I don't see much difference between an agricultural company that uses potentially hazardous crop treatments, to an oil company which gradually destroys the earth, to a cigarette company which continues to produce and sell hazardous products to a drug company that sells a drug with significant side-effects and questionable benefits.

All of those see their profit as their goal and care very little about potential damage which can be a result of it.

The farmers have a responsibility for using those crops, the owners of gas stations have the responsibility for dispensing this oil, small merchants have responsibility for selling cigarettes and physicians have responsibility for prescribing those medications to their patients.

Consumers have the responsibility when they buy those crops, without questioning their source, or when they buy gasoline or when they take medications.

There are certain professions which society sees as protected from litigation-such as judges and even politicians (unless they have performed a serious crime). This should have been so for physicians. Physicians should have been made to know and understand that they have an ultimate responsibility for the life and well-being of their patients which is not and can not be translated to profit or money.

But, unfortunately this is not so. Patients are not seen as people who are suffering and need help, but as "clients" and as "clients" they should be given a good deal for their money. And if they don't get what they want, they will be compensated. When the death of a child can be translated into money, it become a loss of profit, and not a horrible tragedy.

A young man was admitted to the hospital in a grave state. He had a very rare form of leukemia. He was stuporotic with significant metabolic disturbances. The hematology fellow failed to diagnose his illness properly because of a very unusual presentation, but feeling uncomfortable about this patient she called her attending who came immediately.
He diagnosed the disease correctly, did a few more tests and started chemotherapy ASAP. The patient and his wife sighed an informed consent.
This excellent physician took care of him for the next few years and clearly saved his life. He came to see him day and night, got him through serious and life-threatening complications of the aggressive treatment he was given.
5 years later, the patient was alive and well and stopped coming for follow-up visits. His physician received a letter from his lawyer that he is suing him for not obtaining semen prior to treatment with chemotherapy. He now only has one child and can not have any more children.
It's not that there is some treatment he can receive which costs a lot of money that will enable him to have another child (I would be fine with him getting money for that), and it is not that he is losing any profit from not having another child (from my personal experience children cost money and don't bring profit). How can money compensate for what he has lost? and should this excellent physician instead of doing everything possible to save his life during that night done everything possible to save his semen?
I know this specific physician is not going to change the way he takes care of his patients, but I know how shocked he was to see a letter from the lawyer of a patient whose life he saved.

I know excellent physicians, who after similar experiences have started practicing defensive medicine. They no longer see their patients, as patients but as potential rivals in court. They know that if they do not stick to the "guidelines" (even if the think they are wrong) they can be sued.

Some of those "guidelines" and "quality parameters" are the result of lobbying of drug companies and based on very little evidence. Most physicians don't have the courage or are not interested in going against the flow. It is much easier to comply with the rules and have nice laminated cards in their pockets that tell them what to do.

"personalized medicine", is a nice buzz-word that everyone is glad to use, but physicians are discouraged from deciding on the best patient-tailored treatment for their specific patient.

There are still outstanding physicians who manage to work properly despite all those obstacles, but they are becoming more of the exception than the rule.

Equating good patient care with profit is a recipe for disaster.

I once worked for a corporate veterinary practice that had a very large data base of information that was used to calculate maximum wellness and especially maximum profit. They had extensive protocols that were present to maximize profit and minimize risk of litigation. For the most part, they practiced better medicine than most places I have worked because it is profitable to keep your patients healthy. There were cases in which it did not work out well for. I was not comfortable being told how to practice even when it went against my training. I ended up getting fired, which speaks pretty well for me actually.

If I choose not to buy GMO (genetically modified) corn, that GMO corn will not blacklist me to the organic corn, making sure I can't eat it either. I don't need corn and can't eat it anyway.

But I do NEED health care. That's the difference between other corporations and the medical profession. They should be even more responsible for the decisions they make. That does not mean a mistake should go from "oops" to "no medical license!" It means they simply need to try to do their jobs better.

Everyone should be set up for success!!!

I don't know what it's like to be a doctor. I doubt it's very easy. But doctors CHOSE to go into that profession.

And I do so like the decision you made, Celeste. I don't think being ethical and making profits are mutually exclusive goals! But, obviously, there are many in medicine who think that way.

I called up my insurance company a few weeks ago and asked them to stop wasting money by sending me promotional junk in the mail. That's one thing we patients can do - speak up when we see something that could change.

So, Alice, these two examples show why the medical profession's self-imposed Catch-22 is so counterproductive. And hypocritical.

I knew I had MG but I couldn't find a neuro in my state to give me the treatment I needed unless they "rediagnosed" me, even though there was an abundance of proof of MG.

I knew I didn't have lupus or dermatomyositis but my rheumy won't take those diagnoses off of the table, even though there is absolutely no proof for it after nearly two years!

So, they won't confirm what you do have but won't deny what you don't.

That does NOT let doctors off the hook, nor should it.

Farmers - which is the "stock" I come from - would lose their farms if they left their "jobs" half-finished. They don't even worry about lawsuits on the weekends. Doctors don't even get a talkin' to when they leave us half-finished.

Yikes, am I in a mood tonight. No offense meant to you at all, Alice! I'm just really tired of all of this nonsense. Are they really so afraid of a "perception" of a lawsuit? I think they might need some counseling for litigaphobia.

Annie,

What I was trying to say is that physicians are a reflection of the society they live in. They are not saints, they are people.

There will always be exceptional people who will fight injustice or go against what is seen as acceptable and the norm, those who ask questions, but the vast majority of the people will comply with the rules.

There are more and more studies that raise serious concerns regarding the health risks of GMOs. When a farmer grows them, sells them to companies which put them in cereal given to young children without marking them, he is putting those children at potentially serious risk. But, that farmer doesn't bother to read the studies, he doesn't bother to check how the approval for those foods was given, he doesn't bother to ask himself why they are banned in Europe. Because it is convenient to use those seeds.

This is not much different from a physician that gives a certain medication because it was approved by the FDA, the guidelines say he should use it and he has a laminated card in his pocket telling him what to use and when.

What you describe, regarding your personal experience is a crime. It has nothing to do with the practice of medicine. If a physician hides a pertinent test result which has a significant impact on a patient's well-being and life it is a crime. This is not a medical error, it is dishonesty. I want to hope that it is rare for physicians to behave in that way, just like it is rare for people walking into a bank to rob it. I am truly sorry that you had to go through this.

I personally have never encountered such behavior, even from those physicians who made serious management errors. I have all my charts and test results. Including a chart in which the nurse wrote- "Dr. Aware", in large letters, because she realized the severity of my situation and wanted to cover herself if something happens. She also clearly documented that she called the physician because she was seriously concerned with the rapid deterioration in my condition, but he refused to come because he thought is was "functional". I have a score sheet with a very high MG score, marked with "?!" and "not putting enough efforts".

Thanks to those charts I became interested in this entity "functional" and the way in which neurologists determine "efforts" (and possibly/hopefully) this may have helped other patients.

I did experience physicians jeopardizing my care from others, but this was (I believe) because they genuinely thought what they wrote, and not because they tried to hide something or protect themselves. As you know facts can be interpreted wrongly. They did not distort the facts, they just "fit" them to their own theories.

It is true that the way to hell is full of good intentions, but I do think that intentions matter. There is a big difference (in my opinion) between deliberately jeopardizing a patient's care and non-intentionally doing so.

It's not that I have a solution to all those problems. But, I think that awareness of physicians and patients is the first step. I want to hope that we will go back to the essence of medicine, and not get further away from it.

I don't expect a doctor to be perfect. But I do expect them to do their job well.

Which is exactly the point I'm making about a "medical mafia." The culture in which they practice medicine is not set up for anyone but those at the top to win. Doctors don't win. Patients don't win. It's got to STOP.

When a patient has to fly through hoops to get care for MG, that's not good doctoring.

When doctors look for loopholes instead of diseases, that's not good "patienting."

I don't have "the" answer either but someone better start looking for a lot of them before doctoring doesn't work for anyone.

Annie,

It seems to me that we agree that the medical system suffers from a serious illness.

We just don't agree on the causes for it.

And, unfortunately, we don't have a good remedy.

I think that there are more and more physicians and patients that are aware of it. (which is good, as this is probably the first step-recognizing and admitting a problem).

It's not only a matter of physicians doing their job well.
It's a matter of how is their job defined, what tools are they given to do it and what are the expectations from them.

If you expect someone in less than 30 minutes to get to know a person, examine him, generate a list of possible diagnoses, order the proper tests and give proper treatment, while documenting everything in a perfect manner, you have unrealistic expectations which are bound to fail.

If you expect that person to be able to do this 10-20 times each day...

But, this is what modern society is expecting from her physicians.

Just for comparison- psychologists who only have to do the first part (get to know the person) are given 45 minutes for each session.

Alice, I think that you make a good point. A lot of people expect too much from their physicians. They expect a magic wizard that can totally cure them instantly. I am reminded of the scene in the old "Wizard of Oz" movie in which it is revealed that the wizard is just a man. He says, "Pay no attention to that man behind the curtain."

To me, the entire "mystification" process has been undermined. I would prefer magic, but it doesn't work.

On the contrary, Alice, I know there are many causes for what's going wrong with doctoring!

When I had my B12 deficiency, for example, I was going to an internist whom I had known for well over a decade. She KNEW me. I kept going to her, telling her how tired I was. So tired that I felt sick. She kept saying, "There's nothing seriously wrong with you." I was so tired that I had to quit my job over it. It ended up being my last full time job.

I was so scared and frustrated that I bought my first medical book. I figured that I could at least put myself through a crash course on the causes of fatigue. The medical book didn't even have the reason I was sick in the "fatigue algorithm," which I didn't know until after I figured it out. I sought out 2nd opinions but no one knew what was going on.

I brought that info back to my internist, along with my suspicion of having a B12 deficiency. She wouldn't even test for it. So I then put my thoughts in writing and she finally agreed to run the test. About a week later, she had put a message on my voice mail that I had a B12 deficiency - please call for an appointment. I also had a high homocysteine level.

I had parasthesias, some of which never went away because treatment took too long. I was feeling faint all the time. I could not stay awake. I had early onset dementia. For a doctor who had practiced that long and was so smart, she should not have been so dismissive of my concerns.

So that situation only took two years, a bunch of doctors, lots of money, a loss of a job and so much more than I can express - like a loss of trust - and I still didn't know WHY I got the deficiency until a few months later. And I honestly believe that it is during this time period when my lifelong MG took its turn for the worse. As you know, you need B12 for the acetylcholine biochemical pathway.

I did BEYOND what most patients do to help themselves. I KNEW my doctor and she KNEW me. I was crystal clear about my symptoms. I sought out the second opinions. Ironically, it was when I asked my Mom if any of my relatives had been as tired and sick as I was when she told me that my Uncle had pernicious anemia. I didn't have PA but a lack of stomach acid causing my deficiency. But when I read the symptoms of PA, I KNEW I had a B12 deficiency. It just "fit." I've trusted my instincts about medical issues over a doctor's facts ever since.

I don't have unrealistic expectations of doctors. And, I should add, that even though I felt the need to move on from that doctor years ago, she is STILL my internist. I FORGAVE her for being human and moved on.

And she apologized to me. She now considers a B12 deficiency anytime a patient is tired.

Also, I have very good doctors but even they have to work within a very imperfect system. I have known my doctors for a LONG time.

So, PLEASE, don't assume things about what I, as a patient, have been willing to do, to put up with, to work towards to have the very BEST relationships with doctors.

And what about patients who don't have a medical interest, who don't know how to figure out what's wrong and who can't afford to keep going to a doctor over and over again? I honestly believe that there are many doctors who are not trained to be good diagnosticians. Should we all simply sit at home, waiting to die because we expect to get help when we see a doctor? I know doctoring is not as easy as making a "wish" but it should NOT be this hard either!!!

Annie

And just a word about farmers. There are a lot of them who do bother to know about their crops because it's not only their job but their LIFE. I find that to be a very ignorant statement that they do things because they are "easy." Their families live on the farm. They feed the farmhands who help them, even though they often can't afford to feed their own family. And they do whatever it takes to create the best crop they can, even working all night.

Take a gander at the pic below. That's my grandfather. Do you think he did things because they were easy? Nothing was easy. That's a "drag" being used on the fields, in case you thought he was just hauling wood home for a fire. There were no pesticides, no GMO's and no corporations breathing down his neck. Only hard work and a hope for a chance at survival during the Depression.

There are a lot of prejudices out there about all sorts of people. I KNOW many farmers. So many of them are trying their best to go organic, even under pressure from a certain corporate giant who pushes pesticides and GMO food.

And there are now requirements that when a product is labeled as organic, it HAS TO BE Non-GMO.

The point isn't the problems. The point is to identify them, come up with a plan or two and to go about fixing them. Blame helps no one but taking responsibility for perpetuating problems does.

My point about the medical mafia (corporations) is that they are not working hard enough to fix their problems and almost seem to enjoy the dysfunctional environment that they have created. Intention is often the hardest problem to fix.

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I agree, so what do you think is the reason it happened?