Book: How Doctors Think - Mothering Forums

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#1 of 12 Old 06-18-2007, 02:20 PM - Thread Starter
 
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Recent book by Jerome Groopman, M.D. I felt that it explained a lot of the weird behavior you all have encountered from pediatricians, etc.

on page 203:
Quote:
As Delgado gathered a sheaf of lab reports to take to the clinic, she saw a face out of the corner of her eye and froze. Rick Duggan filled the doorway of her office. <skip>

"I don't know what more I can do, Dr. Delgado," Duggan said. He was a sales representative for a pharmaceutical company that made a testosterone product. "You haven't written a single prescription for my drug. Not one." <skip> "Dr. Delgado," he said, his voice taking on a forceful tone. " I want you to write three prescriptions a week for the next month."
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#2 of 12 Old 06-18-2007, 02:28 PM
 
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Wow, that's scary. Though yes... it does explain their behavior.

Suz, mommy to 2 chess-playing, lightsaber-wielding boys

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#3 of 12 Old 06-18-2007, 02:33 PM - Thread Starter
 
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Well, there is a lot more in the book than that one scene, almost all of it very interesting. And most doctors really do mean well, which makes some of the weirder behavior, like firing families who don't vax, a bit harder to sort out.

The reason Dr. Delgado was being bullied: she is an opinion leader in her field. First they tried to seduce her with goodies, then he tried bullying, then he tried having one of her colleagues talk to her...
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#4 of 12 Old 06-18-2007, 02:42 PM
 
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Originally Posted by bygones75 View Post
Wow, that's scary. Though yes... it does explain their behavior.
It would be scary if it worked. Did it? I haven't read his book, but I've read all his New Yorker articles, many of which form the basis of the book.
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#5 of 12 Old 06-18-2007, 04:44 PM - Thread Starter
 
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not with that doctor, but it did work with her colleague and with many other doctors...

he also discusses the big increase in back surgery for lower back pain
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#6 of 12 Old 06-18-2007, 05:15 PM
 
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Quote:
It would be scary if it worked. Did it?
If it did not work in some instances then it would not be a tactic. What's more important is that the sales rep truly felt he controlled the doctor's decision making. Why would a sales rep think that way? This is very important to understand. This cognitive process is representative of the control mechanisms at play within the medical/pharmaceutical industry. This statement offers awareness on many levels.

More on Delgado from Groopman.

Quote:
For years, estrogen was given to menopausal and postmenopausal women, prescribed based on guidelines. Open-minded and curious physicians like Karen Delgado—a doctor I write about in How Doctors Think—questioned this simplistic treatment of aging women and questioned blanket claims that hormone-replacement therapy protected the heart and prevented Alzheimer's. Rather than follow "standardized care," she tried to customize her care. Of course, we now know that the guidelines were flawed.
How much crap did she take before it was realized that the "guidelines" were flawed? What other guidelines are flawed?

Most people are other people. Their thoughts are someone else's opinions, their lives a mimicry, their passions a quotation. - Oscar Wilde
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#7 of 12 Old 06-18-2007, 06:40 PM
 
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Interesting.

Dr. Mendelsohn wrote about the drop in the rate of tonsilectomies in the late 1960s and 1970s. He said he was getting worried that all those pediatric EENT surgeons might go out of business.

Not to worry. This was the beginning of the surgery for tubes in the ears to prevent chronic earaches. Are they still doing this or have they moved on to other procedures as I have not noticed they went out of business.

Quote:
What other guidelines are flawed?
Most of them. Why has MDC so many members posting on the Birth, Vax, Health and Circ forums?

"The great enemy of the truth is very often not the lie, deliberate, contrived and dishonest, but the myth, persistent, persuasive and unrealistic."
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#8 of 12 Old 06-18-2007, 10:34 PM
 
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In the late 1990's, I had a friend who was a rep for a drug company. She told me she could find out if a Doctor was prescribing her products to patients by doing a search of pharmacies in a town with his DEA number.
If he was always asking for samples and she could not find if her meds were being sold she would go out of her way to spend more time to educate his staff about her product and often would give less samples out.
She was told by the company she represented to confront the doctors on why they always wanted samples and why there was no prescriptions being filled.
She would often bribe them with gifts,seminars on coats and other fun stuff.
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#9 of 12 Old 06-18-2007, 10:49 PM
 
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i will be checking out this book next time i hit the library! i knew that's how it was but it's still scary!
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#10 of 12 Old 06-18-2007, 10:50 PM - Thread Starter
 
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The drug rep stuff is a small part of the book. There is stuff about the various things that interfere with doctors' perceptions.

If they like the patient a lot.

If they don't like the patient or find them repulsive (homeless, gay, odd, crazy, into alternative health practices).

If the patient already has a diagnosis that sort of fits.

If the patient's needs don't match with the doctor's ideas of what is right--wanting a lot of treatment when the doctor feels it would be better to just let the person die, for example.

And a lot about the pressures of managed care and how that interferes with good medical practice.
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#11 of 12 Old 06-19-2007, 10:30 AM
 
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Thanks for the recommendation! I think I'll get this for my mom. My folks were just here visiting and my mom complained copiously about how there are always drug reps at the clinic they visit. The docs keep pushing unnecessary prescriptions on her and my dad, and a couple docs they know personally never, ever pay for their own lunch or vacation since the drup reps are always right there waiting to hand out a freebie.

There probably aren't many concepts in the book that they haven't already heard about from *me*, but experience has shown that my word is mud, whereas if a writer from the New Yorker says the same thing then it must have validity. Go, Jerome Groopman!

(They actually went thrift-store shopping with me because Calvin Trillin said my thrift store was cool! I still can't believe it.)
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#12 of 12 Old 06-19-2007, 03:01 PM
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I really want to read this! Could be very helpful for when you have to deal w/ docs...

And just regarding drug reps-- I found another reason to hate them when every time while pregnant and searching for a parking spot at the clinic, I would see these well dressed people with huge brief cases pulling stuff out of their cars, heading in... ack! how many of the precious parking spaces were taken by these folks? I always saw more of them than plain people/assumed patients. This was all before I got my HMO to switch me from lame OB-land of course, .
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