So They Want You To Have Surgery!
(May 25, 2021)
Well, they always do, don't they? Except that YOU don't really want to. Or, maybe it isn't surgery that's the proposed treatment, and you aren't sure about the medication that you're supposed to take. Or you blanch at the cost of a weird-sounding test that your insurance won't pay for because they say it's experimental, but your doctor swears that it isn't. Do you have a choice? Maybe. Gird your loins, oh warrior, and follow me.
Dodging conventional treatments in favor of better, cheaper, safer alternatives is a theme I return to frequently, partly because it's what I do and partly because it's the path that any sane person would prefer to follow. But! Sometimes -- just sometimes -- what your doctor wants you to do is ACTUALLY THE RIGHT THING.
Since they are the experts, they should ALWAYS want you to do the best thing for you. And theoretically, they do. But like most of us, all they really know is what they already do. They may be fabulous at yanking out gallbladders and uteruses, giving cortisone shots, or placing stents. And since when your only tool is a hammer, every problem seems to require a nail, they'll want to do their Thing any time they are given the smallest excuse to do so.
Sadly, then, it is pretty much up to you to make a decision that you often are not really qualified to make. So as I've said before, the way that you get around that is to get other people who ARE qualified to give you advice, directly or indirectly.
1) Everyone should have an actual relationship with a good primary care practitioner. EVERYONE. By PCP I mean a GP, an internist, maybe a nurse practitioner MAYBE. (But not a gynecologist, ladies, please. They are not PCPs, I don't care what they tell you.) As soon as you go to a specialist, you start getting specialized on. Go to a generalist first, who has no skin in the treatment game and can look at the big picture. Then if it's warranted, THEY will send you to the appropriate specialist. And then afterwards you can go back to them and talk about what the specialist said. You might not need a specialist at all. A good GP is worth their weight in rubies.
The purpose of all this is to FIRST get an accurate diagnosis (and maybe one or more recommendations for treatment). Once you and your PCP are satisfied with the diagnosis, then later you start looking up treatments.
2) So once you have a reasonable diagnosis, start your research with a general-information website like WebMD or Mayo Clinic or no end of other respectable organizations. Use them to look up your condition until you feel like you've got a good grip on it. THEN start checking out the treatments.
You MUST look up the treatments that are recommended for your problem. This is important and necessary. Doctors are no more than human, and like so many of us, sometimes even that minimum is barely met. They make mistakes. They have pet treatments that they recommend too often. And do remember the old saying, "science advances one funeral at a time". Often an entire generation of practitioners that is married to a useless or even harmful treatment has to literally die off (hopefully before their patients do) before you see progress. You don't want to be one of those statistics, especially while that's happening. It's sort of like being the last soldier to die in a war. What could be worse than that?
3) "Choosing Wisely" is a health education campaign by the American Board of Internal Medicine that has used specialist input to identify hundreds of overused tests and procedures. At the very least, an unnecessary treatment will waste your money. At worst, it can harm you or delay or even remove the opportunity for you to do something that would actually help you. If something that has been recommended to you is on their list, it doesn't automatically mean to avoid it. It does mean that that procedure is used way too much with very little benefit accruing from it, and your doctor ought to have a very good reason for you to do it. They are at
4) The Cochrane Collaboration is an international not-for-profit organization that uses published evidence to evaluate the efficacy (or lack thereof) of specific medical treatments. There are a bunch of evidence-based medical organizations now, but these folks were the first and are still kind of the flagship group for it. You can see which treatments for a particular condition have the most evidence supporting them, and what kind of outcomes to expect from a given treatment. It is a fabulous place to look these things up. You can start to access their database from here:
5) Not long ago, a few folks decided that they would evaluate about 15 years' worth of the more-respectable medical journals to see how many medical treatments in current use had so little evidence supporting them that they ought to be eliminated. There were literally hundreds of them. Since this list may very well contain treatments that neither of the aforementioned groups have gotten to yet, it's worth looking at as well. I think I gave this link before in my "Medical Reversal" newsletter:
The science of medicine is a whole lot better than it was when I was a kid. And interestingly, doctors are a whole lot more humble and responsive to their patients now than they were back when they mostly just wreaked a lot of havoc. (Ironic, huh?) But that doesn't mean that even the best of them has no prejudices in favor or against certain treatments AND is 100% current in their field. These steps are a good way to make doubly sure that you're on the right track with your care.
--dr. diane holmes
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