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Tuesday, July 24, 2007

Why is there so much over-prescribing of medicine and why is there so much unnecessary medicine?

"You did ask why “perfectly healthy” patients with osteopenia are given medications like Fosamax.

From a primary care perspective, many relatively healthy patients are placed on preventative medications if they have even the slightest indication and no obvious contraindications because

1.) This is what primary care physicians do these days.
2.) It’s expensive for the patient but costs the doctor nothing.
3.) Many of our patients EXPECT us to do something when there is an abnormal test.
4.)We try to do everything to reduce the risk of a lawsuit (defensive medicine)."

(Cynical comments in correspondence with a US-based Dr)
Gary Moller comments:
While I love modern emergency medicine, I am much less a fan of medicine's role in the management of the diseases of modern living, including those associated with ageing. I think medicine's track record is appalling. I think our impressive life expectancies have little to do with modern medicine as one sees practiced in surgeries and hospitals and more to do with wonderful public health measures such as sewage and water projects and road and industrial safety programmes.

I would not like to be a Dr nowadays; especially one in the USA. It is a thankless task and has nothing to do with the practice of medicine and more to do with bland processes that may, by chance, have a positive health outcome. This Dr's comments pretty much sum up how a Dr is between a rock and a hard place - they must choose the path of least risk and that means following the trail of "Best Practice Medicine" and ensuring that the patient leaves the consulting room with a script for a prescription drug or further tests. So long as they stick to best practice guidelines, the chances of being sued are minimal even if the patient is severely maimed by that practice.

A further constraint on the practice of good medicine is the fees structure. Good medicine requires time - up to an hour per patient. The way medical practices are structured, a Dr must process patients at the rate of about one patient per 15 minutes at the longest. If not, the practice is in financial trouble. The sad fact is that 10-15 minutes are just long enough for a quick chat and examination and just enough time to enter the details in the computer and to print out a prescrtiption script. This simply adds up to poor medicine. Sadly, this is the status quo and the solutions are not easy. Nor are they cheap and we would sure need a lot more doctors. But; then again, would we? If Drs spent more time with their patients and practiced real medicine, we might all be healthier; needing fewer visits to the Dr, less need for surgery and less need for drugs that often debilitate and finally kill!

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