Pocket Doc

 HOUSTON, WE’VE GOT A PROBLEM

An online MD story illustrates the sorry state of primary medical care today. On recode.net, we found fdsfgthis: “A Doc in Your Pocket: Doctor on Demand Gets Smarter” By Katherine Boehret, wherein one can get medical treatment on-line with a ‘real’ doctor. You can even get prescriptions, which is perhaps the main point.

Now this launched a bit of an argument between ‘us’. Who are we? These blogs are authored by Dr. Mike Nichols, a long time MD, and Dr. Charles Davis, a long time PhD and patient.

Mike’s response to the on-line doctor was: “Just an avenue to offer prescriptions: you could not discern a viral bronchitis, no antibiotic needed, from a full blown pneumonia, antibiotic needed. Another demonstration of the distorted role of public perception of the role of an MD. Blah, blah, blah, blah,[sic].”

However, Charles saw it differently, “Not sure any public perception of the MD as legalized drug dealers is driving this. There are serious accessibility issues, cost issues, after hours issues, and Emergency Room price gouging issues. These are systemic and these are more likely the cause of this alternative medicine.”

The exchange continued, but we will spare the reader, except to point out that Mike is seriously understating his objections. Other than an annual physical, a patient will seek a doc for a specific malady, fever, broken bone, etc. However, a good experienced doc will look for a thousand different symptoms in the space of a few moments. Good docs have the training and encyclopedic memory to do this. A malignant melanoma might be spotted, or morbidly high blood pressure. How is the online doc going to take a blood pressure, or even a temperature? Partial answers are coming in telemed, but not enough yet and not accurate enough yet to trust this system; not now, perhaps never.

The real point is: We are both right. (Mike: Charlie has the better of the argument, though still, both of us are right)

Access to medical care has been made inaccessible and expensive. This is largely the work of governmental bureaucratization and the insurance industry, which dictates which care can be performed and which not and at what cost. Many hospitals game the system to maximize the amount billed. Several have publicly admitted it. A post on this, Obamacare and socialized medicine, is promised.

On the other hand, the pharmaceutical industry, by virtue of its mega-advertising budget, has convinced the population that medicine is all about getting a doctor to prescribe one of their wonder drugs.  Just look at the ads. “You may need this or that, see (i.e. pester) your doctor.” There is a fully implied patient self-diagnosis here, and the role of the doc is relegated to writing the prescription. These same pharmaceuticals are also continuously wining and dining all the doctors in attempts to convince them as well.

Where has this pushed public perception? “The docs don’t heal, the pills do.” “Get a pill.” “Avoid the ER – even a co-payment will be a budget buster.” “Live with it till a walk-in clinic opens.” “Don’t get sick on the weekend”, etc., etc.  Small wonder there is a market for online docs.

Something has gone off the rails here. The fundamental role of a doctor is to heal. He or she is not a retail outlet for the pharmaceutical industry. In fact, the current crop of wonder drugs hardly work for anyone. Why has the practice of medicine gotten into this place?

Dr. Mike answers thus: “My decades in the medical trenches have taught me that most patients innately, reflexively, trust their docs. However, what we do on a day-to-day basis is not science, but an art, the art of healing. This should be more about the relation between the patient and doctor and their respective concepts of what constitutes health, and how that can be attained than the cold comfort of a smartphone in your hand and the picture of a doc on the screen.”

But that is no longer how it works. The modern medical model is a strange dynamic between insurance company payment policies, pharmaceutical marketing, but also, and here is the scary part, by the biases and predispositions of the medical school elites. They decide what is taught. What is scary.

The medical model of science never contemplates anything other than a drug solution. Medical journals indeed report the benefits of non drugs, peanuts or exercise for instance, but you never see this in the statistics quoted for statins or blood pressure medicines or the like. It’s always pill versus pill or pill versus nothing. As though it’s pills that really matter.

What’s the fix? For the doctor side, medical school has to change. Their working assumption is that the patient is some sort of inert lump that will never change or interact, so therefore prolong whatever the patient has with the appropriate pill. Their working assumption simply isn’t – well – working. This isn’t healing.

For the patient: Rethink health. Go slow, try good food, exercise, relaxation. Stop and measure. Remember the important marker is not your blood pressure or cholesterol level, but your overall health and long-term prognosis. Medications are seldom the right answer. Docs have their degrees, concern and compassion, but only 15 minutes, if that, to cure you. They cannot change human nature and in 15 minutes they certainly cannot change yours. Give’m a break! Take care of yourself for crying out loud!!!

PS Thank you, Mark R; a patient sent me the recode link.

  2 comments for “Pocket Doc

  1. January 23, 2015 at 10:19 am

    Hence the need for a more prophylactic approach. Universal availability and coverage for diagnostics that are truly meaningful. However, for many, being able to get the data that validate an individual’s “healthy” lifestyle can be cost prohibitive. Even with insurance, requests beyond the basic (and often useless) tests are not covered.

  2. January 23, 2015 at 4:56 pm

    There is good news on this front: the cost of tests, at least cash paid, is coming down dramatically. Still, proper testing, properly interpreted and applied, is the one of the best things on which to spend your money. Great contribution, jgeeone. Dr. Mike

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