Are we are all "medical citizens," embedded as potential or actual patients, with our physicians, insurer's, pharmaceutical companies, government bodies and others in a system of societal, moral and organizational stakeholders?Today, with the advent of the Internet, High Speed Bandwidth, Social Media, Support Groups and Self Care Protocols, patients for the first time in the history of medicine have the ability to alter the outcome of disease and illness for themselves, family members, friends and significant others.This essay attempts to address a most compelling issue of our time. Are medical self-help groups and self-care methods helpful or are they challenges to the delivery of traditional medical care? How do they differ and what consequences arise from this debate?Also, how has the advent of the Internet and Social media transformed the landscape of medicine? What limitations may exist in this new era of information technology and social communication? And to what degree do they challenge traditional care models? Can a patient or their advocate become more of an expert on their own medical conditions than their own physicians? The answer to this question is a resounding yes, if the patient uses all the tools now available to them.Various published estimates unanimously indicate that hundreds of thousands of patients die and millions more are injured by medical procedures gone wrong, medication errors or their side effects and by medications improperly prescribed or not taken as directed by patients. And it is not just the infirm that suffer, but their families, their loved one's, friends and employer's who must suffer with the grief and change of lifestyle that so often comes with these mistakes.Furthermore, on May 8, 2013 National Center for Policy Analysis, in a release, stated that first diagnosis error rates are increasing at an alarming rate:• An estimated 10 percent to 20 percent of cases are misdiagnosed, which exceeds drug errors, andsurgery on the wrong patient or body part, both of which receive considerably more attention.• One report found that 28 percent of 583 diagnostic mistakes were life threatening or had resulted in death or permanent disability.• Another study estimated that fatal diagnostic errors in United States intensive care units equal the number of breast cancer deaths each year -- 40,500.Therefore, second opinions are often necessary precautions, as are third opinions when the first two differ. In fact, Medicare and insurers often pay for third opinions under these circumstances as it saves them billions in the long run.Prudence dictates that the "medical citizen" must beware of these pitfalls, as their lives may depend on it.Also, with patient reviews and rating systems available right on our own smartphones, we must question whether or not physician decision making is being compromised as well. For instance, a surgeon knows that his or her treatment decisions can possibly either result in either saving a life or ending it resulting in damning social media judgements, whether legitimate or not, which can then hurt their medical practices? Does this introduce a bias that may alter or cloud a doctor's judgement? There is no data to provide an answer as of yet.So, are doctors becoming more risk adverse as a result of this new landscape? Physicians are now being compensated more and more based on better outcomes, lower costs, reduced re-admission rates and other variables - not staff friendliness or less waiting room times which many doctor review sites measure.Often 5 star rating systems get few patient reviews despite the fact that the average doctor has some 2,000 patient charts (most healthy) and while it is human nature to complain when we don't get the outcome we want, consumers are less likely to praise a positive experience because we naturally expect top service and thus neglect to post a positive patient review yet are rather far more likely to post a negative review to retaliate against the provider. So patient reviews are not a very good or objective source of fair and balanced overall rating of a doctor's performance.How can this dilemma be resolved especially when a surgeon does everything perfectly but the patient becomes a victim of medication errors, poor nursing compliance with medical orders or perhaps contracts a hospital born infection, or some other adverse event out of the doctor's control even if the doctor's work is excellent? Nevertheless these doctor review sites often blame the physician. So Patients need better tools to make judgements about their own healthcare whether it be which plan to select or which treatment option to go with given a choice.If a patient does utilize a rating site, they should make sure it is a government site based on huge amounts of data or a private site wherein doctors nominate other doctors for their excellence and would use these "doctor's doctors" to provide care for their very own friends and loved ones.Doctor reviews by other sites using stupid criteria like waiting room times, friendliness of staff, waiting room decor and other questions that have nothing to do with best outcomes accomplish nothing but make money for their operators.In modern day, it is not unusual for patients to challenge doctors when it comes to illness and disease. After all, according to Tejal Gandhi, MD, president of the National Patient Safety Foundation and associate professor of medicine, Harvard Medical School, "Preventable medical errors persist as the No. 3 killer in the U.S. - third only to heart disease and cancer - claiming the lives of some 400,000 people each year, at a cost of over a trillion dollars a year"".Self-help groups and self-care probably date back to the dawn of civilization when people lived cooperatively in tribal settings. These groups dealt with all life issues related to the survival and political stability of the group. The dawn of medical ethics probably dates back some 2300 years with the publication of the Hippocratic Oath.But now the game has dramatically changed due to major technological advances in medicine and with the great advances of the Internet now being the primary source of medical information for medical consumers. And with the explosion in social media, people have the ability to communicate and share information on a scale never before foreseen or imagined.Add to this all the new stakeholders that have entered the fray such as insurance companies, employers, managed care organizations, Obamacare, biotech companies, governments and, of course, pharmaceutical companies and healthcare policy makers. The challenges faced bythe medical citizen and social policy planners have never been so daunting.Postmodern Medicine probably arose after the institution of Medicare in 1965 when Medicare was signed into law in 1965 by President Lyndon Johnson and third party payer insurance companies soon appeared thereafter. By the 1970's the practice of medicine became the business of medicine and third party payment systems caused a surge in demand for services and the costs of healthcare delivery soared. Also, the debate over what is a disease and what is an illness now must be addressed in a sociological manner more than ever as it affects whether treatments are made available and what costs are covered by third party payers.Self Help Groups are usually a group or set of people who all share or suffer from a similar malady which involves great personal cost and suffering for themselves and those who care for them.Self-care is seemingly clear in meaning. We get a cut and we put a band aid on it. Have a headache, take an aspirin. But is it really so clear as pharmacy shelves that are now filled will medications that used to be available only by prescription and medical devices one can use for self-diagnosis and self-care which measure bodily functions and vital signs such as blood sugar levels, blood pressure, pulse oxygenation, etc. have resulted in patients self diagnosing and treating themselves, often without medical advice. Defibrillators are now a fixture in most large organizations where non-medical designated company personnel are trained
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