Epilepsy Talk

12 things your doctor won’t tell you… | December 1, 2022

Modern medicine can do miraculous things — but every test and treatment has its downside.

And your doctor may not disclose the dangers without prompting, a new survey finds.

Researchers surveyed 2,700 patients who’d recently decided whether or not to have surgery, take a medication, or undergo cancer screening.

Most reported their physician spent far more time talking up the benefits of each choice than explaining the risks.

In fact, with the exception of lower back surgery, less than half the participants reported even some discussion of the cons.

Some patients felt left out of the decision-making process altogether.

Only about 40% of those choosing whether or not to have a mammogram or take blood pressure or cholesterol-lowering drugs said their physician asked for their input.

The results, published in JAMA Internal Medicine, suggest that often, “physicians just make the decisions themselves and then tell patients,” says study author Jack Fowler, PhD, of the University of Massachusetts and the Informed Medical Decisions Foundation.

True or false: You chose your doctor based on how close their office is to yours, and what’s covered by your insurance. For those of you who answered true — and let’s be real, that’s most of us — new research shows that that kind of decision-making could be costing you your health.

The results? Many Americans spend way more time researching what car to buy than they do choosing a doctor. 

While more than 90% of adults say it’s important to make the right choice when selecting a physician or hospital, nearly half of adults feel they’ve made the wrong ones.

1.) I GET PAID TO PRESCRIBE THIS DRUG FOR YOU.

Conspiracy theorists aren’t shy about proclaiming the evils of Big Pharma. But conspiracy theory is one thing, and documented proof is a whole different beast.

When the Harvard Law School took a closer look, they realized that they didn’t have to dig very deep at all to discover that doctors are paid handsomely to prescribe certain drugs, even when those drugs turn out to be harmful.

One of the most publicized recent cases was Dr. Joseph L. Biederman, who began diagnosing two-year-old toddlers with bipolar disorder and prescribing strong antipsychotics that were never approved by the FDA for children under 10.

The manufacturer of the antipsychotics paid him $1.6 million!

Then there’s Dr. Alan F. Schatzberg, who began prescribing an abortion drug to treat depression — he owned $4.8 million of stock in the company that produced the drug.

And then you have Dr. Charles B. Nemeroff, who received $500,000 to advertise a drug as safely when, in reality, it can cause seizures and paralysis.

The fact is, doctors are allowed to prescribe any drug for any illness, no matter what the drug was originally intended to treat.

But the question is: How do you know which ones do?

2.) THIS WILL COST YOU.

From deductibles to drugs, chances are your doctor visit will run more than insurance will pay.

While a Journal of the American Medical Association study showed that 79% of doctors think it’s important to tell patients about these costs, only 35% actually inform them.

Their excuse? Many physicians say they’re under time pressures and don’t know how much patients are spending on out-of-pocket costs, says Dr. G. Caleb Alexander, the study author.

Yet, if you talk with your wallet and question the medical expenses, most doctors will work with you to lower the costs, says Dr. Alexander.

Your doc can prescribe a 3-month instead of a 1-month supply of a drug to help you save on the co-pay. A small thing to them, saved bucks for you.

They can look at the prescriptions you take and services you receive, such as physical therapy, and reevaluate which can be used on an as-needed basis.

Case in point: The insurer WellPoint provided members who had scheduled an appointment for an elective magnetic resonance imaging test with a list of other scanners in their area that could do the test at a lower price.

The alternative providers had been vetted for quality, and patients were asked if they wanted help rescheduling the test somewhere that delivered “better value.”

Fifteen percent of patients agreed to change their test to a cheaper center. “We shined a light on costs,” said Dr. Sam Nussbaum, WellPoint’s chief medical officer.

“We acted as a concierge and engaged consumers giving them information about cost and quality.”

3.) YOU NEED THIS DRUG.

Direct-to-consumer pharmaceutical ads can be pretty effective at convincing patients that they need a particular medication (drugs to treat depression, diabetes, or erectile dysfunction are among the most heavily advertised).

And even doctors can be swayed by these ads, notes David H. Newman, MD, director of clinical research in the emergency department at Mount Sinai Medical Center in New York and the author of “Hippocrates’ Shadow”.

Doctors still aren’t getting the message when it comes to antibiotics.  Prescriptions have risen by 40% in the past 12 years, and for problems they can’t help with, such as colds and coughs.

The overuse of antibiotics brings closer the day of the superbug, which is resistant to all antibiotics, researchers fear.

“40% of patients with colds who go to a doctor get an antibiotic,” says Dr. Howard Brody, director of the Center for Ethics and Humanities in the Life Sciences at Michigan State University.

And studies show half of patients who go to a doctor with a cold are prescribed an antibiotic. Colds are caused by viruses — antibiotics kill only bacteria.

Doctors should explain why antibiotics won’t help and suggest some symptom relief  that won’t come with side-effects such as diarrhea, yeast infections, allergic reactions, and other unpleasant and potentially dangerous side-effects.

4.) THERE’S A CHEAPER AND SAFER DRUG THAN THE ONE I PRESCRIBED FOR YOU.

It’s no secret that pharmaceutical companies push new drugs on doctors.

But now they employ data-mining to do so.

For a licensing fee, industry marketers can access the American Medical Association’s database of physicians, which allows sales reps to track down precisely which drugs a doctor is prescribing.

“That’s how reps get incentivized — they know what drugs to pitch to what physicians,” Arkoosh says.

5.) THERE ARE ALTERNATIVES TO THIS DRUG.

Whoever first said “An apple a day keeps the doctor away” probably wasn’t an M.D.

A study published in the American Journal of Clinical Nutrition found that only one in six doctors preaches to patients about nutrition’s role in preventing disease, while Colorado researchers found that just 28%  of doctors mention exercise.

“We tend to be more pharmacologically oriented because of our M.D. training,” says Dr. Mark Houston, author of “What Your Doctor May Not Tell You about Hypertension”.

If your doctor doesn’t have answers about nutrition or exercise, he knows someone who does.

Ask for a referral to discuss basic preventive health strategies.

And don’t forget there ARE alternative options to complement your treatment.

Consider: Acupressure, Acupuncture, Chiropractic Care, Complementary Medicine, Osteopathy Herbal Medicine, Homeopathy, Meditation, Music Therapy, Reflexology, Relaxation Techniques, Supplements and Yoga.

6.) THIS IS RISKY.

Just about every drug and surgical procedure poses risks to the patient.

Yet some doctors understate the risks posed by the treatments they recommend.

Similarly, when doctors order X-rays, cardiac catheterization, and other diagnostic tests, they sometimes fail to explain the risks.

These include the risk of a false-positive (indicating a medical problem that doesn’t exist), which can lead to needless anxiety and to even more tests.

“Doctors are very good at talking about benefits,” says Newman. “They’re not good at talking about risks.”

What to do: Ask the doctor to explain any risks posed by a recommended test or treatment.

7.) YOU REALLY DON’T NEED THIS TEST.

To cover their own butts, doctors sometimes take a needless trip up yours. A nationwide sample of “surveillance” colonoscopies — follow-up procedures done after polyps are removed — found that up to 50% of doctors recommended these tests unnecessarily.

This better-safe-than-sorry mindset keeps docs safe against lawsuits, and isn’t limited to colonoscopies.

The American Board of Internal Medicine Foundation, one of the largest physician organizations in the US, has released reports on the most overused tests and treatments that provide limited or no benefit to the patient, or worse, causes more harm than good.

The list currently includes a total of 135 different tests, procedures and treatments.

According to a report by the Institute of Medicine, an estimated 30% of all medical procedures, tests and medications may in fact be unnecessary — at a cost of at least $750 billion a year.

Plus, the cost of emotional suffering and related complications and even death – which are impossible to put numbers on.

While overuse and misuse have become a deeply ingrained part of the culture of medicine, there are hopeful signs that things are starting to change.

Dr. Makary points out a number of standard blanket recommendations have been changed in recent years, such as daily aspirin regimen, PSA testing, and annual mammograms.

Watch out for the most overused procedures: MRIs and CT scans, echocardiograms, and stress tests all scored high in a survey of health insurers.

“When your doctor does make a recommendation that seems aggressive, ask why, and where you fit in the assigned guidelines,” says Dr. Pauline Mysliwiec, author of the colonoscopy study.

8.) I’LL ALWAYS PUSH SURGERY.

“In many doctors’ value systems, surgery is the default,” says Christopher Meyers, head of the Kegley Institute of Ethics at California State University.

But research indicates that surgery often isn’t the best option.

A Baylor College of Medicine study showed that chronic knee pain didn’t change after surgery, while another study found that taking a wait-and-see strategy with hernias may be as effective as going under the knife.

9.) I NEED TO PERFORM YOUR SURGERY IN ORDER TO SATISFY MY QUOTA.

Doctors are under tremendous pressure these days. Not only are they asked to see more patients per hour, many surgeons even have surgery quotas to meet.

As horrible and unethical as it sounds, “They’re told they need to do so many operations in a month,” Dr. Martin Makary says.

“Sometimes doctors tell me they get text messages and emails, saying, ‘You need to do so many operations by the end of the month.’ They’re expected to do more, often with less resources.”

Quotas aren’t the only symptom of a major disconnect between healing a patient’s problem and running a for-profit disease management scheme.

As discussed by Dr. Makary, sometimes a computer software program will order tests and studies automatically, and the doctor just has to sign off on them.

“You should always ask what the alternatives are to surgery, including an approach that most physicians feel uncomfortable offering: to do nothing,” says Meyers.

If your doc is still scalpel-happy, get a second opinion from a doctor of osteopathy.

“These doctors take a more holistic approach and are familiar with newer literature that promotes different strategies,” says Dr. Houston.

But before you consent to surgery, ask the following questions:

“Do I really need this done?

When am I going to be back to feeling good?

What if I don’t have this procedure done?

Can I wait a year and see if this gets better?

What if I wait and then something develops in the interim? How do we handle it at that point and what are the odds of success then versus now?”

10.) I’VE BEEN DISCIPLINED.

Doctors won’t post signs on their office doors to inform you of their disciplinary infractions or the number of malpractice claims they’ve paid.

But you need to know.

If a practitioner you like has been reprimanded, ask him about it.

“If a doctor refuses to answer questions about his background or about whether or not patients have sued him, you should run,” says Dan Fee, a spokesman for Citizens for Fairness, a coalition of patients’-rights groups.

11.) I’M A REGISTERED SEX OFFENDER AND VIOLENT CRIMINAL.

Yes, sadly enough, they do exist.

Your doctor doesn’t have to disclose his criminal history, and usually that wouldn’t be considered a problem.

Between the strict admission policies of most medical schools and the vague notion that hospitals probably screen their employees, who would even think to ask?

Well, maybe you should.

Recently, the UK’s General Medical Council, or GMC, released a database with the criminal histories of physicians in the United Kingdom.

It turned out that almost 800 practicing doctors held criminal records, including 31 who were arrested for assault and 330 arrested for drunk driving.

The rest of them?

Crimes range from theft to drug trafficking, and they’re under zero legal obligation to let their patients know about it.

And it’s not exactly rare.

There’s the rapist surgeon working in Miami, and the New York doctor who was caught trying to meet a young boy for sex, and a Scottish physician who had reams of child pornography stored on his computer.

Who’s really taking care of you?

12.) CHOOSE WISELY.

For the past two years, the American Board of Internal Medicine Foundation, one of the largest physician organizations in the US, has released reports on the most overused tests and treatments that provide limited or no benefit to the patient, or worse, causes more harm than good.

In a single year, more than 600,000 patients underwent treatment they didn’t need, at an estimated cost of $282 million.   

More than a third of the money spent on the 47 tests or services went to unnecessary care.

“Do no harm” should include the cost of care, too, the report author says.

To learn more, I encourage you to browse through the Choosing Wisely web site, because they provide informative reports on a wide variety of medical specialties, tests, and procedures that may not be in your best interest. As reported by NPR:

“The idea is to curb unnecessary, wasteful and often harmful care, its sponsors say — not to ration care. As one foundation official pointed out last year, rationing is denial of care that patients need, while the Choosing Wisely campaign http://www.choosingwisely.org/our-mission/ aims to reduce care that has no value.”

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Resources:

https://www.propublica.org/article/unnecessary-medical-care-is-more-common-than-you-think

http://healthimpactnews.com/2014/big-pharma-hiding-dangers-of-cholesterol-lowering-statin-drugs/

http://abcnews.go.com/Health/Wellness/things-doctors-telling/story?id=16175754

http://listverse.com/2014/01/25/10-horrifying-things-doctors-dont-tell-you/

http://well.blogs.nytimes.com/2014/08/01/ask-well-do-i-need-a-measles-shot/?_php=true&_type=blogs&emc=edit_hh_20140805&nl=health&nlid=27745593&_r=0

http://drbenkim.com/articles-xrays.html

http://www.motherjones.com/environment/2013/02/5-things-your-doctor-should-tell-you

http://www.webmd.com/healthy-aging/features/doctor-may-not-tell-you

http://usatoday30.usatoday.com/news/health/painter/2008-09-07-your-health_N.htm

http://www.prevention.com/health/health-concerns/how-talk-your-doctor

http://www.prevention.com/health/healthy-living/patients-choosing-doctors-based-location-and-insurance

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