Eng. 102

                                                                     0928

                                                                  3-30-2002

Thesis: Although we must rely on physicians to prescribe medication and treat illness,
we must take more responsibility in educating ourselves on diseases that affect us and
the physicians that treat us; we must be proactive because physicians often misdiagnose,
are susceptible to human frailties, and the care they provide is limited by most HMOs.

(she uses a Topic outline: all headings  are nouns or noun phrases)

I.  Misdiagnosis     (21 sentences)

    A. Story of an AIDS patient

    B. U.S. fatalities                                        

    C. Blame

II.  Problems with medical school   (19 sentences)

     A. Selection process

     B.  Unnecessary Pressure                          

     C.  Negligence

III. Assumption of competentcy     (20 sentences)

      A. Substance abuse and psychological disorders
                                                                                   
      B. Lack of discipline for serious infractions

IV.  HMOs' effects on health care   (25 sentences)

      A. Control over physicians                      

      B. Control over laboratories

V.  Patient responsibilities             (16 sentences)

      A. Importance of being informed             

      B. Using resources

VI. Choosing a physician              (18 sentences)

      A. Board Certification

      B. Awards for continuing education       

      C. Attention to demeanor

VII. Three states' actions              (6 sentences)

       A. Liability/regulation                                

       B. Public awareness

 
      We depend on various people to aid us throughout our lives.   Teachers,

mechanics, and law officers are a few we rely on for their expertise.  Despite the

fact that we consider them to be the experts in certain areas, we question

their motives, opinions, and knowledge. We ask the teacher who gives us

a poor grade on a project if it was graded fairly. We ask the mechanic who

informs us we need a new transmission if there is not a cheaper alternative.

We insist that the police officer who writes us a speeding ticket check his radar

gun. However, the people we rely on to keep us healthy are not so freely  <<italics for emphasis

questioned.   If a doctor tells us that everything possible is being done to

treat an illness, we usually accept it. " 'A woman is three times more likely <<qwq

to be told that symptoms are all in her head' " (qtd. in Hales 52).  Thus, when a

woman is told that there is no medical reason to explain the pain in her

abdomen, she is more likely to go home and question her sanity than she

is to seek another medical opinion.  "Most malpractice, misprescribing,

overprescribing, unnecessary surgery, and other substandard and dangerous
              interpolation                                                                              interpolation
medicine [are not] even recognized or detected by the patient and [are]

either unknown to or ignored by medical boards and others that are supposed

to police doctors" (Denenberg 1). Although we must rely on physicians to <<<THESIS

prescribe medication and provide treatments for illness, we must take more

responsibility in educating ourselves on diseases that affect us and the

physicians who treat us.  We must be proactive because doctors often misdiagnose,

are susceptible to human frailties, and the care they provide is severely limited by

<>most HMO's.  Cases of misdiagnosis, unnecessary surgery, and inappropriate  <<follow up sentence as a transition

treatment would be greatly reduced if we took responsibility for researching the

illnesses that affect us and the physicians who diagnose and treat us.

        Three years ago a twenty-four year old girl went to the doctor because her throat was

irritated. She was diagnosed with a yeast infection in her throat called Thrush.  In the

next few years, she repeatedly suffered from Thrush, sores on her body, and

pneumonia.  At no time during this period did she research the possible causes

for her constant infections and illness.  Eventually, she ended up in the emergency

room suffering from pneumonia. While the attending physician performed

an examination, she told him about the frequent infections she had had in

the last three years. He immediately asked her if she had ever been tested

for HIV.  He went on to explain that infections like Thrush are very common

in people with HIV and not as common in healthy people within her age

group.  Her test results came back, and she had not only the HIV virus, but

full blown AIDS.  When she returned to her primary physician to discuss

treatment option, she gave her six months to live.  Unwilling to accept her

physician's medical opinion, she began researching treatment options and

physicians that provided them. She found a physician in her area that had been

successful in treating AIDS patients with the AIDS cocktail.  Six months later

her family was not preparing for her burial like her previous physician predicted.

Instead, they were rejoicing in the fact that the HIV virus could no longer be

     detected in her blood. "It is estimated that there are 10,000 avoidable patient <<direct

    fatalities due to physician error each year in the United States [. . .]" (Bonsteel 17).  <word omission

    Cited in Bonsteel, one administrator relates, " 'The physicians are protected by a web <qwq

    of interlocking self interest: impaired physicians in whose hands lives are entrusted--

    and sometimes needlessly lost--are rarely fired ' " (16).  The horrifying story of the <consecutive citation

    AIDS patient and fear-inspiring statistics reinforce the fact that we cannot rely

    solely on our doctors to diagnose and treat illnesses. There are many reasons why

    the health care system in the United States is failing.  Blame is most often placed

    on the government and the managed care providers.  But another, less talked about

    culprit, is the tutelage received by many medical students.  These same students  effective transitional sentence

    experience environments and situations during their schooling that can seriously

    interfere with their ability to practice medicine in the future.

          Working towards acceptance into a medical school is a difficult, rigorous, and

    competitive race for all premed students.  We, as patients, are inclined to believe that

    those who are accepted are the most capable, intelligent, sane, and nurturing of the applicants.
                                                                    interpolation
    Unfortunately, this may not be true. "[The] selection process of student physicians often

    selects for the wrong qualities, while medical training often perversely instills the wrong
                         four spaced periods in brackest indicate words blended from two different paragraphs
    attitudes in physicians [. . . .] The process selects for competitive individualism over teamwork

    and cooperation" (Bonsteel 16).  Even the most capable and compassionate medical< paraphrase

    students face an environment in medical school that seriously strains their ability to

    become worthy physicians. They encounter a training system that seems bent on

    wringing out the idealism and empathy with which most medical students start (18). <consecutive citation

    and one in six medical students had been "physically assaulted" by an instructor. <direct

    One in four students reported severe verbal abuse. "The rate of one physician in <<direct

    they are exposed to medical negligence performed by the individuals that are
                                                                                                       interpolation
    supposed to be their models of conscientious physicians. "[S]ome studies have <<direct

    shown a higher rate of malpractice losses in academic centers than in community

    hospitals" (17).  It is irrational to put the full responsibility of our health on physicians

    who may have been trained by drug impaired, negligent instructors who subjected

    them to physical, sexual, and verbal abuse. Would one willingly give a new born

    child to a person whose only experience with interpersonal relationships was with

    an abusive, alcoholic caregiver?   In many medical schools, students learn not to

    become emotionally involved with their patients and to protect their sometimes

    negligent fellow practitioners.   There is a "medical tradition of not blowing the <<direct

    whistle on fellow practitioners and ignoring the malpractice or incompetence of

    medical colleagues" (Denenberg 1).  During Alan Bonsteel's medical training, he

    of the wounds inflicted upon our future physicians in medical school only fester in their

    professional practice.

            We assume that doctors are competent, ethical, and worthy of our trust.   Doctors are

    assumed to be immune to the things society struggles with in life such as drug and alcohol

    abuse, ignorance, greed, and prejudice. This is a ridiculous misinterpretation of a license

    to practice medicine. They are given a certificate to practice medicine because they

    have completed the necessary schooling.  They are not armed with a device against

    being human.  Due to the stress of their profession, physicians are slightly more susceptible

    to substance abuse and psychological disorders, but they are not carefully monitored.

    "Doctors are at special risk of developing addiction problems, owing to the strain <<direct

    rates in physicians only slightly higher than the general public, but drug addiction rates

    many times higher, in part due to the easy availability of purloined narcotics.  Depression

    is commonplace, suicide rates are much higher than in the general population, and

    among female medical students and physicians, the rates of anorexia and bulimia are

    above those of their counterparts outside the profession. Although the world at <paraphrase

    large views doctors as confident, even arrogant, in many cases that arrogance and

    the walls some of these physicians build around themselves cover up for the

    taken seriously in a lot of states, and as a result, people in those states aren't

    being protected from doctors who aren't practicing good medicine ' " (qtd. in Carton 1).

    Physicians are thought to live by a higher moral code than the rest of society. Most

    patients believe that physicians are not capable of committing the common crimes other

    members of society commit because they are deemed more intelligent.  The belief that

    intelligence breeds morality is purely willed-ignorance because physicians are

    frequently convicted of serious crimes.  The Public Citizen Health Research Group

    recently released a study stating that over 13,000 doctors in the United States

    have been convicted of serious crimes and are allowed to continue practicing medicine

    (Deneberg 1). Physicians will sometimes protect each other even at the expense of

    a black veil ' " (qtd. in Carton 1).  The medical profession is plagued by inefficient training  effective transitional sentence

    and human frailties, but they are not the only parties to blame for the lack of quality

    health care in today's society.

            A majority of the health care providers treating society today are controlled

    by the HMOs. The archetypal physician who made house calls, had time to see our

    latest science projects, and remembered our medical history as if it were one of his

    physician-patient relationships" (qtd. in Goldberg 23).  The HMOs seem to be solely

    concerned with the monetary value of their business instead of the care their customers receive.
                                 interpolation     qwq                                                                  interpolation
   "An HMO executive [stated], ' [w]e see people as numbers, not patients. [There] is no

    Physician's feel that the attitude the HMOs have on medical care seriously limits their
                                                        interpolation
    ability to provide quality care. "[The] loss of control over  resources, restrictions<<direct

    Under these conditions, a physician's sanity rests on his or her ability to see

    patients wanting to be fixed for a fee instead of human beings with lives, feelings, and

    responsibilities that can be adversely affected by an illness. "[Our] lumbering and

    static medical system is leaving less and less room for a doctor-patient partnership"

    (Goldberg 24).  Another disturbing consequence of a health care system controlled

    by the HMOs is the effect it has on the labs physicians use to determine test results.

    Managed care pays the laboratories they contract a yearly flat fee for each individual

    patient's testing. Therefore, in order to make money, the laboratories must hire

    "the cheapest, least-experienced lab technicians" to analyze tests (DeBlieu 107). <<direct

    Faulty test analysis does not seem to be an extremely serious matter when considering

    tests for Strep Throat, but a large part of the tests analyzed at these managed care

    laboratories are for cancer.  Cancer is a disease that relies on early detection in order

    for it to be treated effectively.  A young woman named Karin Smith died from cervical

    cancer because it was diagnosed too late. "After three years of bleeding, three <<direct

    Pap smears, and three biopsies," Mrs. Smith was finally diagnosed with cervical cancer

    (DeBlieu 107).  All of the prior Pap smears and biopsies done were analyzed by a company

    contracted by her HMO called Chem-Bio.  If the technicians in Chem-Bio's laboratories had

    been more concerned with the quality of the test analysis being done daily, instead of the

    the quantity, perhaps Karin Smith would be alive today.  To the uninformed patient, this is an

    unimaginable tragedy.  To the informed patient, the HMOs are "the new kids on the

    block and they've been relatively unregulated" (Bass 2).

    and execute certain treatments.  However, that does not mean we are not responsible for

    researching and informing ourselves about various treatments and illnesses that

    affect us. The information explosion brought on by the Internet has made it

    extremely easy to access information about most treatments, illnesses, and physicians

    we encounter.  It is our responsibility to research illnesses so that we can avoid being

    misdiagnosed.  The people who are the most needlessly tortured by a death that could

    have been avoided are the individuals that pass away and the loved ones they leave behind.

    Since those that are affected have a vested interest in the medical treatment received,

    should they not be the ones aware of the dangers involved in our health care system?

    Should we not be more educated on the latest medical advances on disease and

    treatment and the physicians and laboratories critical to our health?  "You can't assume <<direct

    a doctor is fit to practice medicine just because he's practicing medicine. Nor can you

    assume some government agency or medical society will put your interest above

    incompetent or criminal doctors" (Dennenberg 1).  There are many cases of negligence

    and malpractice that go unreported each year simply because the patients involved do not

    know any better.  There are too many resources available to the general public to

    continue to blame the low-quality health care society receives solely on our physicians and

    government regulators. The American Board of Medical Specialties provides a phone service

    (800-776-CERT) that can verify whether or not a physician is board certified (Blau and

    Shimberg 40).  Web sites on the Internet such as Medi-Nets Web site (http://www.askmedi.com)
                                                                                                                                                  direct
    or the American Medical Association (http://www.ama-assn.org) can render "information regarding
        interpolation
    [a physician's] background and credentials" (41).  The Public Citizen offers a  publication called

    "Questionable Doctors" which can help us learn about specific problems with physicians in our local

    areas. (41).  There are also "Best Doctors" lists available online, in magazines, and at the local library (40).

    It is extremely important to utilize the resources available to research physicians because
       interpolation
    "[p]hysicians like people in other professions, vary tremendously in terms of education, training and

    expertise" (40).

            Physicians are legally able to practice medicine after completing medical school, an

    internship that lasts about three years, and receiving licensing from the state in which they

    intend to practice.  Once physicians are licensed by the state, they "can legally perform any <direct

    medical procedure" (Tanne 65).  However, just because a physician is licensed by the state does

    not mean that he or she is a worthy candidate to perform surgery or treat a specific fllness.

    Dr. Barbara Schneidman warns: "I'm a psychiatrist, and I could do surgery!" (Tanne 65). <direct

    State licensure also does not indicate that they are board-certified. In order to become
                                               interpolation and direct: three words
    board-certified one must "[pass] a difficult examination" (Blau and Shimberg 40). "Board <direct

    certification is not government granted or related to licensure" (Inlander 1).  Therefore,
                                                                              direct                                                             interpolation
    standards for certification can vary from "rigorous standards and frequent testing [to] attending

    a few sessions of a local seminar" (1). "Many specialties now require that physicians take a <direct

    test to renew their certification every seven to [ten] years" (Tanne 62). When choosing a

    physician, one should always search for additional accreditation that is not simply a legal
                                                                              paraphrase
    requirement for medical practitioners.  An accreditation program like The American Medical

    Accreditation Program is a voluntary program that appraises physicians in five areas:

    credentials, personal qualifications, environment of care, clinical performance, and patient

    care results (Wooton 1).  The American Medical Association also presents awards to physicians
         
    who "annually complete and document [fifty] or more hours of formal and personal continuing <direct

    education activities" ("Physician Education" 1).  Few States require more than a minimal amount

    of additional education from licensed practitioners.  Doctors are not annually tested on their

    knowledge of medical advances or new diseases affecting society.  Therefore, selecting a

    physician who has received an award for continuing education is beneficial. When choosing

    a physician, one should also pay close attention to his or her bed-side manner, willingness

    to answer questions, and openness to suggestions a patient may have about treatment options.

    Currently, the health care system makes a well-informed patient necessary because in many

    states the pro-patient laws are anything but adequate.  However, states like Texas, Florida, and  effective transitional sentence

    Massachusetts have been extremely successful in passing legislation that greatly improves

    the laws protecting their patients.

            Health care organizations in Texas can now also be held liable for decisions

    that deny or delay medical treatment.  Florida and Massachusetts have been actively

    pursuing legislation that regulates physicians in many new areas including how

    long a patient can be in a waiting room prior to being seen by a physician.  These

    states are also forcefully working on programs specialized in making the public aware

    of a physician's training, certification, prior convictions, and disciplinary action taken against

    him or her.  Soon United States citizens will be able to access all types information

    about their physicians without spending a great deal of time at the library or the county court

    house.  Until then, however, we must take the time necessary to educate ourselves.

            We spend hours, days, and sometimes even years reading Consumer Digest in order

    to aid us in choosing the right vehicle or computer to purchase.  We consult stock brokers

    prior to investing our money, we hire real estate agents to help us find the most appropriate

    home, and we spend hours reading the newspaper statistics on athletic teams before we

    decide on which team we will place a five dollar bet.   All of the time we spend researching these

    decisions could easily end up being useless if we do not pay closer attention to our health

    and health care providers.  The health care system of the twenty-first century and beyond demands 

    that we take more accountability for decisions regarding our health.  It is our duty to obtain a second, third,

    or fourth opinion on a medical condition until we are satisfied with the diagnoses and treatment

    recommendation. It is our job to research our individual physician's history.  It is our problem

    if we are not educated on the latest medical advances in disease and treatment.  If we continue

    to remain uninformed and do not take an active role in maintaining our health, then we are just

    as much to blame for medical negligence as our physcians, managed care providers, and

    government regulators.  It is our health.  It is our responsibility. <effective echo of thesis and title

     11

                                     Works Cited

Bass, Frank. "Texas Journal: Texas Lawmakers set to Prescribe New

         Pro-Patient Rules for HMOs."  Wall Street Journal  27 November 1996,

         Sec. T: I.  Wall Street Journal  Ondisc.  CD-ROM. UMI Proquest. 1997.  Print.

Blau, Sheldon P. and Elaine Fantle Shimberg. "Choosing your Personal Physician and

          Hospital." Consumer Digest May/June 1997: 40-42.  Print.

Bonsteel, Alan. "Behind the White Coat." The Humanist 58 (March/April 1997): 15-18.  Print.

DeBlieu, Jan. "What 'managed care' did to Karin Smith." Reader's Digest151 (July 1997

          103-108. Print.

Denenberg, Herb. "Bad Doctors: Drug-addicted, Incompetent, and even Criminal."

          Denenberg Reports 1997: 1-2. Herb:denenber@nbc.com.. Online. Internet. 2

          October 1997.  Print.

Goldberg, Robert M. "What's happened to the healing process?'" Wall Street Journal

          18  June 1997, Sec. A: Commentary, 22.  Wall Street Journal Ondisc. CD-ROM. UMI

          Proquest. 1997.  Print.

Hales, Dianne R. "What doctors don't know about women's bodies." Ladies Homes Journal

          114 (February 1997):  50-53.  Print.

Inlander, Charles. "The Smart Patient." Mother Jones  MJ93 1997: 1-2. Mojowire

          @aol.com.  Online. Internet. 02 October 1997.  Web.  7 Feb. 2002.

"Physician Education, Licensure, and Certification." American Medical Association Home Page.

          19 March 1998  Web.  9 Jan. 2002

Strange, John, et al. "Missed problems and missed opportunities for addicted doctors." BJM

           Home page.  19 March 1998   Web.  18 Jan. 2002.

Tanne, Janice Hopkins. "The Best Doctors in America." American Health 15

          (March 1996):  61-82.  Print.

Wootton, Percy MD. "AMAP: Improving Physician Quality for the 2 1st " Century and Beyond."

          American Medical Association Home Page. 19 March 1998.  Web.  11 Mar. 2002.

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