Medical Doctors / General Practitioners

[gdnp]

Same thing applies with driving and incorrect turn signals, or wearing the wrong seatbelt; or wearing the right seatbelt the wrong way; or driving on the wrong side of the road.

Which is why you get tickets for doing most of these.

Look, if you want drugs without a prescription go to a "Canadian" internet pharmacy. Their drugs are cheaper anyway.

 

[Richard Masters]

Which is why you get tickets for doing most of these.

OK, so give tickets to people who misuse their medications.

Look, if you want drugs without a prescription go to a "Canadian" internet pharmacy. Their drugs are cheaper anyway.

They are cheaper if they even exist.

Look, if it bothers you that I'm presenting a reasonable licensing plan that saves you money and educates consumers about their own health, then maybe there is some public school in Kansas where you can counter that by teaching helplessness and intelligent design. Some of those kids might grow up and overdose on OTC hydrogen peroxide.

 

[fls]

Of course not, just as anyone can sue anyone else for anything they want with the current system. If the drug manufacture gave full and complete disclosures, they shouldn't be held responsible for misuse of their products, whether OTC or prescription.

Considering the number of adverse drug events when drug use is overseen by skilled and knowledgeable people, you do wonder how much that will be multiplied when the oversight is taken away. I made that comment sorta tongue-in-cheek, but it will be more difficult to provide full and complete disclosures that fully take a naive audience into account. Drug use is a tad more complicated than putting in a new light switch (having experience with both).

Linda

 

[fls]

See my response to DrKitten. Yes, I want an exclusion for specific individuals.

Ah, I see.

It doesn't seem like it could be a worthwhile endeavour. The circumstances under which it is a reasonable option are fairly limited. I tried to think of various conditions I would be willing to diagnose and treat on my own with the benefit of full knowledge, and all I could come up with is some isolated conditions. The benefit of allowing a few people to manage a few conditions on their own doesn't seem worth the hassle of setting up a program - like it would require more resources than it would save. And I have had numerous opportunities to listen to someone who thinks they have intensively educated themselves on a particular subject, and I have to agree with drkitten as to whether they are as well-informed as they think they are.

Linda

 

[Richard Masters]

Considering the number of adverse drug events when drug use is overseen by skilled and knowledgeable people, you do wonder how much that will be multiplied when the oversight is taken away.

Considering that the medication always ends up in the hands of the patient, maybe it's the fact that the patient has been conditioned not to think for themselves, which affects the incidence of adverse drug events.

Having an "all-knowing" doctor doesn't do you any good when he/she is not around. So taking a little more responsibility for your health (critical thinking) might multiply the incidence of adverse events by a factor between 0 and 1.

I made that comment sorta tongue-in-cheek, but it will be more difficult to provide full and complete disclosures that fully take a naive audience into account. Drug use is a tad more complicated than putting in a new light switch (having experience with both).

Linda

 

[Richard Masters]

Ah, I see.

It doesn't seem like it could be a worthwhile endeavour. The circumstances under which it is a reasonable option are fairly limited. I tried to think of various conditions I would be willing to diagnose and treat on my own with the benefit of full knowledge, and all I could come up with is some isolated conditions.

See my last post.

The benefit of allowing a few people to manage a few conditions on their own doesn't seem worth the hassle of setting up a program - like it would require more resources than it would save.

Such as?

And I have had numerous opportunities to listen to someone who thinks they have intensively educated themselves on a particular subject, and I have to agree with drkitten as to whether they are as well-informed as they think they are.

Linda

That's a pretty strong generalization by both you and drkitten. Apart from the fact that those acquaintances sound like imaginary people, I question the relevance of measuring everyone's competence based on those two friends, and not a more objective test, like I suggested.

 

[fls]

Considering that the medication always ends up in the hands of the patient, maybe it's the fact that the patient has been conditioned not to think for themselves, which affects the incidence of adverse drug events.

Having an "all-knowing" doctor doesn't do you any good when he/she is not around. So taking a little more responsibility for your health (critical thinking) might multiply the incidence of adverse events by a factor between 0 and 1.

That's a separate issue though. A patient can and should be encouraged to think for themselves and take responsibility for having knowledge about their condition.

Linda

 

[fls]

Such as?

For example, it seems ripe for abuse without monitoring.

That's a pretty strong generalization by both you and drkitten. Apart from the fact that those acquaintances sound like imaginary people, I question the relevance of measuring everyone's competence based on those two friends, and not a more objective test, like I suggested.

My observations are based on numerous people, not one person. And as a medical educator, I have had to deal with the issue of assessing competence, so my opinion is also based on the research in this area.

Linda

 

[Richard Masters]

For example, it seems ripe for abuse without monitoring.

What do you mean by abuse? taking too much of a medication? selling unneeded medications to others?

This already happens, but by requiring a relevant test, at least you are educating a new segment of society.

Besides, violent drug cartels would lose out.

My observations are based on numerous people, not one person. And as a medical educator, I have had to deal with the issue of assessing competence, so my opinion is also based on the research in this area.

Linda

Do you assess and test students in groups or as individuals? How did you determine their self-perception of competence?

 

[fls]

What do you mean by abuse? taking too much of a medication? selling unneeded medications to others?

Selling your services to others, abusing substances that lead to altered mental states, bribery, direct-to-consumer marketing, in addition to regular misuse.

This already happens, but by requiring a relevant test, at least you are educating a new segment of society.

I'm not sure why you tie eductation to this idea. People already become educated without this possibility.

Besides, violent drug cartels would lose out.

I don't know what you mean by this.

Do you assess and test students in groups or as individuals?

Both.

How did you determine their self-perception of competence?

You make it sound like it's difficult.

You ask them.

Linda

 

[Neally]

Otherwise you end up paying for their kidney dialysis or taking care of their kids.

Separate issues. If it were up to me, I'd say let private charities cover other peoples medical care if they can't afford it themselves.

So parents shouldn't be buying medicine for there kids. Of course, there is nothing to stop that.

As the care giver and the responsible party, they will have to make the best decision for care that they can. Parents can and do let their kids do stupid things and make rotten decisions with regards to raising their kids. Medical care and treatment is one more in that area.

If you put yourself in a coma through self-prescribing drugs incorrectly are we going to turn off your respirator once you have exhausted your family's resources? Who's going to pay for your now-destitute children's education?

If someone does something stupid, the rest of us shouldn't bear the expense. I'd live by the same rules, I wouldn't expect others to rebuild my house if I made it of straw and it blew away.

Considering the number of adverse drug events when drug use is overseen by skilled and knowledgeable people, you do wonder how much that will be multiplied when the oversight is taken away.

And you have to wonder how many millions of dollars will be saved by people fully able to make their own health care decisions.

it will be more difficult to provide full and complete disclosures that fully take a naive audience into account.

Then the disclosure will state that it is strongly recommended that a licensed physician be consulted.

Drug use is a tad more complicated than putting in a new light switch (having experience with both).

Some drugs are, some drugs aren't. The warning label would state that. The dispensing pharmacy could make it clear.

A patient can and should be encouraged to think for themselves and take responsibility for having knowledge about their condition.

Wait, I thought stupid patients can't do that. Everything should be under the control of the doctor.

 

[fls]

And you have to wonder how many millions of dollars will be saved by people fully able to make their own health care decisions.

How do you see that saving money?

Wait, I thought stupid patients can't do that. Everything should be under the control of the doctor.

That was Richard's particular strawman, not mine.

Linda

 

[Richard Masters]

Selling your services to others, abusing substances that lead to altered mental states, bribery, direct-to-consumer marketing, in addition to regular misuse.

Why does this bother you?

I'm not sure why you tie eductation to this idea. People already become educated without this possibility.

Really? So why are so many people dying from prescription medications? If they are so educated, how come you consider them incompetent to choose their own medications?

I don't know what you mean by this.

I mean, there is a market for drug abuse already; and one of the major factors is drug availability (lack of). By legitimizing certain drug use, violent drug cartels lose their leverage.

Both.

You make it sound like it's difficult.

It's not difficult, but if you are evaluating their confidence when they are in groups, they will overestimate their abilities. If you do it when they are performing by themselves they will underestimate them.

You ask them.

Linda

 

[Richard Masters]

That was Richard's particular strawman, not mine.

Linda

That's your own contradiction. You think patients don't need education; Yet you think they are too stupid to make informed decisions.

 

[fls]

Why does this bother you?

It increases the amount of poor use and increases the amount of morbidity and mortality. It's my job and my inclination to concern myself with considering ways to help people maximize their health.

Really? So why are so many people dying from prescription medications?

Somewhat less than half of those deaths are preventable (10 to 40 percent depending upon what information you use). Some of that would be amenable to patient knowledge - for example, picking up on a contra-indication or precaution whose relevance was missed by the physician or pharmacist. But as you have already pointed out, the degree of interest and the amount of knowledge from patient to patient is highly variable.

If they are so educated, how come you consider them incompetent to choose their own medications?

I consider them competent or incompetent to the extent that they have the requisite knowledge and experience that one reasonably requires for the situation. But that depends much more on the situation than it does on individual knowledge and experience.

Linda

 

[fls]

That's your own contradiction. You think patients don't need education; Yet you think they are too stupid to make informed decisions.

Yes, that is why it is an example of a strawman argument - misrepresenting an opponent's position in order to attack an easier target. It is not my position that patients don't need education or that they are too stupid to make informed decisions.

Linda

 

[gdnp]

So once again, it seems that we are in general agreement that some drugs like narcotics should only be available via prescription and others like aspirin and ibuprofen are safe enough to sell without a prescription. Here is a list of drugs, off the top of my head. which do you think are safe enough that they ought to be deregulated:

1) antihypertensives
2) statins and other cholesterol lowering drugs
3) antidepressants
4) antipsychotics
5) anticoagulants
6) anti-impotence
7) antibiotics
8) oral contraceptives
9) insulin
10) narcotics
11) depressants (barbiturates and benzodiazapines)
12) human growth hormone
13) anabolic steroids

BTW, it has been said that a doctor who treats himself has a fool for a patient. What does that say about a patient who treats himself?

 

[Richard Masters]

Yes, that is why it is an example of a strawman argument - misrepresenting an opponent's position in order to attack an easier target. It is not my position that patients don't need education or that they are too stupid to make informed decisions.

Linda

OK, I'm probably exaggerating your position.

What then, (setting instances of intentional abuse aside) would you consider a sufficient condition for some patients to have safe access to medication without resorting to doctors as gatekeepers?

 

[Richard Masters]

So once again, it seems that we are in general agreement that some drugs like narcotics should only be available via prescription and others like aspirin and ibuprofen are safe enough to sell without a prescription. Here is a list of drugs, off the top of my head. which do you think are safe enough that they ought to be deregulated:

1) antihypertensives
2) statins and other cholesterol lowering drugs
3) antidepressants
4) antipsychotics
5) anticoagulants
6) anti-impotence
7) antibiotics
8) oral contraceptives
9) insulin
10) narcotics
11) depressants (barbiturates and benzodiazapines)
12) human growth hormone
13) anabolic steroids

BTW, it has been said that a doctor who treats himself has a fool for a patient. What does that say about a patient who treats himself?

I'm not asking for deregulation; I'm asking for better regulation.

To start out with, aspirin is not all that safe. 7600 people die from it every year.

But that doesn't mean we should ban aspirin, does it?

Second, most medications have effects on blood pressure, so a plurality will fit your first category or its opposite.

If you routinely take a medication, and suffer no major adverse effects, that medication is probably safe enough for you for all practical purposes, given all other variables remain equal. There is no simple answer to your question, because obviously it depends on the circumstances.

BTW, it has been said that a doctor who treats himself has a fool for a patient. What does that say about a patient who treats himself?

You know what they say about clichés, right?

 

[gdnp]

If you routinely take a medication, and suffer no major adverse effects, that medication is probably safe enough for you for all practical purposes, given all other variables remain equal. There is no simple answer to your question, because obviously it depends on the circumstances.

Unfortunately, the solution that you proposed where the patients take on the responsibility after somehow being certified is even more complex and even more dependent on circumstances.

What if someone is deemed competent to self-prescribe and then develops dementia or has a stroke? What if new information develops about the safety of one of the drugs he takes?

How about this for a solution. Doctors currently write their prescriptions with refills, either a fixed number or for a fixed time (up to a year).

We could, I suppose, allow a doctor to write a prescription with unlimited refills, lasting indefinitely. Or at least a longer time: three years, for example. Is it unreasonable for us to require that a patient's medication be reviewed at least once every 3 years?

The problem I see is that this places the responsibility on the doctor to decide the patient is competent to manage the medication himself. If something goes wrong, the doctor is still liable.