New Threat: “Patient-Dictated” Care

While we’ve been worrying about nuclear war and rising global fascism, a post on KevinMD last week reminded us of a persistent and no less real danger: patients who ask for shit. The blog’s author draws a line between “patient-centered care” and “patient-dictated care”, the latter of which entails the physician sighing mightily yet rolling over at any patient request. What choice does he have, really? He’s just trying to keep the lights on in this crazy world.

The example given is antibiotic abuse, that old workhorse – just as scary and describable as it was in that 60 Minutes episode back in 1998. Can You Believe this Asshole Wants Antibiotics for a Cold?! has been kicking around at least since I was in high school, and despite its wear, it won’t die as the catchall justification for why physicians must remain the keepers of the knowledge. They are the rare, anointed ones, elevated by the combination of intellectual superiority and moral purity; they alone understand the dangers of antibiotic resistance. Continue reading “New Threat: “Patient-Dictated” Care”

Early Detection Doesn’t Save Lives

Breast cancer advocacy has hinged for decades on the idea that early detection – via screening mammography – is the key to breast cancer survival. Mammograms save lives, and questioning the value of that bumper-sticker science is not just raising a hypothesis, but a waging a sexist, classist attack on womankind.

Just look at this screencap from Mammographysaveslives.org:

mammofacts1

Who needs citations? It says right there that these are FACTS.

Some jerk at the Dartmouth Institute for Health Policy and Clinical Practice was not persuaded by FACTS and decided it was time to kill some women. H. Gilbert Welch, M.D., M.P.H. and colleagues reviewed SEER data from 1975-2012 to analyze the impact of screening mammography on the size of breast cancers at diagnosis as well as track mortality trends over the same period. If screening were effective, the villains suggest, we would see a decrease in detection of large cancers over time. Continue reading “Early Detection Doesn’t Save Lives”

You can enroll in a clinical trial, but that doesn’t mean you should

One of the the core accusations of this blog is that cancer patients are pushed toward clinical trials in spite of alternatives with demonstrated safety and efficacy, which takes advantage of two patient biases: new (if unproven) means better and your physician has your best interests at heart.

Physicians are paid to participate in clinical trials. Let’s get that out of the way. There is nothing objective about recommending trials to patients; you only need to notice how often a physician points a patient toward a trial outside his or her practice to deduce that trial suggestions are not without bias.

Continue reading “You can enroll in a clinical trial, but that doesn’t mean you should”