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Saturday, September 22, 2012

STANDARD OF CARE: Just my two cents.


STANDARD OF CARE:  Just my two cents.


Alan Himmel, DC. PA

If there is one thing I am very sure of by now, it is the fact that not all patients respond the same to medical treatments.  For example, if you have five patients and they all come in with the identical complaint of lumboscacral radiculopathy, caused by the identical thing, you will find that each one of these patients will typically respond different than the next patient to medical care.  I have learned over the years to respect this fact.  This, by the way, is a fact across the entire list of medical conditions.  There is no such thing as a guaranteed success with any medical treatment, because each patient is unique.  Any physician who tells you otherwise is lying to you. The treatments given to a patient for any one particular reason, are usually one that comes out of a bag of questionable tricks.  I use the metaphor "bag" here, because that's exactly what doctors have--a bag of tricks or treatments in their arsenal which they grab from, when a condition calls for it.

Within the arsenal of treatments that doctors have, is what is called "standard of care."  In other words, the standard of care treatments are treatments that all your doctor's colleagues do, and so, since everyone else is doing it, it makes it the treatment of choice.  Since the standard of care is the treatment that everyone else does, it is therefore reasonable and correct for your doctor to do the same.  In fact, many doctors are reluctant to step out of the box, and prescribe a medication, or do something, which is not considered the standard of care.

Reaching for the standard of care each time, in my opinion is problematic and can also be dangerous to a patient's health.  This type of thinking by doctors opens up several issues because physicians are well aware that standard treatments do not always equate to resolution of  a medical condition.   Treating patients is not like mathematics where you can predict the outcome, every time.   If you think about it,  if it was as simple as choosing the standard of care, then we wouldn't need doctors at all.  Could you imagine if we could do away with most docs and create a computer program which people would keep on their home computer, or even as an app for the smart phone, that would do everything, including calling in a prescription at your pharmacy?    Several years ago, a well respected friend of mine, who is in medical research once told me that most doctors and researchers are like robots.  She used to say that these people have lost their ability to think on their own, that they have no curiosity, and they don't question anything.  She asked me once, how many physicians do I think go home at the end of the day and do research, and try to find the BEST options and treatments for their patients?  This is something that I never thought of before, but certainly with the advent of the internet, this type of research is pretty easy to do, and reasonable, especially with a patient with a life threatening condition.

If you ever want to stop a physician in her tracks, look your doctor straight in the eyes and ask her what she would do if her mother or father or child was the patient.  This usually works.  If the doctor is giving her honest opinion of the best treatment, then she will confidently look you right back in the eyes and stick to her original recommendation.  If the doctor seems uneasy with the question, or looks away or down, I would be concerned and would seek another opinion.