Unnecessary Treatment: Creating a Partnership with Your Doctor
September 4, 2012
To the person with a hammer, everything can look like a nail; to a doctor with an expensive procedure or incentivized partnership with a specialist, you may seem like money in the bank. If your doctor is seeing dollar signs when you walk through the door – and not the person inside – here are a few ways that you can become better informed before undergoing any expensive health procedures.
Asking a Friend
One of the best ways to learn about a procedure is to discuss the implications with someone with a medical background. Together, you can search the web for guidelines by experts that outline the specific indications for a test, a treatment, or a procedure.
These guidelines are based on the latest literature, as well as the opinions of leading experts and, minus rare exceptions, those making the recommendations have no substantial conflicts of interest. (There have been exceptions to this, particularly in the psychiatric field. If you suspect this may be the case, research the background of the author to see if he or she has mixed loyalties.)
Ask Questions about the Outcome
If you’ve been referred to a specialist, that specialist, many times, truly feels that nearly everyone who sees him warrants the test or procedure he specifically offers. You should ask the physician, “What will you do differently if the test is positive versus if the test is negative?” If the answers are vague, then you can be quite sure the procedure is not likely to be beneficial.
You can also ask if the procedure or test has any harmful side effects. Too often, a physician will gloss over the potential complications of a procedure. Although many procedures are safe, there is almost always the risk of a rare complication, and such complications won’t seem rare if they happen to you.
Show Me the Percentages
You can also try taking a mathematical approach to your questions. Whenever possible, ask for percentages. For instance, you could ask, “What are the chances this procedure will improve my problem: 10%, 20%, or 50%?” You may also want to ask if the procedure could do any harm and, again, ask for specific percentages.
Vague answers, like “rare,” are not acceptable. In order to make an informed decision, you need specific numbers. If your physician is unwilling or unable to supply these numbers, then beware.
A Matter of Second Opinion
If you’ve discussed all your options with your physician and the need for the procedure is still not clear, get a second opinion. You can ask your doctor if she knows anyone; however, this can be risky because she may have a working relationship with them, signaling a conflict of interest.
If you need an alternative, a great place to start is at an academic medical center. Physicians in academic medical centers usually are paid a fixed, annual salary and, therefore, are not as motivated to recommend or perform procedures simply to make money. Unfortunately, this is not always the case, due to an increased number of academic medical centers offering bonuses for increased productivity and procedures.
However, bonuses are usually a minor motivation for academic physicians. If the primary focus was to make more money, everyone recognizes that, in today’s healthcare system, private practice is where the money is.
What You Can Do for Your Doctor
Another great approach is to suggest creating a partnership with your physician. Tell her that you want to learn all you can about your problem so you can more effectively help your doctor improve your health. The concept of the doctor and the patient forming a team will usually allow the physician to reframe her approach and create a more collegial atmosphere.
The most important part of working with your doctor is your ability to describe your personal story and encourage empathy in your doctor. Most physicians chose medicine to help others but, with our money-oriented system, have lost touch with their original goals. Recognizing this problem and sharing the personal consequences of your illness can rekindle that empathy and encourage them to focus on you as a person.
After establishing a partnership with your doctor, ask how she envisions the test, procedure, or treatment being beneficial to your health. Whether it’s getting a second opinion, asking a friend in the medical field, or creating a symbiotic relationship with your doctor, the end goal should be the same: to remain informed about any procedures that have been recommended by your doctor for your health.
A Final Note to Physicians
A physician should always ask himself one simple, but key, question: “Will this test, procedure, or treatment be of value to my patient?” If the answer is “no,” then this approach is wasteful and has the potential to do unnecessary harm. As caregivers, doctors need to continually remember that their goal should always be to do what is best for their patients, not what’s best for them and their practices.
