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Bad Family Medicine

January 25, 2015

As much as I have given the ologists and other members of the dysfunctional U.S. healthcare system a hard time in previous posts, it’s only fair that I call out bad family medicine as well. I have a great example.

I recently saw patient who is relatively new to the area who had seen another family physician in my community. He is 39-year-old male and his only significant potential health problem is borderline hypertension.

When he came to see me he brought a bag full of about 6 medicines and was scared because he was told that he had a whole host of medical problems. Best I can tell, there were some insurance issues that caused him to seek care at my facility: private doctors not taking one of the low-pay exchange plans I suspect. He had saved a copy of the paperwork he received from the previous family physician, which included a “complete set of blood work.”

It would take too long to write out all that he was subjected to, so I’ll give you the main categories of blood tests. They included panels (meaning more than one test per panel) of labs for cardiac dysfunction, cardio metabolic markers, lipids, lipoprotein particles and apolipoproteins, inflammation oxidation markers, myocardial stress/function, platelet function, lipoprotein genetics, platelet genetics, coagulation genetics, other metabolic functions, renal, sterol absorption markers, sterol synthesis markers, glycemic control (more than an A1C), insulin resistance, beta cell function, electrolytes, liver functions, male and female hormones, thyroid function (8 tests in that panel), urinalysis, CBC with differential, PSA, omega-3 fatty acids, omega-6 fatty acids, other fatty acids, and a few more that are harder to categorize.

The patient’s TSH was perfectly normal, but this doctor had prescribed levothyroxine. His cholesterol was 203, LDL-cholesterol 133 and HDL 54, but she put him on a statin. His blood pressure, best I can tell, was never measured higher than the low 150s, but he was prescribed three blood pressure medicines. His pressure was way on the low side of the normal range when measured at my clinic. He also brought a list of stuff from the grocery store he was supposed to take every day such as so many teaspoons of cinnamon, cloves, and some other plants and spices.

What an incredible waste. This poor guy was exposed to financial harm, psychological harm, and completely unnecessary medications. I made my best guess about the minimal regimen he would require to keep him in good stead for the next few years (one blood pressure medicine). I have not seen him back yet for follow-up.

I wish there were some mechanism to report this heinous care that did not involve the state medical board. This lousy care is just as bad as when a cardiologist performed an unnecessary stent or an orthopedist does an unnecessary joint replacement.

At least I have a glimmer of hope that this kind of behavior could be captured using billing data. As the pundits talk about quality of care and metrics, reforming this kind of outlier poor performance would be much more meaningful to our country’s future than the meaningless use criteria being foisted on us now.


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7 Responses to Bad Family Medicine

  1. Laurence Bauer on January 26, 2015 at 8:01 am

    This is sad. Finding a way to communicate with the other FP would be a kindness. But the best thing you could do for this patient is to see him again. He needs a relationship with someone like you so he can slowly regain a sense of his well being. Call him up and invite him to return.

    • Richard Young MD on January 26, 2015 at 9:15 pm

      I should see him soon. There hasn’t been enough tome passed to conclude that he’s drifted away.

  2. Tracie Updike on January 26, 2015 at 1:11 pm

    Yep, this type of abuse is everywhere! I’m now afraid to refer patients to specialist because of what they might do to my poor unsuspecting patient.

  3. R Watkins on January 28, 2015 at 3:49 pm

    It would be interesting to check out the previous doctor’s practice. There are usually a few like this in every city, typically with “Wellness” or “Holistic” in their names. They don’t take insurance and everything is cash on the barrel head, including all those ridiculous tests. And the rest of us get stuck with explaining why those tests are worthless when patients request them.

  4. William McPeck on February 2, 2015 at 7:10 am

    If the care this patient is so egregious, I don’t understand your reluctance to report it to the state board. I thought this was the whole point of medical boards. Doctors policing doctors because no one else can.

  5. Christopher Gregory on February 12, 2015 at 6:14 pm

    I sometimes wonder about the conditions under which family doctors must practice today. In the vanishing species of independent family practice doctors, the doctor runs hard just to stay in place. For the independent family doctor, it’s run at full speed to keep up the full slate of exam room visits at lower insurance reimbursements (thanks RUC), all to keep the practice running. So is there little wonder that face times are short, prescriptions are more quickly given out, tests ordered and referrals made perhaps in more haste than comfortable. It’s a messy equation that I’m sure the vast majority of family physicians would like to re-write. And the docs who’ve been bought out by the bog medical system? They’re under pressure to do more, test more and use more hospital services. Either way, not a pretty picture.

  6. Beth K on November 22, 2017 at 12:40 pm

    I’m trying to come up with who benefits from all of this overtesting, overdiagnosing, and overtreating. As the years have gone by, I keep running into fairly-healthy young or youngish people who spend their leisure time talking about their trips to doctors and hospitals – as the more-boorish elderly did when I was a child… and about all of their conditions which were caught “in the nick of time”, as well as their medications.

    I talk to people in their 20s and 30s who are clearly not at death’s door who are taking upward of a dozen prescription medications – this is more than my stepfather did in the 1970s, after he’d had several heart attacks, several strokes, diabetes, high blood pressure, and tuberculosis! To a person, they’re convinced they’ll die if they stop any of those medications or regimens they’re on.

    Of course, all medications have side effects, and many 3-way or 10-way interactions have never been studied. They get no “help” from this, so is it any wonder that many of them go to “alternative” medical practitioners – herbalists, nutritionists, buy Rafe machines… at least most of these ineffectual things don’t actively make their health worse – and it might have a placebo effect of getting off of an unneeded drug. The harm is that it costs money for no benefit, they may get off a needed and effective drug (randomly), there may be interactions with the herbs and chelated minerals, and the whole thing might cause them to forego a needed treatment – then again, so does this *overdiagnosis* scenario – they could easily be missing a serious condition.

    I’ve had various doctors try to tell me/diagnose me with various conditions, with no evidence, no lab work or even lab work that counterindicated it, but they were fast on that prescription pad! Also, referral to the “ologist” – who several times came back with “There’s nothing wrong here that any Family medicine provider shouldn’t have seen.”

    A family member who had just run a “high” cholesterol right after eating – HDL 50/LDL 110 and is fairly healthy refuse a statin, only to have the doctor run out into the waiting room after him yelling “You’re going to die!!!”

    It’s kind of looking like much of the healthcare industry is in the business of convincing well people that they’re sick, and convincing the sick that they are VERY sick, and close to death. It works kind of like Voodoo does: If someone thinks they are under a Voodoo curse to kill them, often they will sicken and die. If they get someone else to remove the curse, the person gets well again. There may be no curse, and if there is, I doubt it would have any effect. But, the person believes it does, and people tend to live up or down to others’ expectations – especially those whom they hold in high regard.

    No wonder the US has the highest costs in the world, with the worst outcomes by several measures than any industrialized countries. IMX, if a patient won’t buy someone in a white coat (Dr, PA, NP, therapist) telling them that they have condition X and they need treatment Y and medication Z without evidence, a great deal of time is taken up “selling” the condition to the patient. Yes, some of us ask for objective tests demonstrating that we actually have a condition before we agree to treatment. It’s one way to stave off a sales pitch for things that are more expensive!

    I hope you bring the patient back to his senses and that he doesn’t need this regimented life, and just treat his actual conditions, not a myriad of them.

    I wish I could find a provider of medical care, not a used car salesman. 🙁

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