Paging Dr Ikol

[Edie]

NPR story from 10/08/2009

 

Listen to it.... would like to know what you think about the story's conclusions.

 

EDIT -- others can certainly comment too -- just want to hear Dr. Willlie's take on this.

[cryptique]

Fascinating.

[ikol]

I don't completely disagree with the conclusions. It's certainly true that more intervention doesn't necessarily equal better outcomes. When I did my OB/GYN rotation, I did notice that they did a lot of hysterectomies on women in their 30s and 40s that weren't necessarily required. But in those cases, it seemed to me that the patients were the ones demanding surgery. The doctors weren't telling them that surgery was the best option; they explained all the options, and the patients decided on surgery. The problem is that it's almost never a black and white decision. With any sort of intervention, a certain percentage of patients will benefit but you don't know which patients will do well. And the patient almost always chooses what they perceive to be the "quick fix." They want a one-time surgery over daily medication, and medication over lifestyle changes.

[Edie]

Certainly there is a certain amount of patient self-selection as a factor. But it really surprised me that in one location, all else equal, kids were 4x as likely to have had their tonsils out than those that lived mere miles away. It does seem like making money as a driver for patient care is the dirty little secret that no one wants to talk about. I am not just talking about physicians of course.

 

I was also surprised to hear that more does not necessarily = better. I think that the concept of "more = better" for anything really is so ingrained into the American DNA that hearing that it isn't in this case is probably rather shocking to most. I also think that there is an inherent, blind trust that doctors always know what to do -- and that we need to do it no matter what since the doctor says so.

[Guest Speed Racer]

That story makes me want to give my doctor a big, wet kiss. He's dry, wry and sarcastic, always forthcoming about my options, and his opinions about my options, but always supportive of my choices. I could not be happier with my health care plan or my doctor, and it kills me that some people don't have the same effortless opportunities to access care like that.

 

Edited to add: re: more = better

 

That's another thing I love about my doctor - even when I went in with the World's Worst Cold last year (thought it was a sinus infection, or the impending explosion of my brain), he advised that I try a netty pot before he prescribe any sort of medication to clear me up. More often than not, he will always suggest a lifestyle change before a procedure or pill (and I think that has a lot to do with my willingness to comply with his suggestions, which not every physician has the luxury of working with), which really meshes with me.