I posted a blog yesterday defending Doctors in a case where the Doctor was accused of negligence when a boy died of Anesthesia overdose during Cosmetic Surgery in Bangalore,India.
It is not that I am always on the side of Doctors.
I have posted a couple of blogs on Doctor’ unethical practices including administering useless medicine to patients.
Now Doctors, in a study conducted on Doctors selected at random, for medical practice, have admitted to giving useless medicine like
like low-dose drugs, vitamins, nutritional supplements or an unnecessary exam.
Story:
The surveyed doctors said they prescribed them to induce a “placebo effect,” to reassure patients or because patients pushed for a treatment.
“For authorities to put their heads in the sand and pretend (placebo treatments) are not being given out is not helpful,” said Jeremy Howick of Oxford University, one of the authors of the study, which was published online Wednesday in the journal PLoS One. “We need to think of ways to maximize the benefits of using placebos,” he said.
Howick and colleagues used a Web-based survey and got 783 responses. The sample was drawn from a list that included 71 percent of all doctors registered with the General Medical Council, the governing body for doctors in the U.K.
The survey asked doctors if they had ever used a true placebo, like a sugar pill or another kind of dummy treatment such as a drug not meant for the patient’s condition or a non-essential examination including blood tests and X-rays. Nearly all of the doctors — 97 percent — reported having used some kind of placebo treatment at least once, while 12 percent reported having used a fake pill.
About 77 percent of doctors said they used some kind of placebo treatment every week; more than 80 percent of them said their use in some circumstances was ethical.
The “placebo effect” treatments included unnecessary physical exams, joint injections, physical therapy, peppermint pills for a sore throat and antibiotics for infections where they would not be effective.
Dr. Tony Calland, chairman of the British Medical Association’s Ethics Committee, said he was disappointed by the findings. “Prescribing something that you know is of no value is not ethical,” he said.
A previous study found about half of U.S. doctors regularly give their patients treatments that probably won’t work without telling them, and the practice has been reported elsewhere, including Canada, Denmark and Switzerland. The American Medical Association says physicians may only use placebos if the patient is aware.
In 2011, the German Medical Association recommended doctors use fake pills and other placebo treatments more often and said patients didn’t necessarily need to be told.
Some small studies have found dummy pills work even when patients are explicitly told what they’re getting and others have documented the fake treatments can spark a biological effect in the body.
“For illnesses where there is no truly effective treatment, a placebo or alternative therapy is a fine thing to do,” said Dr. Walter Brown, a clinical professor of psychiatry at Brown University and author of a recent book on placebos. He was not connected to the new study”
Let me add some more practices, at the ground level , indulged by the Doctors in India.
1.Most of the Doctors do not examine the patients at all.
They hear the symptoms and immediately scribble some Tests.
These ‘Tests’ have financial implications for the Doctor and the Corporate Hotels, sorry Corporate Hotels.
A scan , in general costs Rs.2000.
But a patient is charged any where between 6000 -8000!
50 % of this , between 3000- 4000 goes to the Doctor.
He gives a cut to the Hospital whee he is a Consultant.
2.The use two different types of pens or inks to write a prescription.
For a a particular type of pen or ink used, the Labs do not conduct any Tests and give a normal parameter Report.
Of course the patient is charged!
Suggesting useless procedures.
This happens mainly in Appendicitis cases.
Appendicitis procedure involves the removal of the Appendix.
Till date no body knows what function Appendix serves and te side effects of removing them.
The patient is threatened that the bursting of Appendix would poison the syste,.which is true.
But that it might be ruptured is a decision for a Doctor to make.
Removal of Uterus.
On unsuspecting patients, i have seen doctors, suggesting removal of the Uterus even for Urine Infection!
Same test is repeated for the same patient in a gap of a day!
Useless Drugs, and at times Procedures .
Physicians recommend against many procedures patients have come to expect, including imaging for low back pain (unless it has lasted more than six weeks) and any cardiac screening, including EKGs, in patients without heart symptoms.
The widely used “DEXA” X-ray screening for osteoporosis landed in rheumatologists’ crosshairs. It should not be done more than once every two years, they advise, because changes in bone density over shorter periods are typically less than the machines’ measurement error, which can cause women to think they’re losing bone mass when they’re not.(life,national post)
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If you’re having surgery, you may wonder if you need an imaging test of your heart to make sure it is safe for you to have the surgery. But if you are not having heart surgery—and you haven’t had a stroke and don’t have a severe heart condition, diabetes, or kidney disease—the imaging tests usually aren’t helpful. Here’s why:
The tests usually aren’t necessary before low-risk surgery.
Some imaging tests use sound waves to take pictures of the heart. This is called echocardiography. Other tests use a small amount of radioactive material. These can be called either a nuclear or CT scan.
Doing a heart imaging test can show whether you’re at risk of having a heart attack or another serious complication when you have surgery. The test results may lead to special care during or after surgery, delaying surgery until the problem is treated, or changing the kind of surgery.
But the risk of heart complications from minor surgeries, such as a breast biopsy, eye or skin surgery, or any “same-day” surgery, is very low. There really isn’t anything doctors can do to lower the risk further. In other words, heart-imaging tests are not likely to change anything. In fact, even major surgery is safe for most healthy people who feel well and are physically active.
Unless you have heart disease or other risk factors, usually all you need before surgery is a careful medical history and physical exam.
Heart imaging tests can pose risks.
The tests are usually very safe, and some can be done with little or no radiation. But if your risk of having a heart problem is low, the tests can produce a false-positive result that could cause anxiety and lead to more tests and an unneeded delay of surgery.
For example, you might have a follow-up coronary angiography (cardiac catheterization). During this test, a catheter is inserted into the heart through a vein, dye is injected, and x-rays are taken. The risks are low, but exposure to radiation adds up over your lifetime, so it’s best to avoid x-rays whenever you can.
Imaging tests can cost a lot.
An imaging stress test costs between $500 and $2,000, and a cardiac CT scan costs $500 to $600. If abnormal results lead to coronary angiography, that can add about $5,000 to the cost. So the tests should only be used when the results would change the way your surgery is done.
Check this site for more before you take any decision on Tests for you and discuss with your Doctor.
It is your right.
http://www.choosingwisely.org/doctor-patient-lists/heart-imaging-tests-before-surgery/
Please watch this clip on Medical expenses from STAR Vijay.
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