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ExploitationAt what point does selling products to patients become exploitation?Consider the physician who begins the appointment by saying that the patient appears to be holding his neck in an unnatural position. The patient has come for help with fever and congestion and gets asked first if his back or neck ever hurts. The patient ends up spending three hours in the doctor's office, gets a chest x-ray that is used for what it shows about his back, and hears six times as much information about spines and what chiropractors can to do than about the reason for the visit. Then, when the patient finally is being allowed to leave, it turns out that the chiropractor next door has an opening at that moment. It appears the patient has been kept in an examination room until the time of the vacancy in the chiropractor's appointment book. The doctor does not present it as an option, and does not ask if the patient wants it, but reaches for the phone to tell the chiropractor that the patient is being sent over. Consider the orthopedic surgeon being seen for the first time by a patient on a Friday afternoon who tells the patient that surgery is needed and can be performed on Monday morning. That leaves no time for the patient to get a second opinion, no time to try to learn anything about this particular surgeon, no time to consult with family and friends and research whether surgery is the best approach for solving this problem (it wasn't). Consider the dentist who tells all patients that they should be using vibrating toothbrushes and then happens to have an expensive model available to sell. Patients not used to declining the advice of their dentists buy them. Many use them only once. Patients not used to returning products to dentists, as they do to retail stores, often throw them away. Each of these instances may or may not be abusive, but each can make patients less trusting and less compliant consumers of healthcare. Healthcare providers will have a reduced ability to deliver the best healthcare and a greater level of frustration wondering why these patients don't do what they say. There are dentists who sell crowns that patients do not need. There are pharmacists who purchase gray market drugs or who "miscount" the number of pills being put in a bottle. There are physicians who do surgeries they've only read about but never practiced, and who do them in communities where specialists exist to whom patients could be sent. Small and large exploitations occur in medicine everyday. No one records them. No one counts them. There isn't any advocate to whom patients can complain about them. There isn't even anyone in patient safety circles giving serious thought to the problem. Patient safety is defined in terms of errors. Abuse and exploitation are not on the map. It is assumed that healthcare professionals are objective and honest and selfless and the only problem is the infrequent error. * * * Among major industrialized countries, the USA ranks last in quality, access and efficiency according to the Commonwealth Fund, a healthcare research group. Healthcare is not run to maximize safety and healing. It is run to maximize profit. Some might wonder if that isn't that exploitation on a large scale. |
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