Friday, December 21, 2012

Case 2 "Pt.'s Request for Possible Useless Tx"

General comments and discussion about the questions at the end of the case.

14 comments:

  1. This comment has been removed by the author.

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  2. In regards to Case 2, I believe that Dr. T should continue with Jeff's requested therapy and prescribe him the drug. Mental health of a patient during a time of sickness, whether it be chronic or acute, is imperative to the patient's recovery. If the doctor sent Jeff home without a prescription, he would not believe he was getting better, making him psychologically less likely to heal. Doctors are responsible for the holistic care of their patients: mentally and physically. If (non-harmful) drugs are required in order to make Jeff believe he is getting better, then it is up to the discretion of the physician to take the responsibility to carry out the appropriate care.

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  3. I agree with Chelsea that Dr. T should prescribe Jeff the antibiotics. If it is not going to cause him harm and will psychologically make him feel better then it is for the best. As long as he is not coming back every week requesting the same thing then there should not be a problem with resistance. I think that it is appropriate for physicians to offer treatments for psychological comfort as long as there will be no harm to the patient. The doctor could also consider giving a placebo.

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  4. I would disagree with the idea that the doctor should prescribe the antibiotics to the patient. While the holistic well-being of the patient is the responsibility of the doctor, the main issue in this scenario is the physical illness. Giving unnecessary medications does pose an unnecessary risk to the patient. The case states that "she figures that an antibiotic will cause Jeff R no harm." "Figures" means that there is the chance, however slight, of complications. You also have to consider the responsibility of the doctor to the community. Lack of adherence to an antibiotic regimen can cause development of antibiotic resistant strains which are considerably more dangerous. Giving the patient the antibiotic unnecessarily increases the risk of creating antibiotic resistant bacteria which may pose a significant threat to the patient and community.

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  5. When it comes to case 2, I believe that Dr. T should not honor Jeff R's request for antibiotics because it is not truly doing anything to benefit the patient. Prescribing medication to the patient will not benefit the physical health of the patient; only their psychological health; which is not the main issue at hand. So I believe it is also wrong for physicians to give out prescriptions for the sole purpose of psychological comfort. This not only misleads the patient, but it can actually harm them and can make the bacteria in the environment more resistant to the antibiotics. This only can make the bacteria stronger and can make others even more sick; just because one physician decided to give out medication for psychological and not physical health. Overall, my belief is that physicians should only prescribe medication for the actual health issue at hand; not for psychological comfort.

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  6. In the situation presented in Case 2, I believe that Dr.T should not give Jeff the prescription for the antibiotic. Prescribing unnecessary antibiotics has caused the issue of "super bugs," such as MRSA and VRE, in the past and this will only make him more susceptible to these. Overuse of antibiotics causes your body to create resistance to them which can cause a lot more harm in the future. The doctor has clearly explained to Jeff that these antibiotics will not provide any benefits to his condition, so there probably wouldn't even be many psychological benefits to prescribing this medicine anyways.

    When it comes to the morality of physicians providing prescriptions for the sole purpose of psychological comfort that is based on false belief or misunderstanding, I think it depends on situation. If that medication will not cause any potential harm to the patient then I do not see anything wrong with it. Sometimes people experience symptoms as a result of their psychological status, and providing a means that helps a person to have this comfort is sometimes all it takes to make them feel better.

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  7. 1. Dr. T should not honor Jeff's request for antibiotics because the antibiotic would be useless against treating the flu. If Dr. T were to give the antibiotic to Jeff, it could actually weaken his immune system. This would make it harder for Jeff to fight off any later illnesses. Dr. T would actually be doing more harm to Jeff than good.

    2. Physicians should not provide psychological comfort to patients when it is based on a false belief. The physician-patient relationship should be built on trust and truth. When the physician betrays that trust by presenting a false belief, it is harder for the patient to trust them when they have a real illness that needs medication.

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  8. 1. As an educated professional, Dr. T is aware of the harm associated with giving Jeff unnecessary medications and therefore, it is her duty as a physician to refuse Jeff's request for antibiotics. In this case, if she were to provide Jeff with the antibiotic, she would not be looking out for his best interest knowing that there are potential negative side effects from overusing antibiotics. There has to be a line between the general population and physicians, demonstrating why people even consult medical professionals rather than just handling situations of their own.

    2. As long as the treatment can do no harm to the patient and there is solid reasoning why the physician is providing the physically unnecessary treatment, then it is appropriate. This situation reminds me of the placebo effect, where a placebo (a fake but not harmful substitute) is given to the patient and the placebo is helpful in relieving the patient's symptoms. Although the placebo effect is not always successful, it has been noted to work in up to 1 out of 3 patients (www.cancer.org).

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  9. 1. Dr. T should not honor Jeffs request for the antibiotic. It will not help him and could end up hurting him in the long run, so it would be unethical to prescribe him the antibiotic. Dr. T is more educated in the are of medicine and needs to work for the best interest of Jeff, which means not giving him the antibiotic, even though Jeff feels that it is necessary.

    2. I think giving a patient treatment for psychological comfort when that comfort is based on false belief or misunderstanding is acceptable as long as there are no negative effects as a result of the treatment. If there are negative effects, it is not morally permissible to give the patient the treatment so he thinks he feels better when it will actually hurt him later.

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  10. 1. Dr. T should not prescribe the antibiotics of Jeff. Dr. T's responsibility as a physician is to take care of the health of the patients. This is not a situation in which the patient has a decision to make, but where the physician only has the decision to make. Knowing that the antibiotics have the potential to harm the patient, the physician should use his or her better knowledge and judgement of the human body and medication, and not treat in a way that could hurt the patient; even if it does not fulfill the patient's wishes.
    2. I do not think that it is appropriate for physicians to offer medicinal treatments for psychological consolation. Physicians should only offer medicinal treatment that directly addresses the issue at hand. Patients should be reassured by the professional's opinion. I am not sure at this time where I stand on placebos because I have seen them work periodically in studies. There is a side of me that wants to say that if it helps the patient in the long run, go for it, but, there is also a side of me that says that it is lying to the patient and really just reassuring the patient that he or she needs to be given treatment every time there is something wrong.

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  11. I agree with Tim I don't think that it is appropriate for a doctor to proscribe the antibiotics. The antibiotics wond work and will possible allow the bacteria go become more resistant to the medication. This situation arises a lot in that patients are seeking drugs unfortunately it is because they are addicted. Although I don't believe you could become addicted to antibiotics you cannot prescribe drugs just because the patient wants them this creates a slippery slope that would not be good and is the same in my opinion of people who are drug seeking for a high. The doctor is the one who should be giving advice and treatment because that is what they went to school for the rest of the people may know some things about the medical world but not enough to go prescribing there own treatments. The idea of maybe giving a placebo is another idea because it allows the patient to get the psychological help without the risk of giving an un needed prescription.

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  13. I have long been opposed to the use of antibiotics in cases where there is no significant infection, and in soaps, cleaning products, etc. Bacteria have built a resistance to antibiotics due to their frequent use, and the consequences of this have been observed. However, this is more of a physiological reason than an ethical one. I think the doctor would be morally justified to prescribe antibiotics to Jeff only if he gave him a low dosage of a very weak antibiotic, so that there was little chance of it causing harm. This would give the patient a sense of security as well, even if it is a false sense of security. As long as the doctor tells the patient that the medicine will not help his sickness in any way, it is not immoral to give the patient the medication. I do not agree with the idea of giving the patient a placebo, because the doctor is taking advantage of the trust of the patient. This is a form of deception, and I think a doctor should never give the patient false information.

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