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part(not all) of the issue of rising cost is a lack of trust both between doctors and patients...and patients and doctors.

doctors sometimes are mistrustful of their patients-

for example 2 out of 3 of my chronic pain patients fail their urine drug screeings - either not taking the pain medications I'm prescribing(which means they are potentially selling it) or, more commonly, by having another medication in their urine that I'm not prescribing - such as oxycodone, vicodin or even methadone.  I'm at risk of losing my license if something bad happens to that patient and am wary of any patient in pain requesting narcotics.  It rarely seem to be an effective way of controlling pain.  I've seen 2 doctors pulled from their practice recently regarding prescribing pain medications and patient's taking other pills at the same time.  It's hard to trust my patients when they tell me one thing in the office, but then do another(especially when I advise against using other narcotics at the same time explicitly). this occurs 2 out of 3 times - both with patient's i suspect and those i would have never guessed.

patient's don't trust doctors - I try to convince patients that expensive imaging tests such was ct scans/mri's aren't always indicated (or helpful)for back pain, and other symptoms.  a scan doesn't always tell us an answer.  but of course, I'm quick to order one when i think it is needed.  for example, a patient came in to see me just last week, demanding mri of his knee and hip before trying conservative care.  He was unbelieving when I tried my best to convince him otherwise.  another patient is upset that I won't prescribe a once a day antibiotic for her urinary infections rather then treating episodically with antibiotics(she doesn't want to take the time to bring in a urine sample three times a year. i won't even require an office visit!).  she just wants the problem quickly fixed regardless of the risks or consequences such as bacterial resistance, diarrhea, etc.  I only have 15 minutes to try to convince untrusting patients of these difficult decisions.  it's easier and pleases the patient just to do what they want.  patients prefer to see a specialist, because they believe it will provide better care, but they get upset when they have to pay the bill. 

i'm sorry to sound cynical, I just finished residency 1.5 years ago.  i am still fairly idealistic.  i love working in primary care.  but it gets difficult and trying when patients don't understand(or try to understand) the idea that more isn't always better.

i'm very certain that both the health care providers and patients both need to make concessions to help make health care more affordable.  Trust is an important part of this.

posted 2 years, 3 months ago
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