MedSmarts

~ Becoming CEO of the rest of your life

Why Less Healthcare May Be Better

When Too Much Healthcare Harms

The choice every patient faces with our healthcare system, whether they realize it or not, is which treatment alternative offers them the best balance of risk and benefit. Most of us, however, see only the benefit and seldom seriously consider – or are even made aware of – the risks.

What we  often receive by deferring to our physicians in our current and continuing fee-for-service payment environment is what pays our doctors and hospitals the best, not what may be our best risk-to-benefit choice.                   

This makes it imperative that you quickly learn how to defend yourself from these often undisclosed treatment risks.

Think Defensively

In our unfortunate but prevailing context of medical exploitation and indifference to treatment risks and medical errors, there’s no viable alternative for thinking consumers but to think defensively when it comes to medical treatments for themselves and their families.

This means considering the risks of treatment as seriously as you consider the risks of any disease you’re diagnosed as having or for which you’re at elevated risk.

Understanding and managing your treatment risks, including diagnostic tests and procedures like CT scans and biopsies, is as integral to staying healthy – or restoring your health – as understanding your disease risks.

This means never consenting to a test or procedure without first asking about – and fully understanding – the risks of a negative effect from the test or procedure. This should then be compared with the known risks and benefits of any alternative tests and procedures that, on average, yield similar results.

Do Your Homework Before Consenting

Considering the evidence of broad-based  incompetence and indifference to patient  safety discussed in Our Healthcare Sucks, the prudent medical consumer fears the possible consequences of medical interventions as much as the suspected disease itself.

This isn’t easy when grappling with the fear inherent in our medical care (see “America’s Health Scare System“).

But when so much of our medical care produces such calamitous results – and up to 440,000 needless deaths every year from medical interventions is mind-bogglingly calamitous – it would seem critical, perhaps literally, to cast a skeptical eye on any and all medical interventions BEFORE consenting to them.

This is no time to be casual in granting your consent to a medical procedure you may not even need – and a third or more of our medical care isn’t needed in the first place.

Medications Are Risky, Too

It’s not just medical procedures of which we should be wary. Medications can also produce more harm than benefit, especially in combinations about which we have little real evidence.

With an aging baby boom population – combined with doctors’ increasing reliance on “polypharmacy” (multi-drug) treatment regimens with increased risk of drug interactions – medical care for conditions caused by our medications are likely to accelerate.

This is why it’s not just wise, but imperative, to consider whether drugs you’re taking are causing symptoms you may be experiencing before embarking on a new treatment regimen. Experts state that the risk of adverse drug interactions increases  exponentially with three or more drugs (including supplements and OTC medications).  The greater inherent risk to patient safety with multi-drug regimens is exacerbated by poor physician communication with patients.

One study found almost a third of 17,000 Medicare patients had 3 or more chronic conditions and 41% used five or more prescriptions.

Despite this high-risk patient profile, almost one-third of their doctors did not even discuss their medications with them. Compounding this communication gap, 54% of these patients had two or more doctors and 36% had two or more pharmacies.

The risk of error and miscommunication increases with more sources of prescriptions and drug dispensing.

Over, Under & Mis-Prescribing

Consumer Reports’ “Best Buy Drugs” states:

“Half of people 60 and over take three or more prescription medicines…and 10% take seven or more medications…Studies found…17% were prescribed a drug they did not need (and) 37% were not prescribed a drug they did need (emphasis added). 

It’s hard to get a handle on the number of patients not getting the medications they need and at doses that are safe and effective. A study by the Rand Corporation, however, found Americans receive only about 55% of “recommended care” for common medical conditions – meaning that almost half our medical care is poor quality care.

Another study found, “42% of patients were taking a drug they did not need and not taking one they should.  Think about that: almost half of American patients are victims of medical misprescribing. 

It’s Likely To Get Worse

As noted in Our Healthcare Sucks, 1 in 8 hospitalizations in a physician survey were for protection for the doctor even though hospitalizations bring an enormous risk of injury and even death from hospital-induced disease. Unnecessary hospitalizations are explicitly cited as “unethical” in the AMA’s Code of Medical Ethics.

This leads to only one logical conclusion: much of the excess income in American medicine is unethically derived from unnecessary tests and procedures that take advantage of patients’ inferior knowledge and poor understanding of treatment risks.

Why should consumers be placed at increased risk for medical errors – and incur unnecessary expense – because of the essential greed of many in its physician community?

The exceptions to this are most physicians who practice in primary care, who are generally underpaid – at least in relation to their specialist counterparts. But even they are under intense pressure to keep office visits brief, which increases patients’ risk of missed diagnoses and unnecessary prescription medications that can increase risk of treatment-induced disease.

It also results in increased referrals to specialists to avoid spending more time with patients evaluating their conditions.

This phenomenon of less time to spend with patients is likely to get worse before it gets better. That’s because Obamacare will expand the pool of paying patients with no comparable increase in our supply of doctors and doctor-extenders like nurse practitioners.

This means patients either get short shrift or they assume greater responsibility for their own care.

There’s no third option.

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