Teaching Consumers to Say "No" to Physicians' Recommendations

I believe that the formula for improving the health of our population and reducing healthcare costs is two-fold: firstly, encouraging patients to take more ownership of their own health and secondly, encouraging them to initially say "no" to diagnostic and therapeutic recommendations from their physicians. The latter part of this approach was discussed in a recent New York Times column by David Leonhardt (see: In Medicine, the Power of No). Below is an excerpt from it. Read the whole column if you can -- I only quote a very small part of it.

The federal government is now starting to build the institutions that will try to reduce the soaring growth of health care costs. There will be a group to compare the effectiveness of different treatments, a so-called Medicare innovation center and a Medicare oversight board that can set payment rates. But all these groups will face the same basic problem. Deep down, Americans tend to believe that more care is better care. We recoil from efforts to restrict care....This try-anything-and-everything instinct is ingrained in our culture, and it has some big benefits. But it also has big downsides, including the side effects and risks that come with unnecessary treatment. Consider that a recent study found that 15,000 people were projected to die eventually from the radiation they received from CT scans given in just a single year — and that there was “significant overuse” of such scans.

It will be extremely difficult for most consumers to say "no" to their physicians. The knowledge and experience in diagnosing and treating disease lies with the physicians we consult for problems. Such a scenario rarely lead to "no". However, try substituting the word "maybe" for "no" in response to a physician's recommendations. This "maybe" approach allows the patient to seek more information to determine whether the recommendation is appropriate. Don't attempt this in the pressure-cooker environment of a doctor's office. Stew on the matter at home, consulting friends, relatives, and, as Leonhardt emphasizes, Dr. Google (see: Paging Dr. Google! We Are Waiting for a Second Opinion).

As part of this simple cost-benefit analysis, here's a short list of possible questions to ask a physician and Dr. Google:

• How much will the recommended diagnostic workup and therapy cost?
• If surgery or drugs are recommended, what are the complications, side effects, and success rates? How often will complications occur and how severe are they?
• Which hospitals and surgeons have the highest success rates for a particular surgical procedure?
• What will be the result of watchful waiting?
• Are there alternative therapies for a disease that can be tried initially?
• Are there lifestyle issues that can tried to change the course of a disease?

You get the idea. The trickiest part of this approach is that the advice you receive from physicians may be biased. After all, they are trained to treat disease and, given our fee for service approach to healthcare reimbursement, they may receive greater compensation for treatment. When searching the web for answers, try to find the most reputable sites and looks for a broad consensus across many of them regarding drug therapy and surgery.

Comments

[finding physician assistant jobs]

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