Evidence-based medicine. The very words send shivers down the spines of many physicians. Modern medicine, in the US, is based on unequal information. Doctors know “stuff” they charge patients to find out. Very few patients know anything about their physicians except whether the physician is nice to them and they get better. Many, if not most, patients would get better on their own so in essence physicians are really judged on a “niceness factor” much like the server at McDonalds.
Physicians order tests for a variety of reasons. They fear litigation. They’re trying to meet patient expectation so they don’t lose market share due to an adverse “niceness factor.” They’re just not very smart and they figure another test might “clue them in.”
Recently physicians at Dartmouth have completed a study that indicates that more aggressive studies and care are not necessarily beneficial. That’s not particularly surprising since we spend more percapita than any other country yet have little objective evidence of value to the care we provide.
For example, many years ago I worked at a well-known tertiary-care children’s hospital. Some of the pediatricians had profoundly impaired patients with “static encephalopathy” from a variety of causes. At least once a day I would provide anesthesia for one of these children for an MRI of the brain. On several occasions I asked the pediatrician “What will you do if the MRI looks better but the patient is the same?” Few of them understood the question and none changed their ordering practices-. The reason, if that pediatrician doesn’t order the test the parents will simply find a physician who will- the pediatrician failed the “niceness factor.”
So what does this mean to patients? Ask your doctor what each test and medication is for. A test which only “confirms” what he already knows doesn’t help it only costs. Do not let fear of the remote possibilities overwhelm your judgment. This also means you need to choose you physician based on skill not niceness. You’re physician should be board-certified and have a clean medical board history.
Only use the care you need. Make sure the care you get is effective and cost effective. More care is not better.
It’s your health. Take care. Take charge.
