Be a proactive patient
In addition to talking to my doctor friends, I spend a lot of time reading various doctor blogs because I want to better understand our health care system from their unique point of view.
The majority of those I read seem to agree with me that the industry has morphed into a giant profit-making machine—profits first, patients second. Many physicians write of their loss of autonomy and the ability to treat patients in a thoughtful, patient-centered and cost-effective way.
More than ever, they say, patients need to be informed and take control of their health care. Ask questions; demand clear, evidence-based answers.
Beware your doctor’s knee jerk reflex.
What does he mean? That a great deal in health care is reflexive—acting without thinking. Such as prescribing certain medications or recommending blood tests or screening exams you might not really need. I’ve certainly been a victim of this kind of unthinking care.
…we should not submit to the knee jerk tendencies that all too readily drive behavior — even in clinics and hospitals. Self-defense is simple, and accessible to us all.
1. Always ask “why?” This seems obvious, but even in this modern era, many patients take it as an article of faith that a doctor’s recommendation is thoughtful and well informed. It may well be; but on any given occasion, it could also be a knee jerk — born of prevailing tendencies, distractions, and want of time. The question “why” is easily addressed by those who have already thought it over; and is a necessary reality check for those of us who have not.
2. Always ask “what else?” “What else?” is a reminder that there is generally more than one way to test or treat, and the one we want is the BEST of them: most likely to help, least likely to hurt. It prods our providers to do the extra work of getting us there when we remind them we want to know the options, and comparison shop them. [my emphasis]
3. Always ask “then what?” This would certainly defend against a screening colonoscopy in a 85 year old with congestive heart failure. If I have this test, then what? The answer would have to be: We can find potential cancer early, and fix it now so it doesn’t cause you trouble in ten years. That would invite all concerned to revisit the relevance of that “help” ten years in the future of someone exceedingly unlikely to live that long.
Regarding the last tip, a recent study published in JAMA Internal Medicine revealed that way too many screening tests (colonoscopies, PSAs, mammograms, etc) are being done on elderly patients who, for various age and health reasons, have a reasonable life expectancy of less than 10 years.
Although forecasting how long someone has left to live is not a precise science, knowing averages is essential to deciding if the inconvenience, expense, and potential adverse effects of screening (and treatment, if an abnormality is discovered) can be justified by the potential benefit.
But as one might expect in our crazy health non-system, cancer screening in patients with limited life expectancies happens all the time. A study published last week in JAMA Internal Medicine found that one-third to one-half of surveyed Americans with a 9-year mortality risk of more than 75 percent reported receiving recent cancer screenings. 55% of men in this group had knowingly been screened for prostate cancer within the previous 2 years – a test that, if it works at all, requires a decade to show a mortality benefit.
This doctor picked up on the reflex analogy, too, and advised fellow physicians:
Think twice before reflexively doing things to elderly patients that can’t possibly help and, therefore, can only hurt.
Screening tests, however, are a HUGE money-maker for hospitals, clinics and doctors. The burden is on you—the patient—to be informed and make a decision based on what is in your best interest.
My own 85-year-old mother recently said “No” to another screening colonoscopy. She thought about the physical hardship of the prep and the sedation, as well as the inconvenience of getting herself to and from the clinic, and decided the test wasn’t worth it. Her physician, luckily, agreed with her.
So be proactive; ask questions and be alert to knee-jerk health care.