How to understand that the doctor does not act in your interests

Fragment of the book “Good Doctor. How to find your doctor and survive "

In mid -January 2021, the book of Alpina Plisher published a book by Kenneth Brigham and Michael Jones, a good doctor. How to find your doctor and survive ”(translation of Elizabeth Rybakova). This is not so much a clear instruction as a conversation about what problems are in medicine and how competent specialists cope with them (and how illiterate the task fails). True, the book has a lot of American specifics. "Medusa" publishes a fragment dedicated to communicating with a doctor.

Michael Rotberg, Professor of Cleveland Clinic, described just such an experience of his elderly father in an article called “Medical Experting worth $ 50,000” (The $ 50,000 Physical), published in the Journal of the American Medical Association . This history is constantly reprinted by different publications, but it serves as such an accurate illustration of the possible consequences of finding final answers in medicine that it should be brought again.

The eighty -five -year -old father of Dr. Rothberg moved with his wife to the nursing home and was in a new environment. An elderly man as a whole felt good: health problems were, but insignificant. Shortly after the Employment, Mr. Rotberg went to examine the general practice. When he palpated the stomach of the new patient, it seemed to him that the aorta - the main artery of the abdominal cavity - was bulging, and he suspected aneurysm - the protrusion of the artery wall, which could have serious consequences up to a fatal outcome. An ultrasound study showed that the aorta is normal, but the pancreas looks suspicious, so the doctor prescribed computed tomography of this area. This study excluded the pancreatic pathology, but some dubious darkening was found in the liver. For many years, the patient worked with organic chemicals, and the doctor knew that such harmful production was sometimes fraught with liver cancer. Mr. Rotberg felt good and did not complain about the problems with the liver. But the doctor directed him to a specialist who considered that it was necessary to make a biopsy in order to exclude or confirm cancer. So, Mr. Rothberg was put to the hospital on a procedure that involves the introduction of a large needle through the abdominal wall into the liver and the extraction of a small fragment of fabrics. It turned out that this is not cancer, but the interweaving of blood vessels, called hemangioma, but picking a needle in blood vessels is not a very good idea. Mr. Rotberg began abundant internal bleeding, and a transfusion of about 5 liters of blood was required. The patient suffered very much and almost died. The total cost of medical services, as it is evident from the heading of the article, amounted to $ 50,000. Thus, the doctor’s curiosity was satisfied, but the patient suffered colossal material costs, experienced physical suffering - and for what? The examination did not bring him the slightest benefit. This doctor, as they said about one priest after a too long Sunday sermon, missed many opportunities to stop.

What would our good doctor do? He would definitely put an end to the research at the very early stage and let Mr. Rothberg let go with the world: let him enjoy the time he had given him up with his new house. But the question is: how will the doctor find out where to stop? There is no clear and unambiguous answer here; If he was, then a zealous doctor could curb his zeal in time. A doctor, who is more calm to uncertainty, knows that some consider it pointless to even conduct an examination of a person, if he does not complain about anything. He also knows that it is useless to feel the stomach of an elderly person - this procedure gives little information. Next: having felt for something suspicious and having conducted an ultrasound study, was it necessary to chase the shadow in the pancreas? Doubtful. Pancreatic cancer is almost not treated, and there is a chance of recovery only if you find it at an early stage. So at each stage of communication with the patient, the doctor faced the next “maybe”. The decision on where it is necessary to be zealous and where not is made on the basis of scientific data, but they should be considered in the context of circumstances, taking into account the characteristics of a particular person. In fact, with the same medical indicators, the solution may vary depending on the patient and the picture of the disease. A simple timely “can” could serve Mr. Rotberg the best service than a “no” series, and also saves him and the insurance company $ 50,000. The ability to make an adequate decision, when and where to resort to “maybe”, depends on the volume of knowledge, understanding the situation and the level of tolerance to uncertainty.

The doctor, with stupidity, seeking the final answer to any question, is responsible for the high cost of treatment. The desire at all costs to detect the nature of a deviation that is not dangerous to health, turns into an excessive amount of expensive analyzes. The Union of Medical Public Organizations founded the project “Choosing Wisely” , within the framework of which lists of analyzes, research and methods of treatment, often used, according to most doctors, were compiled without much need. Here are examples: ECG with a load for people without life -threatening symptoms; MRI to find out the causes of pain in the lower back; CT and MRI with headaches; Bone densitometry in women in the absence of risk of osteoporosis. Each of these studies not only hits the patient, but also entails an avalanche of new analyzes, increasing expenses, but not bringing any benefit to health. In 2009, only 12 medical research, which, according to experts, were not necessary, cost insurance companies $ 6.8 billion. How much it costs the nervous system of patients is unknown, but the price, without a doubt, is very high.

Not moderately, an obstructive doctor can use an unimaginable amount of technology, and it is difficult to stop him. “No one has ever been held accountable for the appointment of optional research,” says Dag Campos-Autkalt, a therapist from Arizona.

For a person who is confused by uncertainty, the temptation to use the constantly expanding technical capabilities is insurmountable. Some choose the profession of a doctor mainly because they are simply fascinated by the achievements of scientific and technological progress and, as often happens in a state of passionate love, lose their heads. With a reasonable approach, advanced technologies are excellent for medicine, but it is better to avoid doctors who are too passionate about them. Such doctors go wrong.

And if so, then how do such specialists remain in the profession? Why do not patients not notice that the doctor is not guided by their interests, but by their own, and continue to be treated with him? Doesn’t it become clear at some point that you pay a lot of money and are undergoing unnecessary risk not to get better, but mainly with the aim of satisfying unhealthy doctoral curiosity?

There are several reasons why doctors choose this approach, but the most important is that we all want to know exactly what is happening to our body; Such is human nature. Actually, the good reason to avoid this type of doctors is that you are a person and, accordingly, are subject to Folie à Deux , and in this case the doctor uses your anxiety about uncertainty and is distracted from the main task - to make you as healthy as possible. You must rely on your doctor, know that at the right time he will be able to explain to you, that you do not need to chase a clear answer, and Aesculapo, accustomed to “yes” or “no”, in itself, this idea is alien to.

A person’s desire to get a clear answer, even when the exact question is not posed, illustrates the study of men's reaction to measuring the level of a prostatic specific antigen (PSA) in the blood. Although there are different opinions on this score, there are data that a noticeable increase in the dog indicates the likely cancer of the prostate gland. The next stage of the examination is the prostate biopsy. The procedure is not very complicated, but invasive, unpleasant and associated with some risk. During this experiment, 40% of men whose results of the dog turned out to be uncertain, that is, “did not provide information about the presence or absence of cancer,” nevertheless chose to undergo a biopsy. Even when the results of the tests do not require explanations, they do not give an answer either “yes”, nor “no”, or even “maybe”, we still want to resort to any, the most ghostly opportunity to make clarity. Therefore, most of us are potential patients of doctors who practice “black and white” medicine.

A doctor who does not recognize uncertainty is fixated on the idea of ​​a diagnosis as a dichotomy similar to the test/wrong test. But the medical history cannot be approached as a questionnaire, where short answers are needed. It is more like a biographical essay. The doctor’s task is to understand a kind of narrative about the patient’s state of health and use this information to ask the right issue and choose such that will most likely provide decisive information from a long list of possible analyzes and research. A good doctor will not ask questions, for the sake of the answer to which you need to doom you to the risk, high expenses, painful procedures or other inconvenience, unless this is mandatory for your treatment. And professional curiosity here must be put aside. Studies in public are conducted in their place and at one time, and we hope that you will agree to participate in them if you are asked, but this type of research should be carried out openly, according to strict rules, under objective and thorough control. You come to the reception in order to improve health, and not satisfy the doctor’s curiosity.

But how do you know that the studies prescribed by the doctor are appropriate, adequate and necessary for proper treatment? There are several ways to identify real motives of the doctor.

Does the doctor explain the purpose of prescriptions, the possible risk and importance of a particular study for treatment?

If not, you should ask these questions, and at the same time think about whether you have a full partnership with your doctor aimed at improving your health. You meet with a doctor for your own well -being, but it’s hard to believe in it if you are kept in ignorance. A doctor aimed at finding a clear answer to each question, most often is not inclined to explain his actions; He simply does not see the point in this. For him, the main thing is to get answers, and you are simply working material.

Never doubt the need to hear the opinion of another specialist about your disease and the method of treatment. Especially if you are offered complex invasive diagnostic methods, prescribe therapy with serious side effects or perform a series of interventions, more and more dangerous once (beware of the slippery slope). If you insist on finding out the opinion of the second professional, your doctor may not like it. Actually, if he is very dissatisfied or concerned about this fact, you clearly chose an unreliable ally in the struggle for your health. Never be afraid of manifestations of discontent from the doctor. You do not come to an appointment to make him pleasant, but because you need help. And if you can not cooperate in a friendly manner, the result is unlikely to be satisfactory.

When something is not clear to you or you are not sure of something, ask as many questions as you need to make sure that you understand everything correctly. The authoritarian doctor will probably not be delighted, but this is his problem. Ask until everything is crystal clear to you. The good doctor is not annoyed by polite sincere questions, and he will answer you in the same spirit.

The questions that you need to ask depend on your personal needs, on how much the doctor tells you, and on the course of the disease. But you should be absolutely honest about what you want to know. The American Government Agency for Research and Evaluation of the Quality of Medical Services offers the next 10 questions to start a conversation. From this list it follows that you should not be shy of your meticulousness.

• What is this analysis for?
• How many times did you carry out this procedure?
• When will I get the results?
• Why do I need this treatment?
• Are there any other options?
• What are possible complications?
• Which hospital will suit me more?
• How is the name of the drug written?
• Are there any side effects?
• Is it possible to combine these drugs with those that I already take?

The reaction to such issues makes it very good to understand which doctor you are dealing with. It is better to set them as early as possible. Since communication with this specific doctor may be unproductive for you, the sooner you realize and change the doctors, the more healthy.

A doctor who strives for answers “yes/no” not only forces you to spend a lot of extra money, but also exposes unnecessary risk. The same applies to the doctor who believes that he knows the answers to all questions (we will get acquainted with one of these doctors in the next chapter), but the motives are different here.