Commentary on medical news by a practicing physician.

  • Epocrates MedSearch Drug Lookup


    "When many cures are offered for a disease, it means the disease is not curable" -Anton Chekhov

    ''Once you tell people there's a cure for something, the more likely they are to pressure doctors to prescribe it.''
    -Robert Ehrlich, drug advertising executive.

    "Opinions are like sphincters, everyone has one." - Chris Rangel

    email: medpundit-at-ameritech.net

    or if that doesn't work try:


    Medpundit RSS

    Quirky Museums and Fun Stuff

    Who is medpundit?

    Tech Central Station Columns

    Book Reviews:
    Read the Review

    Read the Review

    Read the Review

    More Reviews

    Second Hand Book Reviews


    Medical Blogs


    DB's Medical Rants

    Family Medicine Notes

    Grunt Doc




    Code Blog: Tales of a Nurse

    Feet First

    Tales of Hoffman

    The Eyes Have It


    SOAP Notes


    Cut-to -Cure

    Black Triangle



    Kevin, M.D

    The Lingual Nerve

    Galen's Log



    Doctor Mental



    Finestkind Clinic and Fish Market

    The Examining Room of Dr. Charles

    Chronicles of a Medical Mad House



    Health Facts and Fears

    Health Policy Blogs

    The Health Care Blog

    HealthLawProf Blog

    Facts & Fears

    Personal Favorites

    The Glittering Eye

    Day by Day


    The Business Word Inc.

    Point of Law

    In the Pipeline


    Tim Blair

    Jane Galt

    The Truth Laid Bear

    Jim Miller

    No Watermelons Allowed

    Winds of Change

    Science Blog

    A Chequer-Board of Night and Days

    Arts & Letters Daily

    Tech Central Station





    The Skeptic's Dictionary

    Recommended Reading

    The Doctor Stories by William Carlos Williams

    Pox Americana: The Great Smallpox Epidemic of 1775-82 by Elizabeth Fenn

    Intoxicated by My Illness by Anatole Broyard

    Raising the Dead by Richard Selzer

    Autobiography of a Face by Lucy Grealy

    The Man Who Mistook His Wife for a Hat by Oliver Sacks

    The Sea and Poison by Shusaku Endo

    A Midwife's Tale by Laurel Thatcher Ulrich



    American Academy of Pediatrics

    General Health Info

    Travel Advice from the CDC

    NIH Medical Library Info



    Wednesday, April 13, 2005

    If the Cancer's Gone, Why is Death Knocking at the Door?: Practicing medicine within easy reach of a renowned tertiary care center has its advantages. Patients can get highly specialized care, such as bone marrow transplants or epilepsy surgery, without completely uprooting the lives of their loved ones. It also has its disadvantages.

    Aggressive public relations campaigns often leave people with the impression that the specialty center can work miracles, even for run of the mill diseases. And so, once in a while, you'll find someone who has landed in the hospital with a routine illness, such as pneumonia or emphysema, who asks to be transferred to miracle-worker hospital with the expectation that they'll get better faster there - even though there's nothing different to be done. The antibiotics don't work faster at a tertiary care center, and they can't transform old, smoke-damaged lungs into pristine healthy ones.

    But even worse, is the tendency of the tertiary care centers to leave their failures on the doorsteps of others. They've done such a good job of selling themselves to the public that people do really expect miracles. Go to them with cancer, and you'll be cured, just like the guy in the newspaper or on the television special. I don't know what kind of conversations take place in the privacy of the consultant's office. Maybe they do honestly lay out the odds for patients, and the patient (and their family), blinded by hope, doesn't hear the bad mixed with the good. But, I do know that all too often, when the treatment has been exhausted and the patient ends up in the closer hospital in extremis, the miracle-working specialists are nowhere to be found.

    As one of the oncology nurses told me yesterday, when neither my patient's miracle working oncologist nor his miracle working gastroenterologist would accept a patient transfer because there was nothing else they could do - "Don't you get the feeling they want us to take the blame for anything that goes wrong?" Then she added, bitterly, "They do this all the time, you know." Well, I didn't know that, but I certainly did get the impression they were reluctant to take responsibility for the complications of their treatment, or to admit to the patient that all was not as well as he had been led to believe. Meanwhile, my patient can't understand why he isn't feeling better. He's been told by better doctors than me that his cancer is "gone," his treatments "successful." And as far as the tertiary care center's records and statistics go - he is one of their success stories. But not because they cured him, only because they won't let him be anything but a success.

    UPDATE: Dr. Andy wonders if it isn't a comfort for patients to come home to die rather than go to the big specialty driven hospital in a far off city. Undoubtedly it is, but only if they already understand that death is the only alternative. My beef is the lack of communication that often fosters false expectations in patients, who then blame the local doctors when things turn out worse than they hoped.

    posted by Sydney on 4/13/2005 09:02:00 AM 0 comments


    Post a Comment

    This page is powered by Blogger, the easy way to update your web site.

    Main Page


    Home   |   Archives

    Copyright 2006