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.
The goal of good healthcare is to make sure you get everything you need, but nothing you don’t need. Anything you don’t need is only a risk.
We all know that the costs of healthcare are skyrocketing. Most people think that the drivers for the increasing costs are the expensive technologies and pharmaceuticals that provide nearly miraculous improvements in the treatment of common severe diseases like cardiovascular disease, cancer, and kidney failure. However, another major cause of the rising costs of healthcare lies in the overuse of less expensive testing and treatments that have no proven benefits.
Despite the attraction of many traditional or “cutting edge” weakly tested medications or treatment plans, they not only cost a lot of money, they also cause a lot of harm. The best way to be sure you don’t fall prey to overtesting and overtreatment is to be sure you and your doctor have fully explored the benefits, risks, alternatives, and unknowns of any test or treatment plan.
Get any test or treatment that you need to make a diagnosis or treat its consequences. But avoid any test or treatment that you don’t need; it is only a risk without any benefit.
The art of medicine is knowing how to analyze and balance benefits, risks, alternatives, and unknowns. I have done that with all of my patients for my entire career, and I still find it challenging. It starts with listening carefully to a person’s goals and values and then listening carefully to their story. Next, I try to match the true evidence supporting any tests or treatments being considered with the individual story, goals, and values.
If you would like to take charge of your own healthcare by being sure you’re getting everything you need, but nothing you don’t need, we can help.