A reader of this blog named Laura Fisher left a comment about “doctors as bureaucrats” meaning they care more what their employer thinks of them than what their patients do. A scary and plausible idea. I asked for details. She replied:
I live [and practice psychiatry] in a small [Utah] college town that is 80% Mormon. Almost all the docs in town are employed by an outfit called Intermountain Healthcare which owns most of the hospital beds in this and a few surrounding states. Once you get the doctors on the payroll, they really must take instruction from the employer–and they sure as hell do. The doctors who refuse to take instruction that is ethically or morally conflicted or repugnant are typically subjected to “peer review” as a means of punishment, either by hospital medical staffs or by state licensing boards. If you want details on the abuses of “peer review”, you should find plenty of information on the website of the Association of American Physicians and Surgeons .
The typical patient I see has been jollied along for years [by IHC doctors], sometimes decades, without any of his physicians taking the time to review his/her medications effectively. There isn’t a billing code for actually taking the time required to deliver good care, so the patients do not get good care. Some of them get good surgeries. Some get bad surgeries. Often a patient has had a surgery or procedure that he or she did not need. Often the surgery creates new needs for expensive pharmaceuticals. Most often he or she is on a pharmaceutical which is causing psychiatric effects. Either no one has thought of this, including psychiatrists, or no one other than the patient has thought of this and the patient is afraid to discontinue medications for fear of alienating the doctors he needs to stay on good terms with and for fear of unanticipated withdrawal syndromes. The docs who are seeing these salt of the earth working-class patients are young physicians who are not familiar with the old-fashioned notion of the doctor-patient alliance as being somewhat sacred, private and full to the brim of ethical obligations on the part of the physician. These docs check out at quitting time. I have seen them fail to save a sick person at risk of death when one of their colleagues is responsible for putting the patient in that predicament. They refuse to answer questions from patients about whether or not a given treatment change would help that patient, apparently because that doctors employers’ treatment guidelines don’t include answering such questions or choosing different treatment and because that doctor’s professional society leaders are reading from the same page where treatment is conveniently canned such that even nurses can dole it out pretty successfully.
I have seen depressed patients whose depression completely resolved when he or she stopped taking the statin they were on. I have also been interested in the statin users apparently having a higher risk for infections and therefore cancers. Duayne Graveline wrote a very short book (Lipitor, Thief of Memory) on his personal experience with transient global amnesia. This short book is great introduction into the statin subject. The best book I have found on the statins is Fat and Cholesterol are Good For You by Uffe Ravnskov. There is an International Network of Cholesterol Skeptics and their website is marvelous. If you look at this material you are going to learn that it is a poor idea to interfere with cholesterol because we have to have it for brain function.
Don’t forget to read The Trouble With Medical Journals by Richard Smith and The Emperor’s New Drugs by Irving Kirsch.