small typo: I wrote "simple" when I meant to write/say, "simply" MDs -- "simply" as in ONLY MDs.

Believe it or not, there is a difference between an MD (skill set) and MD/PhD (researcher.)

I really hate bulllies!

well, your liver tests could be normal and you could still be drinking...not saying thats the case, just playing devils advocate

Eric the correct response is that the "denies xyz" is standard lingo for doctors. Or did you miss that class? My charts have "Denies drug use, alcoholism, smoking" It's a cover their a##. Fact is it's near impossible to prove a negative. I don't smoke, use other than prescribed drugs and rarely have a beer. See that's one of those phrases a DR should explain to their patient, but the DR probably doesn't have time to explain and would rather the patient not even know those words are in their records.

Trust is right. The word "denies" means nothing more then you said no, aka you denied drinking. Doesn't mean they don't believe you.

I've seen my records and I had a "denies husband abuses" in it. I flipped until my husband explained the lingo. It really is standard.

eric-2573068

"well, your liver tests could be normal and you could still be drinking...not saying thats the case, just playing devils advocate "

Based on your (many) previous posts, I'd call what you're doing TROLLING. IMHO.

so, in other words, you think that liver enzymes MUST be elevated in a drinker?

No, eric-2573068,

I think I was pretty clear when I called you a TROLL.

Elevated liver enzymes can be a result of a lot of things. All real MDs would check this further.

I still think you are a TROLL, IMHO.

Boris... LMAO what can I say?

In all honesty I'm surprised the three of us have NOT been visited by our favorite moderator SALLY.

Be careful crossing bridges folks :)

wow boris, did that topic fly over your head...

You have it backwards

we are not discussing what the differential diagnosis of elevated liver enzymes is; we are discussing whether drinking can CAUSE elevated liver enzymes

Let me make it simple so you can understand...not are all sweaters red, but is YOUR sweater red.

And that point is central to your argument. If Im correct, then how can I be trolling? If I bring up a valid point?

There....better?

eric actually this sub thread is discussing the terms used by the medical profession within a patient record... specifically the terms that begin with "denies xyz". Perhaps a less harsh phrase would work but I'm guessing that "denies...." is the standard and is a cya term. Perhaps using the patients own words like "Patient states they do not use ......" "Patient states they do not have......" Denial is an ugly term. Patient denies having poor eye sight as an example. Perhaps you would care to explain why they use the term deny or acknowledge it is the standard phrase?

trust,

you may have missed this, but I was responding to boris's post above. Read it again, then read my post, and I think it will make sense to you

As for the phrase "denies xyz"..ugh, I guess youre right? Ive never really thought about it, nor have I found anyone that did. If a patient asked me about it I would explain that it is just a term we use, and does not carry the same connotation as it does outside of a chart. Honestly, I think if you provide good care to a patient, that kind of stuff is really insignificant, don't you think?

Anyway, I use "no etoh" because its quicker :)

my point exactly.

When you mentioned that your wife is a nurse, I was reminded that if you want to find a group of people who generally don't like doctors, look no further than nurses. To me it says a lot about doctors that the group of people that have to work the most closely with them is the same group of people who don't like them.