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A tipping point for patients demanding better medical care?

Recently, a friend lent me a copy of Demanding Medical Excellence: Doctors and Accountability in the Information Age by Michael L. Millenson. It was first published in 1997 with a paperback edition published in 2000, but I was thinking that it could have been written yesterday because the stories are so similar to those in books on the same topic published more recently. Given the number of books, magazine and journal articles, and blogs on the topic of overdiagnosis and the need for “right” medical care, it looks like the subject is gaining momentum and grabbing patients’ attention.

I think we have our work cut out for us to change how health care is provided not just here in the U.S., but in other countries, too, and have some suggestions to help bring about change.

From the patient’s perspective there needs to be:

  • More responsibility for our health and a genuine effort to alter our lifestyles before requesting medications and treatment from doctors
  • Demands for shared decision making with medical professionals.
  • Less influence and more education from drug companies and medical device manufacturers.

From the doctor’s perspective there needs to be:

  • More time spent with patients to get a better understanding of situation to assist with diagnosis / less time on tests to rule out issues
  • Practice “minimally disruptive medicine” As per another great video from James McCormack
  • Less influence and more education from drug companies and medical device manufacturers.

We take it for granted now that people understand that smoking isn’t good for our health, but there was a time when it was considered the socially acceptable thing to do. In the years between there was a lot of effort to change public opinion, but it was successful. From Wikipedia:

Rates of smoking have generally leveled-off or declined in the developed world. Smoking rates in the United States have dropped by half from 1965 to 2006 falling from 42% to 20.8% in adults.[91]

Congress passed the Public Health Cigarette Smoking Act in 1970 and banned television/radio advertising of cigarettes. I imagine it would help avoid considerable overdiagnosis if advertising of prescription medications, medical devices and procedures could be similarly restricted.

In September 2013 I attended the Preventing Overdiagnosis Conference, at Dartmouth College and had the privilege of hearing Iona Heath, former president of the Royal College of General Practitioners, speak. You can listen to her entire speech here, but here are a couple of quotes that caught my attention because they are so perfectly worded:

  •  . . . And we’re also seeing how closely linked overdiagnosis and underdiagnosis are. Because if you widen the pool of a disease, what you do is take resources away from those who are most seriously hurt.
  • In a world where it has become acceptable to treat risk factors, however weak, as diseases in their own right, we must and will learn to resist over-diagnosis.

Iona also quoted James McCormack:
General practitioners  . . . would do better to encourage people to lead lives of modified (hedonism) so that they may enjoy in the full the only life that they are ever likely to have.

Patients Are People, Too!
Let’s help ourselves and encourage our doctors to allow us to live our lives as people and not patients.

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