Ethical responsibility to treat

[reactive]

I have been reading some of the most recent threads. I see a trend that I can't believe we are still talking about. Physicians still not educated in PANDAS/PANS and or physicians who know about the disorder but refuse to treat it.

 

I am lucky to have a local rheumatologist who is open minded and will treat my son. But her one and only partner will not treat. I attempted to hand him the latest consensus paper and he wouldn't even take it from my hand to read it. REALLY?

 

I work in health care, but in a different specialty. It irks me this is still happening...since when, if you are a licensed medical professional, do providers get to shun treatment for a group of patients?

 

Don't get me wrong. I am grateful for the gains that have been made so far. But we are at a point now, with major institutions treating this disorder, that patients should have better access to treatment. Game on.

 

Rant over. Thanks for listening.

[pr40]

Hippocratic oath says do no harm, it does not say help anyone who needs it. Unfortunately. P/p is still considered controversial. it does not exist in the diagnostic manual and most insurance does not recognize it. that is a bureaucracy

[kmacdonald34]

I also think a lot of doctors do not know enough about it. My pedi initially refused when I asked for a referral because she said a negative strep test and blood work meant no Pandas. Then I pushed and she wanted me to go to Boston Childrens Hospital because it was in her network and not Mass General where I wanted to go. After a lot of pushing by me she gave the referral and now my daughter is being seen by 3 great dr, on antibiotics and so much better. Even one of the dr my daughter is seeing said 5 or so years ago he did not believe either but after seeing case after case after case, there is no way he can't believe. I think over time more and more dr will change their views but it is hard. I feel your frustration.

[reactive]

The Hippocratic oath states "do no harm".

To do no harm:

Correct diagnosis.

Treat the condition.

If unable to treat the condition, refer to someone who can. ("Treat it or refer it")

Failure to do this will do "harm".

[4Nikki]

We have seen Doctor's willing to try and then give up after finding nothing and Doctor's who are willing to stick it out and not quit. We have come across doctor's that just flat out say, "I can not help." Then, we have come across two neurologist, that say "We do not believe in PANDAS". I would venture say, that this latter attitude clearly violates the oath. It's one thing to say you don't have faith. It's quite different to refuse to accept tangible evidence contrary to what your were taught because you have faith in what you were taught.

"A Modern Version of the Hippocratic Oath

I swear to fulfill, to the best of my ability and judgment, this covenant:

I will respect the hard-won scientific gains of those physicians in whose steps I walk, and gladly share such knowledge as is mine with those who are to follow.

I will apply, for the benefit of the sick, all measures which are required, avoiding those twin traps of overtreatment and therapeutic nihilism.

I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon's knife or the chemist's drug.

I will not be ashamed to say "I know not," nor will I fail to call in my colleagues when the skills of another are needed for a patient's recovery.

I will respect the privacy of my patients, for their problems are not disclosed to me that the world may know. Most especially must I tread with care in matters of life and death. If it is given me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play at God.

I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person's family and economic stability. My responsibility includes these related problems, if I am to care adequately for the sick.

I will prevent disease whenever I can, for prevention is preferable to cure.

I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm.

If I do not violate this oath, may I enjoy life and art, respected while I live and remembered with affection thereafter. May I always act so as to preserve the finest traditions of my calling and may I long experience the joy of healing those who seek my help."

Edited April 20, 2015 by 4nikki

[MomWithOCDSon]

Unfortunately, too many doctors fulfill an ethical responsibility to "treat" by "treating" with the wrong responses, such as multiple psych drugs, recommendations that the parent switch up their "parenting techniques" and the like. Drives me nuts.

[pr40]

The Hippocratic oath states "do no harm".

To do no harm:

Correct diagnosis.

Treat the condition.

If unable to treat the condition, refer to someone who can. ("Treat it or refer it")

Failure to do this will do "harm".

this is just about the logic: do refers to what doctor does. if he does not treat, the doing is not treating. not treating, by definition, does no harm. also, doing is defined in respect to what the doer can do, not inrespect to what someone else would define as doing.

medecine is very conservative. not treating is an option. not treating does imply that you need to go elsewhere for care. it is a referal. I am of course not defending the doctors.

Edited April 22, 2015 by pr40

[4Nikki]

I tend not to agree with the logic of not treating as an option for the doctor, but rather its an attitude that is a polite way of not discussion what the doctor really thinks.

 

A referral is a specific action of doing, not an inaction. No action, being a bystander, watching something happen, is not getting involved with their patient, is not acceptable. When a doctor sees a patient, there is an obligation to do, whether the action is to treat or refer, an action is required. Doing nothing and accepting a fee in my opinion, is not only hypocrisy, but criminal.

[pr40]

sorry, 4nikki, i can't resist it: if in dr's eyes, patient is not sick, there is no obligation in his/her eyes to treat. not treating is in this case an opinion and fee is for service rendered just as it would be when there is a diagnosis.

if not treating were criminal according to the law, I would have sued many drs so far and would have gotten rich in the process. what it is substandard performance. they SHOULD know. but they don't.

Incompetence, unfortunately, is very hard to prosecute. negligence, on the other hand, is very easy if there is evidence.

Edited April 24, 2015 by pr40

[4Nikki]

We will just have to be in disagreement. Although I have to eloborate. The case of our children is that there is tangible evidence of a illness not that our children are viewed as being not sick.

 

When you bring your electric car in that has a trouble light for service to a gasoline engine mechanic, he listens to you and says he doesn't work with electric motors and can't help you. He doesn't get to charge you for a diagnosis because he has preformed no service. The car still has a problem and if the mechanic knows another mechanic who does work on electric engines, he can offer you a referral where you can get your car serviced. Where the ethics line is crossed is when the mechanic says I see you have an electric motor with a service light, well... we don't like electric motors and won't work on them so we can't help you. Oh BTW we have to charge you for the time we took to tell you we don't work on electric motors.