As we have already established in the previous post, even though it is set up to serve you, healthcare system may not only do good but also bad. Physicians fail as do football teams, businesses and political parties. The latter are however judged by their scores, earnings reports and elections, respectively. How can we rate doctors? Quality of care among both doctors and hospitals in a particular specialty can vary a lot. In fact, if one plotted a graph showing results of all medical institutions for a particular treatment, what one would find is a so called bell curve1. It means that you as a patient have highest chance of receiving mediocre care but there’s a smaller risk that you will get disturbingly bad or outrageously good outcome. This “belies the promise that [doctors] make to patients: that they can count on the medical system to give them their very best chance. It also contradicts the belief nearly all of us have that [doctors] are doing [their] job as well as it can be done“2.
Bell curve: you as a patient have highest chance of receiving mediocre care but there’s a smaller risk that you will get disturbingly bad or outrageously good outcome.
So if we cannot blindly trust the healthcare system but still need to turn to it, what can we do? Here are four steps that can help you – for starters. Yes, they will all require more from you than simply being a passive spectator but hey if you can reduce your chances of getting incomplete, inappropriate or – in the worst case – lethal care, it may be worth giving this a shot!
1. Take responsibility for your wellbeing.
Find confidence in the fact that you know yourself and what you need best, which entitles you to at least be part of the discussion with your clinician when it comes to your health choices. Decision-making regarding your health doesn’t have to be top-down. Find out all you can about your condition and write down any questions you have: why is the suggested treatment the best? What are the most recent findings of peer-reviewed randomized double blind placebo control studies that examined your illness, response to suggested treatment or drugs? What is the second best alternative? What are the side effects? Is medication necessary?
2. Do not feel intimidated to engage in a discussion with your doctor
We already made it clear that healthcare system is fallible and your doctor doesn’t necessarily know best. So if you are not happy about the quality of answers you get – ask for a second opinion. And a third one if need be. You don’t need to become a doctor yourself but you should demand clear information on the benefits and trade-offs before undergoing any treatments or taking drugs and be able to tell if what’s being proposed is really best for you, the hospital or the insurance company. Recognized as the leading authority on health care quality and improvement, Dr. Berwick has suggested that there are two things that are required to fix medicine: measure outcomes of care and increase openness of what’s being done3. While it’s up to healthcare institutions to engage in measuring, it’s up to you as a patient to demand transparency. You should be able to know about anything that affects your life.
3. Be prepared that your informed approach will meet resistance.
Asking questions can be perceived as challenging authority: “The danger with both doctors and politicians, comes when they start to believe in their own illusory importance. People want doctors who are confident, certain, able to offer treatment. The confidence that makes people trust doctors has a way of working its way into the doctor’s character”4. Remember however that knowledge doesn’t equal competence, and doctors – even if they mean well – are just as subject to mental errors, prejudice and simply risk of making mistakes as any other people. There should be no such thing as doctor’s orders.
4. Question whether your condition truly requires medical intervention.
Studies have shown that in the US alone, over 100 000 people a year die from noxious and unintended effects of approved medicines taken as directed and administered at normal doses5. As a rule, physicians engage in standard treatments: pills and surgery. There is on the other hand abundant evidence consistently showing that simply reducing – and preferably eliminating – consumption of animal protein (dairy, meat, eggs) reduces blood cholesterol levels, reverses (yes, as in “puts an end to”) heart diseases and diabetes, lowers the risk of different types of cancer – to name a few. Lack of nutrition knowledge, close ties to the drug industry and/or their own unhealthy life choices prevent however most of the doctors from recommending dietary intervention6.
- Atul Gawande “Better”(2007), p.206
- Ibid, p.207
- Ibid, p.227
- Druin Burch “Taking the Medicine. A Short History of Medicine’s Beautiful Idea, and Our Difficulty Swallowing It”(2010), p.33
- T. Colin Campbell, PhD Thomas M. Campbell MD “The China Study. Revised and Expanded Edition” (2016), p. 8
- Ibid, chapter 1