Quora – Have you ever fired a doctor?

I think I’ve “fired” about 8 doctors so far. There are many reasons to do so but the most important quality of a doctor is good administrative practices. One of my prior doctor’s administrative staff forgot to call me and tell me I had tested positive for cancer. I had a 3 year insurance battle with my insurer at the time due to that error. Luckily I had scheduled a follow-up for the test which is standard practice for me. Don’t ever believe that they’ll call you if there is anything abnormal on the test. My recommendation for everyone is to seek out a clinic with good admin and also offers a “shared care practice”. That is, you see whatever doctor is available and they share your file. That way you get exposed to multiple opinions. I write a lot about this, consider the following:

Just 12% of diagnosis by Doctor is correct. Value 2nd, 3rd, 4th opinions… See Mayo study for more details on the study – click here. More on my post here.

Death from health related administrative errors is 10x the rate of automobile accidents and the 3rd leading cause of death in the USA after heart disease and cancer (see Consumer Reports May 4, 2016). See more at my post here.

Think twice about handing over the responsibility for your health to the health system. They are not god; it’s a partnership where the responsibility rests solely with you. Not your doctor. Consumer Reports on Health reported in their June 2016 issue “… doctors continue to recommend treatment even when newer evidence suggests they shouldn’t. In fact, research shows that it can often take some doctors years, even decades, to give up old therapies after studies show them to be ineffective or dangerous.” More on my post here.

Bring a Health Advocate With You When Using Health Care. Consumer Reports on Health (April 2015 issue page 2) agrees that it is “… one of the keys to a safe and comfortable experience.” What is an advocate? See my post here.

Stay out of hospitals if at all possible! 11% of people picking up hospital based infections die. See more on my post here.

Be aware that our culture’s go to treatment is via drugs. Consumer Reports explains the love affair with prescription medication and the dangers of too many medications here. Statistically the problem costs the USA $200B per year, 1.3M/year hospital visits and 10% of those resulting in death. Your doctor may encourage medication. I recommend doing your research and discussing with them non drug options. My own experience is that long term drug use is nearly never the best option and usually indicates a major issue which I’ve also found have been correctable via non-drug therapies. Long term drug use could also be an indication that you are speaking to the wrong specialist (possibly right field, but wrong person).

Understand what “informed consent” means and demand an informed consent discussion from your doctor.  Consumer Reports on Health explains more in their Sept 2017 issue which can be viewed here.

Cross posted from Quora.

The Value of Second Opinions

Just 12% of diagnosis by Doctor is correct. See Mayo study for more details on the study – click here.

Don’t forget doctors are just one expert on your team. Value 2nd, 3rd and fourth opinions and hopefully those include other disciplines. General practitioners favor dispensing drugs, surgeons favor surgery, etc…. there are alternative therapies that don’t include drugs (and side effects).

More on my posts about doctor / patient relationships here.

Absolution of Your Health Responsibility Kills

Think twice about handing over the responsibility for your health to the health system. They are not god; it’s a partnership where the responsibility rests solely with you. Not your doctor. Consumer Reports on Health reported in their June 2016 issue “… doctors continue to recommend treatment even when newer evidence suggests they shouldn’t. In fact, research shows that it can often take some doctors years, even decades, to give up old therapies after studies show them to be ineffective or dangerous.” Therefore, the responsibility rests with the patient to ask questions, consider second opinions, etc. And further consider that visiting a hospital puts you in great danger of dying, making hospital visits in Canada worse than the Ebola crisis by 36 times: https://textor.ca/2015/04/11-of-people-picking-up-hospital-based-infections-die/ This doesn’t mean you shouldn’t visit a hospital, but if your issue can be resolved outside a hospital it makes sense to do so.

 

Bring a Health Advocate With You When Using Health Care

Do this as much as you can; especially for life changing health care. After surviving cancer, this is my number one piece of advice to anyone. It will save your life as it did mine. And I believe this one approach would drastically improve our perception of the quality of our health system. (No, not more money) And this isn’t just my advice, Consumer Reports on Health agrees to (April 2015 issue page 2). CRoH reports that it is “… one of the keys to a safe and comfortable experience.” What is a health advocate? Ideally this person is a good listener and “… has the confidence to raise concerns and the ability to make firm but polite requests.” Since they are not the patient, they may be less affected by emotions that affect our ability to process the information we are told.

Also, make an attempt at asking your doctor and clinic to adopt a patient portal to open up access to your doctors notes. OpenNotes.org, an international movement, has a canned email letter to send them: https://www.opennotes.org/join/. OpenNotes.org is referenced by the Canadian Medical Association Journal: http://www.cmaj.ca/content/186/11/811.

 

11% of People Picking Up Hospital Based Infections Die

Staying out of the hospital is more important today than ever before. Hospitals are breeding grounds for antibiotic resistant infections; themselves a product of humanity’s overly enthusiastic use of antibiotics. Consumer Reports on Health reports in its February 2015 issue (page 9) that 650,000 patients develop an infection from visiting a hospital. Of that number, 75,000 die as a result. “That’s more than 12 times the number of Ebola deaths worldwide as of December 2014.”

May 11, 2016 Update:

“There are 220,000 cases of hospital-associated infections each year in Canada resulting in 8,000 deaths.” UCalgary Alumni Magazine Spring | Summer 2016, page 9.

The problem is worse in Canada. Adjusted for population, Canada has 3.09 times the number of infections than the USA. Deaths resulting from the infections is approximately the same.

Jan 29, 2018 Update:

“WHO’s first release of surveillance data on antibiotic resistance reveals high levels of resistance to a number of serious bacterial infections in both high- and low-income countries.”

http://www.who.int/mediacentre/news/releases/2018/antibiotic-resistance-found/en/

 

 

Death from Health Related Administrative Errors is 10x Rate of Automobile Accidents

Administrative errors made when managing your health caused 10 times the death from car crashes in the US at 440K deaths per year. In fact, it’s the 3rd leading cause of death in the USA after heart disease and cancer (see Consumer Reports May 4, 2016). As a cancer graduate, this is near and dear to my heart.

I have personally experienced administrative errors in Canada and they are alive and well. In my particular circumstance, they had forgotten to tell me that I had been diagnosed with cancer.  For my surgery, I circled the part being operated on with a marker and got a “that’s a very good idea” from the attendant. When my son was in one of the top hospitals in Canada, we corrected at least 3 administrative errors since there were lag times between when the doctor entered notes into the computer system and when the nurse visited.

In the USA, Consumer Reports is asking Americans to send a letter to their representative in support of a National Patient Safety Board (similar to the National Transportation Safety Board & the Consumer Financial Protection Bureau). Follow link here to find a suggested letter via article “Patient Safety Advocates Urge the Creation of a National Patient Safety Board to Fight Medical Errors”.

 

What can you do as a patient?

Try to bring to all your appointments a second pair of eyes and both of you take good notes, ask lots of questions and do your research. For the hospital, this person will be your advocate since there will be a lot of activity. If you don’t have such a person, you might want to think about hiring a nurse to help you out.  More important than a good doctor (a nice to have) is an administratively efficient medical team since even with a good doctor a small mistake by anyone on the team could kill you. Remember, they are human too and not infallible.

Ensure to follow-up with your doctor on all test results.  Never accept “we’ll contact you if there is anything to discuss once we get the results back.” That means getting the exact test results paperwork from a patient portal or a photocopy from your doctor (which means a follow-up visit). Consumer Reports on Health reported in their March 2018 issue “Test information sometimes slips through the cracks. Some offices receive tests results on paper, which can get lost, misfiled, or overlooked. And even electronic results may not always be followed up on appropriately. … [Test results themselves] can be hard to read or interpret correctly – even for healthcare professionals at times. … The bottom line: You should know and understand your results, and never take anything for granted.” Once you have those test results in your hands, try to make sense of what they say by doing your own research. It can generate good questions for discussion with your doctor.

Finally, make an attempt at asking your doctor and clinic to adopt a patient portal to open up access to your doctors notes. OpenNotes.org, an international movement, has a canned email letter to send them: https://www.opennotes.org/join/. OpenNotes.org is referenced by the Canadian Medical Association Journal: http://www.cmaj.ca/content/186/11/811.