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Tuesday, September 15, 2015

Medical Evidence and Getting the Right Care


Choosing Medical Treatments Wisely
The spate of media articles on unnecessary procedures and treatments which do not improve health and can harm patients is a sentinel cry to the public. This article addresses the types of questions patients and their families need to ask when faced with health care decisions and where to get answers.
Understand the Disease Evidence
One of the statistical principles which patients should understand is that an increase in the incidence (precursor) of a disease does not mean an increase in the invasiveness or death from the disease. A good example of this is thyroid cancer, here-to-for a relatively obscure disease which has now hurtled into 9th place in the cancer lexicon, as elucidated by Dr. R. Michael Tuttle in Medscape Oncology. [1] What this phenomena means to the general public as well as clinicians is the surveillance and testing for this condition has increased in specificity and volume. This does not in fact mean that there are more invasive thyroid cancers or that more people are dying from it, merely that smaller nodules are being found because of the improvement in imaging. The same can be said for the explosion in breast cancer in the U.S. where conditions which are pre-cancerous are lumped into the cancer milieu, causing an increase in prophylactic breast amputations.
 Before you consent to a medical procedure, whether it involves radiology (radiation transmitted into your body), treatment with drugs, or an invasive surgical procedure, there are questions you should ask.  I am citing Dr. Nortin Hadler’s prolific publishing and seminal work at the University of North Carolina, as the expert in debunking the medicalization mythology. Dr. Hadler states, “The best we can do today is to impose rationality on the current (healthcare) system- iron clad, science supported, and patient-driven rationality with the goal of assuring health and providing recourse when that assurance falls short.” [2]
Rational Questions for Patients and Families
Does the lab test contribute to an increased cancer risk?
What are the risks and side effects of the procedure or the prescription?
Are there other treatment options such as watchful-waiting?
Organizations Which Can Help Inform Your Medical Decisions
The ABIM Foundation, which is a physician driven nonprofit working to discern and promote methods to provide high value health care, has created the Choosing Wisely Campaign which aims to focus on reducing the overuse of tests and treatments.[3] The ABIM Foundation has come up with a list of 70 procedures that physicians and patients should question.[4] Here is my short list, but follow the link in the footnotes to find all 70: 
  1. Colonoscopy is often done too frequently- Unless you have an irregular test (polyps or other cancer risk factors), this test need only be done every 5 or even 10 years. This is a baseline test folks, not part of your “annual physical” and it is a very expensive test, running over $2,000 (U.S.) and requiring the use of anesthesia, which has other risks.
  2.   Screening tests regardless of health condition- These ubiquitous “fishing” tests are often promoted by “special clinics” or at “shopping malls” and offer full body scans, which are unnecessary and not shown to improve health or extend life. Again, it is best to avoid the extra doses of radiation when you can. Yes, a full body scan may find something wrong with you, but this information won’t necessarily impede your health or hasten your death.
  3.    Prescribing Opioids for chronic pain-In laypersons terms these drugs are known as Vicodin, OxyContin, or Percocet which are designed to work in the short term (following surgery) and over time they become less effective for pain relief. Also, one fourth of all patients who use these medications become addicted and they can cause death. Other side effects include world class constipation, nausea, confusion, mental disturbance, and if that isn’t enough, liver damage if you take enough of the stuff.
  4.   Medical tests administered at the end stages of life-For example after your cancer has spread to Stage V, it is wise to start asking quality of life questions, such as: Will the treatment help you live longer or What are the side Affects and Risks? Ask about palliative care, which does improve your life. These same questions can and should be asked by all octogenarians. In other words, how is the test or treatment going to improve your life? 
  5.   Ubiquitous testing for urinary tract infections- This is a test frequently given when no symptoms exist and results in an over use of antibiotics. Taking antibiotics kills friendly bacteria which your body needs to fight infections and over use causes super bugs which are resistant to treatment. 
Initiatives to Help Patients Make Informed Decisions
Currently, there are a number of medical initiatives in the Unites States, which are researching how to create and test patient and doctor shared decision making tools.  The Centers for Medicare and Medicaid provided $9,332,545 to a Texas initiative called Med Expert International, which is testing a shared decision making process. This award is a collaborative effort with California, Idaho, Texas, and Washington State.[5]

Things you can Read to Improve Your Health Care IQ
Dr. Nortin Hadler has been a persistent voice for clarity in how we much waste we have in U.S. healthcare and his most recent book, The Citizen Patient, published by the University of North Carolina Press, in 2013, reveals critical information about hospitals, interpreting scientific findings, and health care procedures which are more about revenue than enhancing health. [6] Dr. Nortin Hadler has also written, “Aging: Growing Old and Living Well in an Over Treated Society”, University of North Carolina Press.[7]

Roberta Winter is the author or Unraveling U.S. Healthcare-A Personal Guide
http://www.amazon.com/Unraveling-U-S-Health-Care-Personal/dp/1442222972
 And this is the healthpolicymaven signing off encouraging you to share this article with anyone whom may benefit. "healthpolicymaven" is a trademark of Roberta E. Winter, a graduate of the University of Washington School of Public Health and Community Medicine and the Daniel Evans School of Public Affairs. This article in no way provides medical advice.


3 comments:

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