Thursday, October 25, 2012

Should the Government Mandate Physician-Patient Conversations?

Five states have recently passed legislation requiring 'clinics' to inform women with dense breast tissue on mammography that the mammograms may miss tumors and that such dense tissue may increase the risk of beast cancer.  This has caused a conflict between patients who believe in 'the right to know' and physicians who maintain that the significance of breast density is uncertain, and providing such information can only lead to potential needless panic and further unnecessary screening and breast biopsy.

There is no question that it is the duty of a physician to provide the patient, or her representative, with all the information at hand about a problem such as this.  The physician, or other medical provider, should offer all available information and present it in a manner that is easily understood.  Information should include a discussion of the risks, and risks should be presented with clarity, using actual percentages.  At the end of the visit, it should be very evident that the patient, or her representative understands the situation.

Now, should a government mandate that such information be provided?  Dr. Otis Brawley, the chief medical officer and executive vice president of the American Cancer Society opined the following:  "I object to legislation that says doctors should have a conversation with their patients that I believe they should have with their patients."  Read this carefully - it is well said - and so true.

It is a disservice when physicians, or other providers, do not furnish their patients, or patient-advocates with the proper information to help them make informed decisions about their health.  But government mandated conversations are out of line.  Patients who feel they have been inappropriately treated or informed can always resort to existing legal redress.

The important 'take-home' message for a patient is to be certain (and not afraid) to ask the right questions and request detailed answers and information.  It is always a good idea to have someone accompany you - four ears are better than two.

Wednesday, October 24, 2012

Choreography and The State of New York

"Court Upholds The Taxation Of Lap Dances" is the headline of an article in today's New York Times   (page A19) describing the ruling by the New York State Court of Appeals (4-3) that lap dancing fails to meet the definition of a "choreographed performance", and, hence, is not exempt from state taxes as are ballet companies, among other performing groups.

Judge Robert S. Smith, in a dissenting opinion, said it is not proper to define a "choreographic performance" as "highbrow dancing" only and that "lap dancing" is a "dance routine" that is, indeed, entitled to similar tax exemptions.

"I would be appalled," said the judge, "if the state were to exact from Hustler (Magazine) a tax that The New Yorker did not have to pay, on the ground that what appears in Hustler is insufficiently 'cultural and artistic.'  That sort of discrimination on the basis of content would surely be unconstitutional."

So what do you think.

The defendants plan to appeal the ruling to the Supreme Court.  

Wednesday, October 3, 2012

Too Much Information - Obama v Romney

Today's New York Times (page A13) has a large section devoted to text and photos under the heading "Squaring Off With Body Language" - a detailed analysis and comparison of the gestures of our two presidential candidates.

Two gestures that really deserve major attention:  Both termed "The Pointer."

Obama- "This may be Mr. Obama's most frequent gesture.  He holds his hand in a fist with his thumb overlapping the first joint of the forefinger as if he were operating a remote control."

Romney - "This gesture is similar to Mr. Obama's.....except that Mr. Romney holds his thumb to the palm side of his forefinger......"