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Rapid Responses: Rapid Responses published:
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![[Read Rapid Response]](/icons/misc/sectionDOWN.gif)
how undemanding can we be before we die?
- Wendy M McLean (13 June 2003)
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Rapport
- D Nethercott (13 June 2003)
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Are Doctors surgerys to become dispensaries?
- Stephen Beazer (16 June 2003)
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Care in the age of Internet needs Internet solutions
- Sir Nil (16 June 2003)
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The Demanding Patient
- Stephen Beazer (2 July 2003)
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Wendy M McLean, retired home
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As a patient I would like to think that my doctor is better informed about treatments than I, but that it is for me to decide whether to risk the adverse effects of treatment. Unfortunately in these days of busy doctors and easy interent access my gp is not always as well informed as I am. I have a nut allergic child. The initial reactions were mild because I recognised the risk and treated them rapidly with antihistamine. My gp was poorly informed and initially refused a referral to a paediatric allergy clinic. Blood tests show my child is extremely allergic to peanut. We now have the epipens that may save my child's life, since accidental exposure is almost impossible to avoid. Doctors are not infallible - and a patient has more time to seek out information about their problem. Competing interests: None declared |
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D Nethercott, SHO UK
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I am not at all surprised to hear that establishing good rapport, or otherwise, with your patient effects their outcomes to some extent. Whilst we all should (and mostly do) strive to be egalitarian, immunity to the instinctive and unavoidable reflex of not liking somebody is impossible. Patients are fooling themselves if they think that being pushy and interrogative will always be to their advantage. Just as with people who are demanding in any other aspect of life this often simply evokes reciprocating antagonism. This is especially so when time pressures are significant and having a nice long chat with a patient is a luxury only afforded by one's own good will. Anybody who is so cold and unresponsive to the vagaries of human interaction probably shouldn't be doctoring in the first place. Should they? Competing interests: None declared |
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Stephen Beazer, self employed YO12 4UH North Yorkshire
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I am a sufferer of Sarcoidosis a disease that is ruining my day to day life in many ways. Through research on the internet I have gained valuable knowledge about this disease and possible ways to send it into remission. I gather Sarcoidosis is regarded as "too specialised" by the BMJ and therefore not mentioned in the journal. Presumably due to doctors following guidelines set by the BMJ that is why very little is known about Sarcoidosis and it’s many all too commonly misdiagnosed symptoms which in turn leaves the GP totally in the dark and unable to offer the correct medication or patient reassurance. I have never been a burden on my GP. But unfortunately in recent times due to prolonged ill health I have needed to seek professional advice, however, simply being told “it’s very rare”, “it might go away on it’s own” and “there is nothing we can do at this stage” is hardly encouraging or reassuring to me the patient. Therefore I assume I now fit into the category of the "demanding patient" as I visit my GP and Specialists with regularity clutching various items of literature I have obtained through my research on the Internet. I have the time to do this research cutting out many valuable hours of doctors time. Surely this type of “homework” is invaluable to the medical profession I am not asking for anything other than their time to read the information and report on their findings. If patients like myself were to stop this approach, take up no more than their allotted 10 minutes of the doctors time and at best be prescribed another ointment or course of tablets in an attempt to pacify us presumably that would make life a lot easier for all doctors. But what about the patients who need answers and remedies? Competing interests: None declared |
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Sir Nil, Internet patient activist Retired SE83545
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Sirs -- The care is rather conservative and old fashioned in many aspects although it at the same time stands at the front line of science and is impressing successful. Naturally, this is caused by the fact that care is constituted of millions of individuals with different backgrounds and skills. The medical research is also focused on new therapies and diseases rather than how the care is actually delivered to the patient. Patient involvement it important, but can consume time and cause increased costs of care and thus care for less individuals, as care are often publicly funded. To make the care more efficient, safe and equity Internet solutions are desperately needed. Prior to the visit to the doctor a web based questionnaire about the disease and medication could be answered. Then the doctor could read it at the consultation and add additional questions. Thus a greater part of the visit could be used for discussions about the patients needs and wishes without causing increased need of time. Another time saver is that the protocol could be included in the patient record. The editorial in this issue criticizes doctors of being to focused on their own person. I think this is not only the doctors fault, but the fact that care is dominated by women (90-95 %). I have worked in a sector with 97 % women and experienced meetings with only women except me, where the only questions have been related to staff specific questions and the customers perspective, when brought up by me caused irritation. My own impression is thus that women have it more difficult to leave their own personal sphere also in their profession and this have affected the care negatively, as they dominate it. Competing interests: None declared |
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Stephen Beazer, Self employed Scarborough YO12 4UH
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I refer to my earlier post and wondered if anyone could suggest how I deal with my predicament I am deeply concerned at doctors failure to remove their blinkers on the subject of Sarcoidosis. I do not want to be refered to as a "demanding patient" but due to receiving no co-operation or support towards embracing new research via medical people in America I am faced with shutting up and continuing my life on Steroids. Which If I refuse to take my hospital will no longer treat me. I feel this goes against the "Do no Harm" oath since there are safer drugs available that could be used instead. On several occasions I have pointed out to my GP and specialists alike that Steroids are damaging to the Sarcoidosis sufferer and are not the way forward to either send the disease into remmision nor cure it, it merely stops inflammation while shutting down the immune system leaving the disease totally intact, which will return as soon as Steroids are discontinued. I as many Sarcoidosis sufferers feel that as long as inflammation is reduced or no longer present on X-Ray it is regarded by the doctors as a result and the patient can be sent home. Does anyone have any suggestions? Competing interests: None declared |
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