Is Chiropractic an Art or a Science? 

When I grew up on the East Coast, I had little or no contact with chiropractors.  Back then, most people I knew and most medical centers did not regard them as real medical practitioners.  Years later, after I came out to the Mid-West, I found a much wider acceptance of chiropractors.  Over the past 40 years of living in Minnesota and Wisconsin, I have known many people who have gone to chiropractors and who firmly believe that they were being helped.  Most of the people I have known were suffering from back problems.  Here is one comment regarding chiropractors from an obviously very satisfied patient:

“I go to a chiropractor irregularly, usually when my neck is bothering me.  He uses heat, ultrasound, and massage therapy to undo the tension in my back and neck, caused by two vertebrae in my back that have been out of alignment since I was 16.  I go away, and am usually good for another 6 months.

I’ve never had a chiropractor offer to cure anything, from gallstones to depression by cracking my back; I’ve never had one suggest I needed to try any homeopathic remedies; I’ve never had one claim my bipolar disorder was all due to a misaligned spine. When I did have gall bladder trouble, my then chiropractor told me to see my primary care doctor post-haste.”

reno-chiropractor-940x627

If chiropractic medicine has any single claim to fame it is in dealing with back and skeletal muscle problems.  Chiropractors are famous for treating such problems with spinal manipulation and “adjustments.”  Often the diagnosis given to the patient will include the claim that the patient has a “pinched” nerve or some type of “subluxation”.  The patient spends an hour or so with the doctor getting an adjustment to treat the problem.  Many patients will then leave feeling much better then when they arrived.  They will also be out between 65 to 200 dollars per visit.  In most states, Chiropractic medicine is recognized and eligible for insurance reimbursement.

“Medicare does cover medically necessary chiropractic services.  According to the CMS,  Medicare Part B now covers 80% of the cost for ‘manipulation of the spine if medically necessary to correct a subluxation.’  There is no cap on the number of medically necessary visits to a chiropractor.”  — Does Medicare Cover Acupuncture or Chiropractic?, Senior 65

OK, so far, we have happy patients, insurance reimbursement in most states and Medicare coverage for chiropractic service, so what is my problem with chiropractors?  What if it is an art, what’s wrong with that?  Well, an art is something that as opposed to a science does not have objective reproducibility.  There is little or no evidence for cause and effect in an artistic relationship.  From an art, we would expect a much wider variation of results then we would get from something that has demonstrated scientific reproducibility.

“Chiropractic theory and practice are not based on the body of knowledge related to health, disease, and health care that has been widely accepted by the scientific community.

 Most chiropractors believe that spinal problems, which they call “subluxations,” cause ill health and that fixing them by “adjusting” the spine will promote and restore health. The extent of this belief varies from chiropractor to chiropractor. Some believe that subluxations are the primary cause of ill health; others consider them an underlying cause.” —- Twenty Things Most Chiropractors Won’t Tell You  by Dr. Preston H. Long

Another way of looking at the difference between and an art and a science lies in the ability to assign risk factors.  With a science, we should be able to assign a probably of risk in terms of outcomes.  With an art, we cannot reliably assign risk factors since they have no bearing in empirical outcomes.  What difference does this make to a potential chiropractic patient?  It should make a great difference since their chances of getting an accurate diagnosis for many potential problems is much less with chiropractic medicine than with traditional medicine.  Here are two comments from people who have gone to chiropractors.  These comments are from the http://www.spine-health.com forum and website.  The subject was: “Does chiropractic treatment help with pinched nerves:”

“Chiropractic “medicine” deals with the musculoskeletal system. However, many chiropractic offices use TENS therapy, which stimulates the nerves. Most of my back problems come from nerve issues and I have personally never found relief from chiropractic, in fact, it made me worse. But this is only my personal experience. My portable TENS unit helps me; I would ask the doctor who is managing your condition if TENS therapy may be right for you. Good luck!”

“In my case, I made the biggest mistake in my life, I was complaining about little pain in my knee but my chiropractor damaged my upper back T5 and T6 which I’m suffering now with a lot of symptoms nerve pain in between my shoulder, legs , arms , headache ….., I’ll never advise anybody to go to the chiropractor , and this is my own  experience.”

Anecdotes and grievances do not prove a case against chiropractic.  However neither do testimonials from satisfied patients prove the efficacy of chiropractic treatment.  It can be argued that the placebo effect will explain much of chiropractic’s reported success.  I have often argued that massage therapy will produce the same results with lower cost.  Some evidence exists to support my contention.

“A study called Patterns and Perceptions of Care for Treatment of Back and Neck Pain appeared in 2003. The studied questioned over 2,000 people on how they dealt with their aches and pains. Massage took home the gold with people preferring it to chiropractic for any kind of back pain or general body pain, but chiropractic led the race in upper-back pain and neck pain. Even with these results, visits to chiropractors were much more common than visits to massage therapists.”  — Chiropractor Vs. Massage

The above study notes that more people go to chiropractors than massage therapists.  You might wonder why?  Especially since seeing a massage therapist will cost you about 1/2 to 1/3 the cost of seeing a chiropractor.  I propose that the reasons for this propensity of people to prefer chiropractors to massage therapists lies in the more successful lobbying and marketing that chiropractors have done.  A second and related reason is that massage therapy will generally not be covered by most insurance plans or Medicare.  The following applies to Medicare coverage for massage reimbursement:

“Original Medicare does not cover massage therapy. Services that are not covered by Medicare are the sole responsibility of the patient.  In some cases, Medicare Part B will cover chiropractic services if they are medically necessary and are meant to correct a subluxation of the spine. In most cases, Original Medicare pays 80% of the cost for this treatment, but the patient is responsible for the other 20% and all other tests and services performed by the chiropractor.” —  Does Medicare Cover Massage Therapy?

Note that in the above description that chiropractic care is covered but massage therapy is not.  The lobby for chiropractors is much more powerful than the lobby for massage therapists.  This latter fact demonstrates that the type of medical care and medical coverage you are eligible for will be determined not by objective scientific facts but by political persuasion and money spent by lobbyists.  How does that make you feel?  But let’s get back to chiropractic treatments and look more specifically at “adjustments”.  This is the bread and butter treatment for chiropractic patients.  Do you need them?  Will they help you?

Chiropractic Adjustments:

chiro with an adjustmentIf homo sapiens have a weak link in their skeletal structure it is the back.  It has been argued that the problem arose when we switched from hanging in trees to walking upright.  Whatever the cause, back problems are easily the most common and perhaps one of the most painful problems faced by Americans today.  I have heard it said that the “opioid epidemic” is really a “pain epidemic” as more people age and have to deal with back problems, knee problems and hip problems.  No one beset by continuous pain can be blamed for wanting to find an escape from that pain.  However, as I noted in the previous blog, this desire to escape pain often leads to bad choices.  Surgery is too often prescribed when other treatment modalities would be more effective with less side effects.  This brings us to the issue of chiropractic adjustments for back pain.  How effective are they?  Here is another comment from Dr. Preston H. Long regarding the effectiveness of spinal manipulation:

“Research studies that look at spinal manipulation are generally done under strict protocols that protect patients from harm. The results reflect what happens when manipulation is done on patients who are appropriately screened—usually by medical teams that exclude people with conditions that would make manipulation dangerous. The results do not reflect what typically happens when patients select chiropractors on their own. The chiropractic marketplace is a mess because most chiropractors ignore research findings and subject their patients to procedures that are unnecessary and/or senseless.”Chiropractic Abuse: An Insider’s Lament Paperback – 8 Oct 2013, by  PhD. Preston H Long D.C

abuse

I highly recommend you read the book by Dr. Long.  If you are going to go to a chiropractor, you should have a realistic assessment of finding out your chances of getting help and relief.  Too many people leave their medical treatment entirely in the hands of so-called experts.  This is a big mistake.  I will discuss this later in another blog, but you need to be a strong advocate for your health care and not trust any one medical practitioner too much.  How much is too much?

 

  • It is too much if you are uninformed and have done little or no research into the causes and treatments of your illness.
  • It is too much if you expect that your treatment will take the place of discipline and hard work on your part.
  •  It is too much if you would rather get surgery than lose weight or exercise.
  •  It is too much if you expect that your doctor will advise you to pursue less invasive treatments before surgery or pills.
  •  It is too much if your doctor is overweight, has no exercise program of his/her own or smokes.
  •  It is too much if you have not pursued a second or third opinion.
  •  It is too much if your doctor cannot show you fairly persuasive evidence of a diagnosis and an empirically related treatment modality.

Conclusions:

For the record, I have no vendetta or grudge against chiropractors.  However, it has been my observation that they often treat many problems that they are not competent to treat or that have not had a proper diagnosis.  I have seen too many friends go to a chiropractor and not have a long-term fix to their pain or problem.  Chiropractors may offer a good short term fix to some pain problems but usually no long-term fix.  For the record though, massage, surgery and pills do not usually provide a long-term fix and with surgery, there will usually be consequences that the patient was probably not aware of.

(For more facts on the pro’s and con’s of chiropractic treatment see “Evidence for Chiropractic Treatment“) 

Chiropractors are no better than regular medical doctors when it comes to dealing with the underlying cause of pain.  Sadly, some of the problem for hasty diagnosis must be laid on the patient’s doorstep.  Many pain sufferers want either instant relief or relief that will entail little or no effort on their part.  Doctors too readily give into this desire either because of the financial remuneration that awaits them for treatment or laziness or perhaps simple ignorance.  My skeptical side says that giving a patient an exercise program or diet program is not nearly as lucrative as treating the patient with adjustments or surgery.  Back surgery will generally cost between 50k and 100k.  Spinal adjustments may take place for up to 6 months and final costs may total nearly $5000 dollars (computed as 50 treatments multiplied by an average cost of $65 dollars per treatment.)

On the positive side, there are many chiropractors who offer an alternative to the pills and surgeries so often recommended by mainstream medical doctors.  Perhaps because they have been viewed as less professional by traditional medicine, many chiropractors have considered a variety of non-traditional treatment options.  Many of these treatments are not very scientific or have no proven scientific effectiveness but this does not mean that they may not be effective.  Scientific proof has often taken many years to prove things that traditional folk medicine long knew was true.  However, there is a drawback in delaying some treatments to pursue unscientific remedies.  For instance, when I was diagnosed with prostate cancer, I decided to pursue a “wait and see” or “active surveillance” policy.  I was not ready to accept either the PSA reading or the biopsy or even the MRI results.

During my wait and see time, I opted to try some herbal remedies that were reported to have some success with prostate cancer.  I started taking several of these remedies each day in the hopes that a future biopsy would show a decrease in cancer cells or even the disappearance of my cancer.  No luck.  My next biopsy and a third biopsy all showed increases.  In addition, my Gleason score and PSA scores kept going up.  I now risked the danger that the cancer would spread out of my prostate and migrate to other organs.  It was time for surgery.  Not to pursue surgery at this point would have been foolish and even hopeless.

Thus, there is an ever-present danger that pursuing treatment programs that are a dead end might endanger your life and prevent you from going down more fruitful paths.  There is a reason that many people pursue such options.  It is called “hopefulness.”  I cannot blame anyone for this outlook.  I too was hopeful that I could keep my prostate and continue to pursue a normal life.  Many people go to chiropractors rather than medical doctors in the hope that they will find a cure beyond pills and surgeries.  Some do and some don’t.

Time for Questions:

Have you ever been to a chiropractor?  Why or why not?  Did you find them helpful?  Why?  What evidence did your doctor provide to show why he/she gave you the diagnosis you received?  What kind of exercise program do you follow?  Do you think people without an exercise program are higher risks for medical problems and pain?

Life is just beginning.

“The doctor of the future will give no medicine, but will interest his patients in the care of the human frame, in diet and in the cause and prevention of disease.” – Thomas A. Edison

 

 

 

 

 

 

 

 

 

 

 

 

Should We Be Cautious When Seeing Our Family Doctor?

can you trust your doctor

This is the first of the ten perspectives I am going to discuss about medical care in the United States in the 21st Century.  Before I begin, I have already warned you that if you regard physicians as gods or if you love your MD for saving your life and cannot bear to hear anything wrong about the medical profession, you should probably not read what I am going to say.  One of my friends on Facebook sent me this message or caveat:

“I practiced medicine for 30 years. Be careful about generalizing. I got burned out, I cared. I saw the whole person. I’m not unusual. Medicine is hard. You are always looking over your shoulder. Afraid to be sued. We go into this not for money but to help. Really. Believe it.”

I am quite sure that what she says is true.  True for some.  Not true for others.  Is it the majority?  I don’t know.  But there are a lot for whom the medical system is not working and even more importantly for whom it is dangerous and harmful.  Let’s start with some specifics.

After writing and publishing this blog, a good friend of mine reviewed it.  He had a very different perspective on things than I present.  Together, we are like the Yin and Yang. I see the negative side of things and he sees the positive side of things in the medical profession.  It is my belief that we need to see more of the problems with our medical practices and bring them out so that they are more transparent.  Nevertheless, I realize that there are thousands of medical people who work hard and try to do their best to help their patients.  Thus, I am going to print Fred’s letter to me following my comments.  I hope this will “balance” out my negativity somewhat and create a more balanced view of American medical practice in the 21st century.  (Thank You Fred for taking the time to send us your thoughts.)

  1. Number of Needless Surgeries that are Done

There are many people who are enamored with surgery.  There are an equal number of doctors who are enamored with surgery.  When anyone in the first group goes to anyone in the second group, you can bet that surgery will be the answer to all their problems.  AbracadabraAnd like magic, their hip pains, knee pains and back pains will go away.  The patients are joyous, (unless they die on the operating table like my friend did last summer after going in for a hip replacement).  The doctors are joyous since they are thousands of dollars richer and of course the hospitals are also joyous since they too are also thousands of dollars richer.

signs-that-you-should-see-a-doctor-physical-therapyHave you ever heard of a doctor turning anyone down for back surgery, knee surgery or hip surgery by telling them that they are overweight and would be better served by an exercise program or by physical therapy?  If so, I can guarantee they are not typical of most medical practitioners.  How many doctors look at the major cause of back, knee and hip problems and try to deal with that?  Impossible, because doctors do not treat you over a lifetime.  You don’t see a doctor until you have a problem and by then it may be too late.  Surgery is the fastest solution because exercise, dieting and physical therapy take discipline and time.  Doctors do not want to tell you the truth because it is an inconvenient truth but many problems should not be treated by surgery until it is a last resort.  Too often, it is the first resort.

  • Data show that 10% to 20% of some common surgeries are done unnecessarily – USA Today – June 20th, 2013
  • “I think there’s a higher percentage who are not well trained or not competent to determine when surgery is necessary, Santa says. ‘Then you have a big group who are more businessmen than medical professionals — doctors who look at those gray cases and say, ‘Well, I have enough here to justify surgery, so I’m going to do it.” — USA Today

Here per the study reported by USA Today are the six leading surgeries that often performed and just as often not needed:

  • Cardiac Angioplasty, Stents
  • Cardiac Pacemakers

Pacemakers are used to correct heartbeat irregularities, but research shows that more than 22 percent of these implants may be unnecessary.

  • Spinal Fusion Back Surgery

lumbar-spine-surgeryIf you have low back pain and see different specialists you will get different tests: rheumatologists will order blood tests, neurologists will order nerve impulse tests, and surgeons will order MRIs and CT scans. But no matter what tests you get, you’ll probably end up with a spinal fusion because it’s one of the “more lucrative procedures in medicine,” author Shannon Brownlee says – even though the best success rate for spinal fusions is only 25 percent!

  • Hysterectomy
  • Knee and Hip Replacement, and Arthroscopic Knee Surgery

Patients who were informed about joint replacements and alternative treatments had 26 percent fewer hip replacements and 38 percent fewer knee replacements than those who did not. Arthroscopic knee surgery for osteoarthritis is also one of the most unnecessary surgeries performed today, as it works no better than a placebo surgery.

Proof of this is a double-blind placebo-controlled multi-center (including Harvard’s Mass General Hospital) study published in one of the most well-respected medical journals on the planet, the New England Journal of Medicine (NEJM) over 10 years ago.

knee surgeryRecent research has also shown arthroscopic knee surgery works no better than placebo surgery, and when comparing treatments for knee pain, physical therapy was found to be just as effective as surgery, but at significantly reduced cost and risk. And yet another study showed exercise is just as effective as surgery for people with chronic pain in the front part of their knee, known as chronic patellofemoral syndrome (PFPS), which is also frequently treated unnecessarily with arthroscopic surgery.

  • Cesarean Section

According to the World Health Organization, no country is justified in having a cesarean rate greater than 10 percent to 15 percent. The US rate, at nearly 32 percent, is the highest rate ever reported in the US and is higher than in most other developed countries.

The USA Today article went on to talk about many diagnoses that were based on limited medical knowledge and that doctors often lacked the expertise to explore alternative treatment modes.  This is an issue of incompetence and it seems to be a major problem in the medical field with many doctors getting their information from their pharmaceutical representatives.

I have not even touched on the issue of malpractice.  But I will say a few words about this.  No one is perfect.  Everyone makes mistakes.  Medical treatment and diagnosis is a very difficult process.  I will not blame any doctor for an honest error committed with good intentions and not simply out of ignorance or greed.  This is one area where I sympathize with the doctors and hospitals more than I do the lawyers.  Nevertheless, there are some egregious examples of medical practice and a lawsuit might be the only recourse for such cases.

I use the information from the USA Today article, but none of it surprises me.  I have had many friends who have undergone surgery for the situations noted above. I have often tried to counsel them as to other solutions but it is generally a waste of time.  I have had two notable successes though and they have both expressed their gratitude to me for sharing my opinions and thoughts with them and preventing them from getting surgery.

drugs

  1. Pills, Pills and more Pills

If life were fair, many doctors would be in jail right alongside of other drug dealers.  Doctors do not have the violence associated with illegal drugs because they have a license to prescribe drugs.  However, doctors prescribe drugs that are no more needed than heroin or cocaine and at much greater rates than your street drug pusher.

The size of the illicit drug trade (2012 data) in the USA including Marijuana, Heroin, Cocaine and Methamphetamines was estimated to be about 100 billion dollars a year.  —- How Big is the U.S. Market for Illegal Drugs?  We can assume that street dealers and drug pushers are responsible for most of these drugs.  So how much do doctors push?

If we look at the following fact, we can extrapolate from it the total amount of prescription drugs sold each year in the USA.

“In 2013, per capita spending on prescription drugs was $858 compared with an average of $400 for 19 other industrialized nations. In the United States, prescription medications now comprise an estimated 17% of overall personal health care services. —  The High Cost of Prescription Drugs in the United States (2016). 

deaths from over druggingSo if we assume roughly 326,000,000 (USA Population in 2016) people and we multiply that by $858 dollars per capita, the total amount should equal the total amount spent on prescription drugs.  This amount equals = $279,708,000,000.  This is almost three times what is being spent on illegal drugs.  I am not even going to talk about caffeine, alcohol, nicotine, and other “legal” drugs.  Given that doctors love to prescribe pills and many patients love to take them, is there any wonder that we have or are currently experiencing an opioid epidemic in the US.

“Americans are in more pain than any other population around the world. At least, that’s the conclusion that can be drawn from one startling number from recent years: Approximately 80 percent of the global opioid supply is consumed in the United States…. The 300 million pain prescriptions equal a $24 billion market.”  — Americans consume vast majority of the world’s opioids (2016).

I say again that if life were fair, many doctors would be called drug pushers or DP’s rather than MD.’s   They would also be in jail.  Who should be responsible for the opiate epidemic if not doctors.  When and where do they stand their ground.  Even if people are stupid or lazy enough to want surgeries to cure problems of obesity and diet or if they want pain killers to mask the problems from their obesity and lack of exercise, who is the expert here?  Do parents give their children everything they ask for?  You go to an expert on medicine to get help and not to have them take advantage of you for their own benefit or pander to you because they are afraid to tell you the inconvenient truth.  What is this inconvenient truth?  I will talk more about this truth later in this series but to be quite direct and blunt it is this:

“British businesswoman and columnist Katie Hopkins has a controversial view on the obesity epidemic: that the solution is simply to eat less and exercise more — and that fat people have no one to blame for their weight issues but themselves.” — I gained 43 pounds to prove obese people are lazy

I had a friend that I used to ride motorcycles with.  He died in a motorcycle crash a few years back.  He was a great guy.  He always had a smile and something nice to say to someone.  His name was Gary.  He was also obese and exercised little.  He had chicken legs and bad knees.  Well, what would you expect if you weighed 100 lbs. more than you should and you let your leg muscles go to hell.  Of course, he went in to see his doctor with knee pains.  The doctor was more than happy to suggest Gary should lose some weight but in the meantime, he would schedule the surgery for knee replacement.  To my mind, this is criminal, irresponsible and ignorant behavior on the part of his doctor.  Gary got the surgery.  Never lost much weight and died not too long after from other causes.

Doctors pushing pills, pushing surgery.  It is like the Yin-Yang of American medical practice.  Throw into the mix a lot of lazy people who do not exercise or take care of themselves and you have a health care system spending tons of money on acute care when preventive care would be a much more sensible solution.

  1. Me Doctor, Me Busy.  Who are You?

Some of you might remember the skit on Saturday Night Live with Martin Short playing a doctor.  When asked what his badge that said MD meant, he would reply somewhat superciliously “Me Doctor, You Patient.”  When I was working as a consultant to some hospitals, it was not uncommon to hear nurses complain that doctors were like gods whose every word should be obeyed.  They seldom came to team meetings because “their time was too valuable.”

I will stay away from the subject of how much money doctors rake in since they often ascribe their high incomes to the length of time it takes to finish medical school and all of the attendant costs.  This sounds like a reasonable explanation but an alternative theory might mention the strangle hold that the AMA had on medical admissions and the role that restricting the supply of doctors has had on the cost of their services.  The law of supply and demand says that if you have fewer doctors, the cost per care will be higher.  For years, the AMA did all they could to help keep the supply of doctors down.

  • But the entities that will be most injurious to the nation’s health are not so much in the evil-mongers’ group but the first group, including the American Medical Association–a doctors’ cartel that has controlled the medical labor market in the U.S. like its personal fiefdom for a century. — The Evil-Mongering Of The American Medical Association (2012)

So, doctors come to regard themselves as the elite who know more than you do and who must be smarter than you since they make a great deal more money than most of their patients.  Doctors used to do house calls many years ago; back then, a doctor might have known something about your family and you personally.   My wife Karen told me the following story about her family doctor.   It generated the following conversation:

Karen —

“When I was married, and raising four children, my ex-husband Ron and I became good friends with a local White Bear doctor.  He became a family friend as well as our family doctor.  We knew him for over thirty years and he knew me and my family personally and really cared about us.” 

John —

“Okay, so now you have been seeing a doctor in Frederic for about seven years.  How much does she know about you personally or really care about you?”

Karen —

“I think she really cares about me.”

John —

“But how much does she know about you personally.  Your goals.  Your dreams.  What you did this past winter?”

Karen —

“Well, at first, she used to take more time to talk to me but the past few years she has seemed much busier and anxious to keep our meetings short.  I suppose the clinic has a quota for how much time she can spend with a patient.” 

Again, there are numerous anecdotes and articles describing the lack of time doctors have to spend today with patients.   Here is an excerpt from one:

“Joan Eisenstodt didn’t have a stopwatch when she went to see an ear, nose and throat specialist recently, but she is certain the physician was not in the exam room with her for more than three or four minutes.

‘He looked up my nose, said it was inflamed, told me to see the nurse for a prescription and was gone,’ said the 66-year-old Washington, D.C., consultant, who was suffering from an acute sinus infection.

When she started protesting the doctor’s choice of medication, “He just cut me off totally,” she said. “I’ve never been in and out from a visit faster.” — You’re on the clock.  Doctors rush patients out the door (2014)

I can guarantee you that if your doctor only takes a few minutes with you, once or twice per year, there is not much they can know about you personally regardless of how caring and concerned they are.  You might ask “well, why is this important.”   Here is the reason stated very well I think in Wikipedia:

“The quality of the patient–physician relationship is important to both parties. The better the relationship in terms of mutual respect, knowledge, trust, shared values and perspectives about disease and life, and time available, the better will be the amount and quality of information about the patient’s disease transferred in both directions, enhancing accuracy of diagnosis and increasing the patient’s knowledge about the disease. Where such a relationship is poor the physician’s ability to make a full assessment is compromised and the patient is more likely to distrust the diagnosis and proposed treatment, causing decreased compliance to actually follow the medical advice.”  — Wikipedia

Conclusions:

I promised some solutions to each truth that I am telling you.  Here are some that might help you to deal with this first truth.

  1. Get a second opinion for any surgery.
  2. Use the Internet to search for alternative treatment modes. Get advice if you are not Internet savvy. Remember, there are many opinions and not all are right.
  3. Exercise and have a health care plan. Follow it.
  4. Don’t take any pills unless you must. Try to unwean or get off them as soon as possible.
  5. Beware side effects from pills. Every pill has a side effect.  Make sure you are aware of any that might affect you and be cognizant of any changes in your life while taking these pills.
  6. Take a friend with you whenever you go in for an appointment or treatment. Talk to your friends to get their insights and opinions.
  7. Don’t assume your doctor is God and knows what is best for you. Be a skeptic but be realistic.  Modern medicine is better than sorcery but not always much better.
  8. Don’t assume that your doctor is your friend or has your best interests at heart. They might not have enough time to care.

Fred’s letter to me:

I read your blog on medical practice and it was indeed thought provoking.

I’ve had good results with doctors over my lifetime. Not always perfect but usually satisfactory and in some cases, it was excellent.

Medical care is a process and requires the same attention as any process. It seems especially complex today because of how rapidly technology and all the stakeholder’s needs and expectations are changing.

Overall, it’s greatly improved in its capabilities. My main concern for medicine is the same as I’ve had for years in business. My business life became more and more controlled by the bean counters and the lawyers. The same is true of medicine. Blaming doctors is blaming people, which is always a red flag to me as one who has a bad habit of judging others without knowing them. Like the driver for quality improvement, expectations always move to higher and higher expectations. And based on what I’ve heard from friends over my life, expectations are often unrealistic.

A friend recently died. He was an old school, oil field production engineer and didn’t trust any of his doctors. He’d get pissed at one and then begin to “doctor hop”; never telling one what the other had done or prescribed. I questioned him many times, always inquiring why he’d not share his history. His reply: “I ain’t telling them anything.  They make good money and are supposed to tell me what’s wrong.”

I see the process much as we viewed our manufacturing and service processes ..with customers, suppliers, inputs and outputs being carefully considered. A critical output is the result when your illness is diagnosed and this is too often a major problem source. My friend tends to expect this to be an exact outcome but in reality it isn’t. It’s only a statistical prediction that too many older doctors failed to point out to naive, uneducated patients.

In recent years, our doctors point out the statistics and involve us in the decisions for corrective action. My wife’s breast cancer surgery was a good example. Years ago, the doctor would have made the decision for which surgery, mastectomy or lumpectomy. Sandra made the decision armed with various study statistics and discussion with the Doctor. The Internet was a source for me to verify the statistics but that isn’t easy because there are often many studies,

The surgeries are complex and the statistics often work out for the worst. Records on lawsuits and doctor reviews are more readily available today. I recall a bad experience with my dad years ago. Our family doctor became a friend from making many house calls as 3 kids were raised. Dad was a merchant seaman and would provide Porte Rico rum for our good doctor. They were the best of buddies and talked about the old days during visits. Dad visited him yearly but when dad’s tobacco tarred lungs became late stage cancerous it was too late. Doctor “Tom” as an individual practitioner didn’t have the computer technology that red flags today’s doctors. Doctor Tom was as heartbroken as my dad. He and his wife nurse apologized that they’d not x rayed dad 6 months earlier. We probably could have sued but dad would never have agreed to such.

The body of knowledge has expanded too much for any one doctor to master it all, so now we have multiple knowledge based “Specialists” having to deal with the directives from medical organization bean counters and their lawyers.

I consider our medical providers to be leading edge. They seem to focus on continuously improving to meet customer expectations. I’m hoping, but doubt the doctors and staff will be given additional support. They track customer satisfaction inputs so I should be more confident.

I can email any of my doctors and I can access historical results. I especially like being able to take a picture of a physical observation and sent it in.  A couple of years ago, I tore a muscle on the back of my leg and a huge blue area surfaced overnight.  It scared the heck out of me. I emailed a picture and he emailed back telling me what it probably was, how to treat it and to see a doctor if it didn’t heal. My expectations are now at an even higher level which puts more load on the doctor. He not only has to live up to corporate standards on office visits but he must respond to patient emails. Just yesterday I received a corporate email announcing that they have decided to do “Face Time” appointments for $25!

Overall, I have concerns for the profession but I think problems are “process” related. To think otherwise would go against what I’ve believed for a long time.

Fred

Time for Questions:

How satisfied are you with your medical care?  Why or why not?  Have you ever had a loved one die?  How were they treated by the medical profession?  What do you think could be done to improve medical care for you and your family?  What would you like to change in the American medical care system?

Life is just beginning.

“We have really good data that show when you take patients and you really inform them about their choices, patients make more frugal choices. They pick more efficient choices than the health care system does.” — Donald Berwick

 

 

 

 

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