Physician Patient

Archive for July, 2018

Minnesota physicians do not want to be our vaccination police

Thursday, July 19th, 2018


Minnesota physicians do not want to be our vaccination police

A July 19 letter from the Minnesota Medical Association and MN Academy of Pediatrics urges our legislators to act to “tighten Minnesota’s law by closing the current loophole that allows parents to express a conscientious objection to administering vaccines.” In our view there is no reasonable disagreement that scientific information readily available to parents and vulnerable communities about vaccinations is a laudable goal and worthy public expense. For example, the Somali community is combating false claims that measles vaccines cause autism in their children Moreover, today children who are not immunized for diphtheria, tetanus, and pertussis (DTP) in Minnesota are denied admission to schools or day care programs unless their parents formally object (the conscientious objection). This is how it should be. Our Minnesota public health goal ought to be reduce parental objections. However, requiring Minnesota’s licensed physicians (and other professionals) to administer vaccines is counterproductive. Making a medical license contingent on administering vaccines smacks of George Orwell’s dystopia. Such public policy only sows patients’ distrust for doctors and discontent among clinicians.

Motivational Interviewing

Tuesday, July 10th, 2018

This well written article by Rebekah Bernard MD highlights a perplexing dilemma for physicians and patients today. Doctors and other professionals who are denoted as “providers” within a clinic, insurance plan, or government program are graded and paid based on lab tests or questionnaires aggregated as scores for their performance derived from a population of patients who’ve been (arbitrarily) paired with that physician or “provider.”

Yet, we know that in most outpatient settings physicians have little control over what their patients will actually do. The terms “patient adherence” or “patient compliance” attempt to quantify discrepancies between the recommendations of the physician and the actual result of the patient in following his or her advice. Ironically, given the narrow (and narrowing) time crunch for allowable doctor-patient interactions, current P4P methodologies are likely to discourage patients from taking responsibility for their health care.

That’s where motivational interviewing comes in. Motivational interviewing enhances (realistic) patient and doctor decision-making. It helps put “skin in the game” for patients and doctors, especially when both patient and doctor can readily compare real, consequential prices of health care services, medications, and insurance benefits.