What patients want

I recently spent some time with a doctor. In the few short days I spent with him I noticed a few trends. Every new patient got AB index done by the nurse with the doppler. Every new patient got a full lab workup with everything from Lyme titers to ESR. Most patients got PFTs. Every patient was either given an ultrasound and a joint injection or given a perscription of whatever drug the rep serving us food in his office was pushing.

Examples:

Woman with diabetes comes in uncontrolled on her current drug regimen. She isn't taking the drugs at the prescribed time. She admits to feeling "low blood sugar" every day after she takes her medication so she eats whatever is in the vicinity such as cookies to bring it back up. Her A1C was like 15. No diet or medication counseling was done. Instead he grabbed the rep that was in his office pushing some drug class I never even learned in med school (it was that new) and had him explain the drug and then gave it to the patient.

Woman with hypothyroidism gaining weight. He sends her for gastric sleeve at her request.

Guy with outrageous uncontrolled hypertension on 4 different medications. He decides those aren't working (none of them are maxed out, or the correct combination of medications you are supposed to put patients on) and switches him to the newest combination hypertension pill that I have again, never heard of.

Guy with abscess. He drains it and then proceeds to give him a few specially formulated tubes of stuff to put on the wound that he has specially mixed and delivered to his office. It was basically flavored neosporin. I bet you anything he's charging a good bit for that.

The kicker? He's one of the highest rated doctors around. Patients LOVE him. They eat this crap up. He practices the worst medicine I've seen, but he makes the patients all feel like they are celebrities. He profits from a bustling practice built by robbing these patients not only of their health, but their money.

Patients love expensive medicine. If you go to your doctor feeling really crappy and he tells you that you have a virus and don't need an antibiotic what will you do? Well, most people will whine. "My last doctor would give me an antibiotic". "I had this a few months ago and I took the antibiotic and it helped." "I got this from my husband and he got better on an antibiotic." Everyone thinks they are doctors. And most doctors will cave. Otherwise they get bad reviews online and their practice tanks. No one can trace antibiotic resistance back to that doctor, but they sure as hell can trace crappy reviews. I can make the same argument for pain medication, lab tests, etc. The list goes on. Patients want what they think they need.

If you go into an office and get told you have this and that wrong with you, but don't worry it will be fixed with a knee injection and this brand new medication, you're elated. This doctor is so smart he found things wrong with me other doctors didn't! And he hooked me up to this crazy machine and measured my blood flow! No other doctors do that! And he checked every single one of my labs (including PSA and all the other ones no longer recommended) because he really cares to make sure I don't have cancer or liver disease or kidney failure! And he has all these new medications that work better than the old ones! And he fixed me all up by doing an ultrasound in his office and injecting me with medication right there!

And people complain that medicine is too expensive. It's a vicious cycle. People want to be validated for going to the doctor. They think they know what's best for them and want a doctor who just gives them what they want. They don't want good, efficient, smart medicine. Then what happens to the good doctors who only order the necessary tests, only give the generic medication, only practice evidence based medicine? Patients don't read the literature, but they do watch the TV and read the internet and listen to their friends.