I wanted to comment on two subjects recently discussed, even though I might
be a little late.

<<
 She called her Ped to tell him she was switching to ABM.  He called in a
 prescription for a diuretic to dry up her milk....
 The med was Furosemide.
  >>

>This is crazy & dangerous.  I have never heard of doing this and I certainly
>don't know any peds doing that, until now.
>

This is being done often here in Israel. I heard it recommended by many
doctors, and it seems to work. I don't know about references, but when a
mother is given one tablet, I don't think much harm could be done. I
personally don't use it.

                  ***********************

<< They found some protein in his urine, and then a whole
 bunch of investigations began, which ended with a kidney biopsy >>

>....  Afterall, he just had a
>thorough physical and they said he was fine and healthy!  Excuse me, I
need to
>call my lawyer..........


We community doctors face the dilemma of how much to investigate a
complaint, or an incidental finding, all the time. I would call this "The
art of medicine". Of course you would like to make a little too many tests,
than so few that you keep missing diagnoses, but deciding what to do, whom
it should be done to, when it should be done, when you should stop - all
these make the difference between a good, experienced doctor, and someone
who knows all the options in the book.

I'm sure there are personal differences between doctors, and I find
patients choose the doctor who best fits their needs. Some like endless
tests, and only then feel secure, others want a doctor who does as few
tests as possible, explains the situation, and reasures the patient.

It has been shown that the doctors who get sued most are not the ones who
make more mistakes, but those who have a communication problem with their
patients. Doctors have made big mistakes, and not gotten sued, if the
patient felt that the doctor really did his best, and really cared about
the patient.

You can probably guess that I don't like too many tests, but I do my best
to answer a patient's medical and psychological needs.

Mira Leibovich, MD
Family Medicine Specialist
Israel
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