Those free medication samples may not be the best -- or safest.
If You Only Knew ...
Reader's Digest offered two dozen doctors a chance to tell it like it really is, and general practitioners, surgeons, shrinks, pediatricians, and other specialists took the challenge. Some wanted to be anonymous; some didn't care. But all of them revealed funny, frightening, and downright shocking things that can help you be a better, smarter patient.

We're Impatient

• I am utterly tired of being your mother. Every time I see you, I have to say the obligatory "You need to lose some weight." But you swear you "don't eat anything" or "the weight just doesn't come off," and the subject is dropped. Then you come in here complaining about your knees hurting, your back is killing you, your feet ache, and you can't breathe when you walk up half a flight of stairs. So I'm supposed to hold your hand and talk you into backing away from that box of Twinkies. Boy, do I get tired of repeating the stuff most patients just don't listen to.
--Cardiologist, Brooklyn, New York

I was told in school to put a patient in a gown when he isn't listening or cooperating. It casts him in a position of subservience.
--Chiropractor, Atlanta

• Thank you for bringing in a sample of your (stool, urine, etc.) from home. I'll put it in my personal collection of things that really gross me out.
--Douglas Farrago, MD, editor, Placebo Journal

• One of the things that bug me is people who leave their cell phones on. I'm running on a very tight schedule, and I want to spend as much time with patients as I possibly can. Use that time to get the information and the process you need. Please don't answer the cell.
--James Dillard, MD, pain specialist, New York City

• I wish patients would take more responsibility for their own health and stop relying on me to bail them out of their own problems.
--ER physician, Colorado Springs, Colorado

• So let me get this straight: You want a referral to three specialists, an MRI, the medication you saw on TV, and an extra hour for this visit. Gotcha. Do you want fries with that?
--Douglas Farrago, MD

• I used to have my secretary page me after I had spent five minutes in the room with a difficult or overly chatty patient. Then I'd run out, saying, "Oh, I have an emergency."
--Oncologist, Santa Cruz, California

• Many patients assume that female physicians are nurses or therapists. I can't tell you how often I've introduced myself as Dr. M. and then been called a nurse, therapist, or aide and asked to fetch coffee or perform other similar tasks. I have great respect for our nurses and other ancillary personnel and the work they do, but this doesn't seem to happen to my male colleagues.
--Physical medicine and rehabilitation doctor, Royal Oak, Michigan

• The most unsettling thing for a physician is when the patient doesn't trust you or believe you.
--Obstetrician-gynecologist, New York City

• It really bugs me when people come to the ER for fairly trivial things that could be dealt with at home.
--ER physician, Colorado Springs, Colorado

• Your doctor generally knows more than a website. I have patients with whom I spend enormous amounts of time, explaining things and coming up with a treatment strategy. Then I get e-mails a few days later, saying they were looking at this website that says something completely different and wacky, and they want to do that. To which I want to say (but I don't), "So why don't you get the website to take over your care?"
--James Dillard, MD

• I know that Reader's Digest recommends bringing in a complete list of all your symptoms, but every time you do, it only reinforces my desire to quit this profession.
--Douglas Farrago, MD

Pills, Pills, Pills
• Sometimes it's easier for a doctor to write a prescription for a medicine than to explain why the patient doesn't need it.
--Cardiologist, Bangor, Maine

• Those so-called free medication samples of the newest and most expensive drugs may not be the best or safest.
--Internist, Philadelphia

• Taking psychiatric drugs affects your insurability. If you take Prozac, it may be harder and more expensive for you to get life insurance, health insurance, or long-term-care insurance.
--Daniel Amen, MD, psychiatrist, Newport Beach, California

• Ninety-four percent of doctors take gifts from drug companies, even though research has shown that these gifts bias our clinical decision making.
--Internist, Rochester, Minnesota

Bills, Bills, Bills

• Doctors respond to market forces. If the reimbursement system is fee-for-service, that results in more services. If you build a new CT scan, someone will use it, even though having a procedure you don't need is never a good thing.
--Family physician, Washington, D.C.

• I really do know why you're bringing your husband and three kids, all of whom are also sick, with you today. No, they are not getting free care.
--Douglas Farrago, MD

• Doctors get paid each time they visit their patients in the hospital, so if you're there for seven days rather than five, they can bill for seven visits. The hospital often gets paid only for the diagnosis code, whether you're in there for two days or ten.
--Evan S. Levine, MD

• Twenty years ago, when I started my practice, my ear, nose, and throat procedures financially supported my facial plastic surgery practice. Today, my cosmetic practice is the only thing that allows me to continue to do ear, nose, and throat procedures, which barely cover my overhead.
--Ear, nose, throat, and facial plastic surgeon, Dallas/Fort Worth

Free Advice

• Avoid Friday afternoon surgery. The day after surgery is when most problems happen. If the next day is Saturday, you're flying by yourself without a safety net, because the units are understaffed and ERs are overwhelmed because doctors' offices are closed.
--Heart surgeon, New York City

• In many hospitals, the length of the white coat is related to the length of training. Medical students wear the shortest coats.
--Pediatrician, Baltimore

• Often the biggest names, the department chairmen, are not the best clinicians, because they spend most of their time being administrators. They no longer primarily focus on taking care of patients.
--Heart surgeon, New York City

The Darker Side

• It saddens me that my lifelong enjoyment and enthusiasm for medicine has all but died. I have watched reimbursement shrink, while overhead has more than doubled. I've been forced to take on more patients. I work 12- to 14-hour days and come in on weekends. It's still the most amazing job in the world, but I am exhausted all the time.
--Vance Harris, MD, family physician, Redding, California

• In many ways, doctors are held to an unrealistic standard. We are never, ever allowed to make a mistake. I don't know anybody who can live that way.
--James Dillard, MD

• Not a day goes by when I don't think about the potential for being sued. It makes me give patients a lot of unnecessary tests that are potentially harmful, just so I don't miss an injury or problem that comes back to haunt me in the form of a lawsuit.
--ER physician, Colorado Springs, Colorado

• Doctors often make patients wait while they listen to sales pitches from drug reps.
--Cardiologist, Bangor, Maine

• It's pretty common for doctors to talk about their patients and make judgments, particularly about their appearance.
--Family physician, Washington, D.C.

• Everyone thinks all doctors know one another. But when we refer you to specialists, we often have no idea who those people are. Generally, we only know that they accept your insurance plan.
--Pediatrician, Hartsdale, New York

• In most branches of medicine, we deal more commonly with old people. So we become much more enthusiastic when a young person comes along. We have more in common with and are more attracted to him or her. Doctors have a limited amount of time, so the younger and more attractive you are, the more likely you are to get more of our time.
--Family physician, Washington, D.C.

• Plan for a time when the bulk of your medical care will come from less committed doctors willing to work for much lower wages. Plan for a very impersonal and rushed visit during which the true nature of your problems will probably never be addressed and issues just under the surface will never be uncovered.
--Vance Harris, MD

• At least a third of what doctors decide is fairly arbitrary.
--Heart surgeon, New York City

• Doctors are only interested in whether they are inconvenienced -- most don't care if you have to wait for them.
--Family physician, Washington, D.C.

The Sensitive Side

• When a parent asks me what the cause of her child's fever could be, I just say it's probably a virus. If I told the truth and ran through the long list of all the other possible causes, including cancer, you'd never stop crying. It's just too overwhelming.
--Pediatrician, Hartsdale, New York

• Most of us haven't been to see our own physicians in five years.
--Physical medicine specialist, Royal Oak, Michigan

• When a doctor tells you to lose 15 to 20 pounds, what he really means is you need to lose 50.
--Tamara Merritt, DO, family physician, Brewster, Washington

• If a sick patient comes to me with a really sad story and asks for a discount, I take care of him or her for no charge.
--Surgeon, Dallas/Fort Worth

• Though we don't cry in front of you, we sometimes do cry about your situation at home.
--Pediatrician, Chicago

Shocking Stats
60% of doctors don't follow hand-washing guidelines.
Source: CDC Morbidity and Mortality Weekly Report

96% of doctors agree they should report impaired or incompetent colleagues or those who make serious mistakes, but ...

46% of them admit to having turned a blind eye at least once.
Source: Annals of Internal Medicine

94% of doctors have accepted some kind of freebie from a drug company.
Source: New England Journal of Medicine

44% of doctors admit they're overweight.
Source: Nutrition & Food Science; Minnesota Medicine

58% would give adolescents contraceptives without parental consent.
Source: New England Journal of Medicine

Anatomy of a Doctor's Bill

Just how much of the $100 your doctor charges for taking 30 minutes to investigate your stomach pain goes into his pocket? After paying the bills, he gets less than half. The breakdown, according to Robert Lowes, senior editor at Medical Economics:

$3.50 for malpractice insurance

$3.50 for equipment, repairs, and maintenance

$6 for supplies, including gowns, tongue depressors, and copy paper

$7 for rent and utilities

$11 for office expenses, such as telephones, accounting fees, advertising, medical journals, licenses, and taxes

$28 for secretary, office manager, and medical assistant salaries and benefits

$41 Amount that goes into the doctor's paycheck

Over the course of a year, that adds up to $155,000, the annual salary of the average family physician. That number rose just 3.3% between 2002 and 2006, while expenses increased nearly 25% over the same period.

那些免費(fèi)藥方可能不是最好的甚至可能不是最安全可靠的。

若果你只知道….

讀者文摘為24位醫(yī)生提供了一個(gè)平臺來講述事情的真相，而且包括一般的實(shí)習(xí)醫(yī)生、外科醫(yī)生、精神科醫(yī)生、兒科醫(yī)生以及其他�？漆t(yī)師也接受這個(gè)挑戰(zhàn)性的邀約。這些人當(dāng)中有的希望匿名參加，有的則不在乎。但是，他們所有的人都爆料出一些或有趣、或令人害怕或令人相當(dāng)震驚的事情，由此可以讓我們參考有助于讓我們做個(gè)更好更聰明的病人。

我們不能忍受

我們已經(jīng)極度厭倦做你們病人的“老媽”了，每次我只要見到你就不得不說那些戒條“你該減肥了”，可是你卻賭咒發(fā)誓說你“沒吃什么東西”或“自己的體重就是減不下來”，因此就這個(gè)減肥計(jì)劃就沒能成功。然后你到我這里抱怨你的膝蓋受傷了，你的背疼死了，你牙疼，還有就是才走了一半的樓梯就喘不過氣來。因此這時(shí)我就要像往常一樣抬起你的手并且說服你遠(yuǎn)離那個(gè)”box of Twinkies”。孩子，我真的厭煩了重復(fù)那些大部分病人都不屑聽的話。

——心臟病醫(yī)生  布魯克林，來自紐約

在學(xué)校我就被告知當(dāng)病人不遵醫(yī)囑或不與醫(yī)生合作就讓他穿上醫(yī)生的外衣，這樣可以讓病人處于醫(yī)生的從屬地位。——按摩師，亞特蘭蒂。

多謝你從家里給我們帶來的醫(yī)學(xué)檢樣（糞便,尿液等），我將會把檢樣放在我一堆的檢樣品中，可是那真的會讓我惡心地要吐。

—道格拉斯 佛拉格 醫(yī)學(xué)博士，編輯，《普雷瑟波周刊》

其中一件事情最令我惱火的是有些病人一直用手機(jī)呼叫我。我每天都要趕著一些緊湊的診療工作日程，我想將時(shí)間盡可能地放在照料病人方面。希望這些病人利用我出診的這段時(shí)間多找些適合自己病情的信息和治療程序，請不要總是打我電話。

——詹姆斯 迪拉德  醫(yī)學(xué)博士，疼痛�？漆t(yī)師，來自紐約城

我希望病人們可以更多些地對自己的健康負(fù)責(zé)，而不是依靠我們醫(yī)生來擺脫他們自己的病情。——急診內(nèi)科醫(yī)生，科羅拉多 斯普瑞斯，來自科羅拉多

因此我得出這樣一個(gè)結(jié)論：你想將一份病例？送交三位�？漆t(yī)師，一位磁共振成像，你在電視上看到的一種藥物，以及額外一小時(shí)去看醫(yī)生。難倒你了, 你想跟薯?xiàng)l一起吃?

——道格拉斯 佛拉格，醫(yī)學(xué)博士

以前只要我在診室遇到一個(gè)難纏或是非常能說的病人并且跟他呆在一起達(dá)5分鐘，我就讓我的秘書用擴(kuò)音器叫我，然后我就立刻出去并說一聲：“哦，我有個(gè)急診。”

——腫瘤學(xué)家, 桑塔 克魯茲，來自加州

許多病人都覺得女性內(nèi)科醫(yī)生就是護(hù)士或是治療醫(yī)師。我無法告訴你我多少次向別人介紹自己是M.博士，可是下一刻又被叫做某某護(hù)士或是醫(yī)師或是某某助手，還讓我去幫他們?nèi)】Х然蚴菐兔ψ銎渌�類似的打雜工作。我絕對尊重我們醫(yī)院的護(hù)士和其他助理醫(yī)護(hù)人員以及他們的工作，可是這種稱呼上的誤會似乎從未發(fā)生在我的男同事身上。

——理療醫(yī)學(xué)和康復(fù)醫(yī)生，羅伊爾 奧克，來自密切根

對于內(nèi)科醫(yī)生來說令他最不安的事情是病人不再相信和信任你的時(shí)候。——婦產(chǎn)科醫(yī)生，來自紐約城

我真的很煩有些人，分明可以在家處理的小病小恙就來掛急診。

——急診內(nèi)科醫(yī)生，科羅拉多 斯普瑞斯，來自科羅拉多

你的醫(yī)生懂的東西比網(wǎng)上的醫(yī)學(xué)知識的要多，我跟些個(gè)治療了好長時(shí)間的病人解釋他的病情并且提出治療方案。然后我在幾天后收到他們的電子郵件，上面說他們在網(wǎng)上看到了他們病情的相關(guān)治療方法，說我說的與那些方法相比有個(gè)別的完全不同并且很怪異，他們想試試網(wǎng)上的治療方法。我想說的是（當(dāng)我沒說出來）：“那么你們干嘛不直接從網(wǎng)上查找保持健康的方法呢？”——詹姆斯 迪拉德   醫(yī)學(xué)博士

我知道讀者文摘建議帶來一份完整的病癥清單，可每次你這樣做，只會讓我很想以后結(jié)束醫(yī)生的職業(yè)生涯。——道格拉斯 佛拉格 醫(yī)學(xué)博士

藥片，藥片，藥片。有時(shí)比起解釋為何病人不需要某種藥片來，醫(yī)生寫個(gè)藥方則更方便。

——心臟病醫(yī)生，班歌，來自緬因州

那些所謂的最新出的也是最昂貴的藥品的免費(fèi)試用品可能不是最好、最安全的。

——    費(fèi)城

使用神經(jīng)性藥物會影響你的保險(xiǎn)。如果你使用百憂解，那么對你來說要得到人壽保險(xiǎn)、健康保險(xiǎn)或長期護(hù)理保險(xiǎn)，就會更添難度而且買這些保險(xiǎn)也更昂貴。

——丹尼爾 阿門  醫(yī)學(xué)博士 精神科醫(yī)生， 新港海灘，加州

94%的醫(yī)生都得到過制藥公司的禮物，盡管相關(guān)調(diào)查顯示這些禮物都是對我們做出的冷靜客觀決定的偏見。——內(nèi)科醫(yī)生  羅徹斯特   來自明州

賬單，賬單，賬單

醫(yī)生也對市場壓力做出回應(yīng)。如果補(bǔ)助系統(tǒng)是免費(fèi)提供服務(wù)因而引出更多的服務(wù)，如果你建立一個(gè)新的CT掃描儀診療室，那么有人就會使用它，盡管你不需要這個(gè)程序不會是一件好事。——家庭醫(yī)生，華盛頓特區(qū)

我真的很了解為什么你今天帶著你生病的丈夫和三個(gè)孩子一起來就診。不，他們都沒有得到免費(fèi)護(hù)理。——道格拉斯 佛拉格 醫(yī)學(xué)博士

每次醫(yī)生在醫(yī)院會診他們的病人都會得到報(bào)酬，因此如果你住院7天而不是5天，醫(yī)生們會出7個(gè)會診單。意愿常常根據(jù)診療條碼來計(jì)算改收的報(bào)酬，如論你住院2天或10天。

——伊萬 S. 萊文，醫(yī)學(xué)博士

20年前，我開始了我的實(shí)習(xí)，耳鼻喉科行診的實(shí)習(xí)程序讓我的面部整形手術(shù)的實(shí)習(xí)有了經(jīng)濟(jì)支柱。現(xiàn)在我的整容實(shí)習(xí)是唯一可以讓我繼續(xù)進(jìn)行耳鼻喉科行醫(yī)的支持，也僅僅夠我的醫(yī)療經(jīng)費(fèi)。——耳鼻喉集整容手術(shù)醫(yī)生，道拉斯/福特沃斯

免費(fèi)建議/好心建議

避免周五做手術(shù)，手術(shù)后的這一天正是問題多發(fā)之日，如果第二天是周六，那么你就要無安全保障地忙亂了，因?yàn)獒t(yī)院科室人手不足，而且急診室超負(fù)荷，因?yàn)獒t(yī)生辦公室大門緊閉。

——心臟手術(shù)醫(yī)生，紐約城

在許多醫(yī)院，醫(yī)生們穿得白大褂的長度跟他們接受培訓(xùn)的長度掛鉤，學(xué)醫(yī)的學(xué)生穿的白大褂最短。—— 兒科醫(yī)生，來自巴爾的摩  

通常最出名的醫(yī)院科室主任并不是最優(yōu)秀的醫(yī)生，因?yàn)樗麄児ぷ鞯氖滓�重點(diǎn)不再是護(hù)理病人，而是將絕大部分時(shí)間都用在怎樣做好一個(gè)管理者這件事上了。——心臟手術(shù)，來自紐約城

更黑暗的一面

讓我傷心地是我一生習(xí)醫(yī)的樂趣和熱情都已經(jīng)被淹沒了，我眼看著補(bǔ)助金萎縮，而醫(yī)療經(jīng)費(fèi)雙倍以上地上漲，而我要負(fù)擔(dān)更多的病人，我日日要工作12-14小時(shí)并且常常在周末都要到醫(yī)院來加班。世上仍然有做不完的大量工作，當(dāng)我一直都很厭煩。

——萬斯 哈瑞士，醫(yī)學(xué)博士，家庭醫(yī)生，來自加州萊丁

在許多情況下，醫(yī)生都被限制在一個(gè)不切實(shí)際的標(biāo)準(zhǔn)上，我們不能也不允許犯錯(cuò)，可我知道沒有人可以這樣不犯錯(cuò)地生活。——詹姆斯 迪拉德  醫(yī)學(xué)博士

我不考慮被起訴的潛在危機(jī)，那樣只會讓我對病人實(shí)施許多沒必要的病理測試，這些測試都對他們有潛在的危害，正是如此我沒有遇到過反饋到我的且會讓我官司纏身的這樣的傷害或困擾。——急診醫(yī)生，科羅拉多泉，科羅拉多

醫(yī)生常常會因?yàn)轳雎犓幤反�理人員的推銷而讓病人等待——Cardiologist    班澤  緬因州

醫(yī)生跟病人探討病情并下結(jié)論這樣的事情再普通不過了，特別是病人的表面癥狀。

——家庭醫(yī)生，華盛頓特區(qū)

每個(gè)人都認(rèn)為醫(yī)生應(yīng)該彼此之間都了解，但是但我們對一個(gè)醫(yī)生提起你時(shí)，往往都不知道你是何方神圣。一般來說，我們只知道他們樂意接受你的推薦的保險(xiǎn)計(jì)劃。

——兒科醫(yī)生，哈慈德爾，紐約

大部分醫(yī)療部門都常常護(hù)理一些老人，因此當(dāng)有年輕人陪同時(shí)我們會展現(xiàn)更多的熱情。我們跟年輕人有許多共同之處而且更容易被年輕的他或她吸引。醫(yī)生的時(shí)間有限，因此你越年輕越有吸引力，你們年輕人更有可能從我們有限的時(shí)間里得到更多的信息。

——家庭醫(yī)生  華盛頓特區(qū)

做一次計(jì)劃，你的主要醫(yī)療保健由一個(gè)愿意被支付低薪水而又不負(fù)責(zé)任的醫(yī)生；你的問題實(shí)質(zhì)有可能永遠(yuǎn)不被重視并且問題隱藏在表面下永遠(yuǎn)不會被揭露，這時(shí)來個(gè)冷漠而又緊急的會診。——萬斯 哈瑞斯 醫(yī)學(xué)博士

醫(yī)生下的病癥結(jié)論有至少1/3是很武斷的。——心臟病手術(shù)醫(yī)生，紐約城

唯一讓醫(yī)生感興趣的事情是他們是否被打擾，他們大都不在乎作為病人的你要等待他們。

——家庭醫(yī)生，華盛頓特區(qū)

令人生氣的一面：

如果一位父親或母親問我是什么原因?qū)е滤?她的孩子感冒，我只會說很可能是病毒。如果我說出真相并且羅列出一長串其他可能的原因，包括可能原因是癌，那么你就永遠(yuǎn)不會停止哭叫，那太讓人絕望了。——兒科醫(yī)生，哈慈德爾，紐約

我們這些做醫(yī)生的大部分人在5年內(nèi)都沒見過自己的家庭醫(yī)生。——體育醫(yī)學(xué)專家，羅伊爾 奧克，來自密歇根

如果一個(gè)醫(yī)生告訴你要減肥15-20磅，那么他的本意是你需要減輕體重50磅。

——塔瑪拉 麥瑞特，DO，家庭醫(yī)生，來自華盛頓的不魯斯特

如果一個(gè)病人來我這里就診訴說著一個(gè)悲慘至極的故事并要求醫(yī)療折扣時(shí)，我會免費(fèi)為他或她進(jìn)行醫(yī)療護(hù)理——手術(shù)醫(yī)師，道拉斯/福特 沃斯

雖然我們不在你們病人面前哭，可是我們一定會因?yàn)槟銈冊诩依锏奶幘扯�哭�?/p>

——兒科醫(yī)生，芝加哥

令人震驚的事情：

60%的醫(yī)生不按照洗手規(guī)程來。資料來源：《CDC發(fā)病率和死亡率周報(bào)》

96%的醫(yī)生同意通報(bào)那些容易出醫(yī)療事故且能力不夠的同事，但是46%的人至少要對這樣的醫(yī)生視而不見/放水一次。

來源：《內(nèi)部醫(yī)藥資料》

94%的醫(yī)生接受過藥品公司的某些贈品。來源：《新英格蘭醫(yī)藥雜志》

44%的醫(yī)生承認(rèn)他們體重超重了。來源：《營養(yǎng)和食品科學(xué)》；《明州醫(yī)藥》

58%的醫(yī)生沒有青少年的父母同意的清空下給他們避孕物品。來源：《新英格蘭醫(yī)藥雜志》

醫(yī)生的手術(shù)賬單

30分鐘胃痛檢查，醫(yī)生收取的$100的費(fèi)用中有多少落入他的口袋？付過診費(fèi)后，醫(yī)生得不到一半。這個(gè)爆料的來源根據(jù)是來自《醫(yī)藥經(jīng)濟(jì)》的高級編輯羅伯特 羅斯：

$3.5是營私舞弊的保險(xiǎn)費(fèi)

3.5是器材維修和維護(hù)的費(fèi)用

6是相關(guān)的醫(yī)院供給費(fèi)用，包括醫(yī)生服、壓舌板和復(fù)印紙。

7是租金和水電費(fèi)

11是辦公費(fèi)用，如電話費(fèi)、報(bào)賬費(fèi)、廣告費(fèi)、醫(yī)藥周刊費(fèi)、許可證費(fèi)和繳稅

28是給秘書/助理，辦公室主任和醫(yī)療助手的費(fèi)用和利潤

41就是醫(yī)生的薪資部分

一年的時(shí)間一個(gè)普通家庭醫(yī)生的年薪就追加了155000，，而且這個(gè)數(shù)字在2002-2006年間上揚(yáng)了3.3%，而在同一時(shí)期醫(yī)療費(fèi)用上漲了近25%。