A recent study published in the British medical journal reveals why strong collaboration is so critical to good healthcare.
The authors tried to compare aerobic exercise and Tai Chi for treating fibromyalgia. Both are known to be effective for some patients; so the authors tried to discern which might be better.
Due to limitations in study design and execution, the results of their trial could not achieve their goal.
However, they did confirm that exercise helps fibromyalgia, and also that an individualized treatment plan is critical to getting the best outcome possible:
Beware of a doctor, however well intentioned, who does not collaborate with you to find the best treatment for you as an individual. Suggesting one type of exercise or another must always be accompanied by a robust discussion of the benefits, risks, alternatives and unknowns, and a shared decision on which plan to try.
Simply offering a prescription for exercise, or for any other treatment, is not collaborative care, and runs a strong risk of failing to help you achieve your goals.
A recent news article on NPR describes a patient experience with doctors who prescribed an effective but very expensive medicine to treat a minor toenail fungus they noticed but that the patient did not even go to them for.
This story illustrates why the best care is also always the least expensive, and Why collaborative care is the best care.
There were many safe, effective and inexpensive alternatives available to treat the problem.
A good shared medical decision would have included a discussion of the mild nature of the problem, and the benefits, risks (including financial risks), alternatives and unknowns of the treatment.
The best care is collaborative care because it is individualized, and it strongly engages the patient to optimize the healing process.
A trial presented recently at the American College of Cardiology found that a novel medication for preventing gout increased both cardiovascular and all cause deaths compared to an older medication.
One of the principles of good medicine is to weigh benefits, risks, alternatives and unknowns when making any medical decision. In a post in June we discussed that many medications approved by the FDA are found to have serious problems years after heir initial testing.
Some of my colleagues and I like to call the first several years of initial use of a newly approved drug the phase 5 trial. That means it continues to be tested by trial and error, as opposed to with the rigorous testing before approval.
Because of the unknowns, we like to save novel medications for use only when there are no alternatives. That way we gain experience when the benefits are stronger than the unknown risks.
Make sure you ask your doctor about the alternatives, risks, and unknown risks of any new drug they prescribe. Although they may think they are using a better drug for you, you may prefer to wait until it has finished its phase 5 trial before you submit to taking it. Especially, as in the case of this new drug, there is a very good alternative.
The word heal comes from the old English “Haelan” which means not simply to cure, but “to make whole”.
When modern medicine adopted a scientific approach to healing, it made great strides in finding ways to cure a multitude of maladies that invaded human biology, from traumatic to microbiological to inflammatory to metabolic to genetic.
However, the real tradition of medicine is healing, not curing. Healing takes into account the entire person, from individual biology to individual cognition to individual goals and values. A good healer will collaborate with their patient to find the right combination of technology and techniques to achieve both cure and healing. That means looking not only at the simple application of medical knowledge and technology, but at the consequences of their use within the entire context of the individual patient’s life.
Unfortunately, with technology now so powerful that it dominates the healing relationship, and with the efforts to control of the costs of that technology so burdensome, it can be difficult for a doctor and a patient to achieve that collaboration.
We at Operam Healthcare have over 35 years of experience collaborating with patients, and we are dedicated to helping people learn to collaborate with their doctors to rebuild those healing relationships.
Making good healthcare decisions is often difficult because the science behind them is often incomplete. What makes sense based on observing large groups of people does not always make sense when it is subject to the scrutiny of good science. Think of the way it makes sense to say the earth is flat until we take a more disciplined look at it.
This applies to many supplemental treatments people used to manage their health. The use of calcium and vitamin D supplements for prevention of fractures has long been perceived as safe and effective. However, the science behind those two supplements is very incomplete, and very shaky.
Two recent studies raise major questions as to whether you need calcium and vitamin D supplements, and also whether you don’t need them. If you don’t need them, they’re only a risk.
One study looked at the effect of supplements on colon cancer, and found a higher risk.
The second study, a meta analysis, found no benefit from them in reducing risk of fractures.
The science of vitamin D and calcium remains incomplete. Remember, when making the decision to take supplements, think of all the benefits, risks, alternatives and unknowns of the plan. You can talk to your doctor, or you can ask us to help you sort them out.