June 9, 2015
The “Less Is More” Medical Campaign – Part 1
I have to wonder if doctors are really interest in practicing medicine. When I see new terminology after new terminology being used, I know this is done to confuse an issue that they are uncomfortable talking about with patients. This is also done to confuse and keep patients off guard.
This latest is an outgrowth of the "Choosing Wisely" campaign started by the nefarious American Board of Medical Specialties (ABMS) and the American Board of Internal Medicine (ABIM). There is some good being done, but at the same time, many things that harm patients were not listed on the procedures to be avoided. There were some procedures and items listed that were adopted by various medical groups that are necessary to prevent patient harm and some that were left off that do patient harm.
One of the problem patients need to be aware of is not over requesting tests. This is what the hospitals want to hear, because they get paid more for tests and want the business, even when the test may harm patients.
There are other catchy phrases many doctors like to use that also do not mean anything. They like to use these and think this is what the patients need to hear. To these, I say BS (not blood sugar).
There are five points to know when talking to doctors about tests or treatments:
1. Learn Clinical Guidelines If Possible, Ask The Doctors to Explain Potential Harms. Patients need to be skeptical when doctors recommend a particular test or treatment. Doctors will often withhold information about the test, the purpose, and that the hospital is recommending the test.
Unless this is an emergency, do not be afraid to ask for the name of the test and have the doctor spell it out. Then ask for permission to return home and look it up on the internet. This may help the doctor understand that you will not be bullied into the test.
If the doctor Points out the risks and unanticipated consequences of tests then this may be helpful because this makes it clear that the clinician is looking out for your interests. It's also worth noting that a test can be done later, if circumstances change.
2. Elicit Unspoken Concerns About a Symptom or Illness. Carefully asking a doctor about unspoken concerns is worthwhile because you may often fear the worst, such as cancer causing back pain. Because misconceptions may arise from information you have read on the Internet or gleaned from conversations with friends or family, it may be helpful to ask specifically about some worst-case scenarios that commonly raise concerns.
3. Be Concerned and Look for Empathetic and Supportive Doctors.
It's important to find empathy and support even if your request is not granted. It is important that the doctor address your concerns to your satisfaction. If this does not happen, find a different doctor.
4. Have the Doctor Summarize the Care Plan and Follow-up. It's always important to receive a brief summary of the care plan, invite questions, and ask if you are in agreement with the plan. A clearly laid out follow-up plan is also important, with instructions for you to contact the clinician if any "red flags" emerge. Again, if you do not receive this, look for another doctor.
5. Make Sure the Doctor Provides Resources. Newer decision aids (available either directly to clinicians or through insurance plans) are valuable for helping the doctors help you navigate the many gray areas in medicine, where reasonable people might make different choices. These aids can make it clear that there are options, describe the full range of options, and lay out the key benefits and risks of each.