First, do no harm

Thank you to Char for sharing this very well-written article on Forbes.com: "Why Rating your Doctor is Bad for Your Health." It quotes some colleagues from UC Davis, where K and I trained in residency, and really should be mandatory reading material for all patients (and doctors).

I believe in patient-centered care. I believe in being nice to patients (and hoping they're nice to you) and listening to and considering their concerns carefully. I like patients to be satisfied. But I don't believe in performing unnecessary diagnostic tests or over-treating to "get good reviews" and I certainly would not do anything I didn't feel was medically indicated just to keep a patient from getting upset with me or because I'd be better compensated (this, to me, is absolutely abhorrent).  I'd rather "do the right thing" and get a bad review than potentially cause a chain of harm by doing what a patient (who, with a few exceptions, did not go to medical school) requested.

I have refused a lot of antibiotics in my day (note to all future patients: save yourself a visit for a "cough/cold" lasting fewer than 2-3 weeks, as antibiotics will not help you, and bronchitis is rarely bacterial).  I have refused to do a pap smear in an appointment made for a "pap" as it was not due (note: pap smear screening has recently changed to every THREE years for most women ages 21-65, or every 5 years if negative and HPV co-testing is available; however, annual exams/health reviews and pelvic exams may still be indicated). I have refused to order imaging as I felt the chance it would be abnormal was minimal (note: not all abdominal pain requires a CT scan). I don't agree with Lyme testing for asymptomatic people, even though I live in a Lyme-endemic area. I don't think all pain needs to be treated with narcotics. I request urine specimens in almost all patients who "think" they have a urinary infection, as many do not, and won't usually treat over the phone. We are still over-screening people for prostate cancer.

Doctors need to stand strong in their medical decision-making and not be swayed by threats of patient dissatisfaction or poorer compensation. As we all swore at a ceremony in medical school in accordance with the Hippocratic Oath, "First, do no harm."