Tuesday, April 10, 2012

How Honest Is Your Doctor?


Story at-a-glance

  • When making health care decisions, you must be your own advocate; it’s important to ask questions before opting for tests, procedures or treatments, and it’s your decision if you’d rather opt for less medical intervention while choosing a more natural way of healing your body
  • Amazingly 40% believed that they should hide their financial relationships with drug and device companies to patients, and 10% said they had told patients something untrue in the previous year
  • One-third of physicians polled did not completely agree with disclosing serious medical errors to patients, and one-fifth did not completely agree that physicians should never tell a patient something untrue
  • A survey of nearly 1,900 physicians revealed that many are not completely open or honest with their patients

By Dr. Mercola
A U.S. telephone survey found that 79 percent of Americans trust their doctor.i Only 8 percent said they do not … But can your doctor really be trusted?
Doctors are human, after all, and though most would certainly expect that their doctor is being upfront when it comes to health advice and diagnoses, it's safe to say that humans are not perfect … nor are they always honest.

Study Reveals Some Physicians Not Always Open or Honest

The Charter on Medical Professionalism, which is endorsed by more than 100 professional groups worldwide, "requires openness and honesty in physicians' communication with patients."
A new study in Health Affairs presented data from a survey of nearly 1,900 physicians to see how well they follow this principle … The results were less than impressive, to put it mildly:
  • One-third of physicians did not completely agree with disclosing serious medical errors to patients
  • One-fifth did not completely agree that physicians should never tell a patient something untrue
  • Amazingly 40% believed that they should hide their financial relationships with drug and device companies to patients
  • Ten percent said they had told patients something untrue in the previous year
While most of the physicians surveyed did agree that they should "fully inform patients about the risks and benefits of interventions" as well as "never disclose confidential information to unauthorized persons," in their entirety the findings cast serious doubt about the trustworthiness of the doctor-patient relationship. As the researchers stated:
"Our findings raise concerns that some patients might not receive complete and accurate information from their physicians, and doubts about whether patient-centered care is broadly possible without more widespread physician endorsement of the core communication principles of openness and honesty with patients."

One Third of Doctors Won't Tell You They Made a Mistake

If your doctor prescribes an inappropriate medication or gives you an incorrect diagnosis, would you want to know about it? Sure you would, but about one-third of doctors would rather stay "mum" for fear of being sued for malpractice. This may be in the best interest of your doctor, but it's certainly not in your best interest, especially considering how common serious medical errors actually are.
A June 2010 report in the Journal of General Internal Medicine, which analyzed 62 million death certificates from 1979 to 2006 (the most recent year available), found that almost a quarter-million of those deaths were coded as having occurred in a hospital setting due to medication errors.ii  In an AMA article discussing the study, one co-author was quoted as stating that "medication errors are the second-leading cause of accidental death, and the only kind of accidental death that is increasing over time."iii
An estimated 450,000 preventable medication-related adverse events occur in the U.S. every year, and adverse drug reactions cause injuries or death in 1 of 5 hospital patients. That is nearly HALF a MILLION people who die every year that don't have to. The costs of adverse drug reactions to society are more than $136 billion annually -- greater than the total cost of cardiovascular or diabetic care.iv
Further, an analysis in the New England Journal of Medicine in 2010 found that 18 percent of patients were harmed by medical care (some repeatedly) and over 63 percent of the injuries could have been prevented.v In nearly 2.5 percent of these cases, the problems caused or contributed to a person's death. In another 3 percent, patients suffered from permanent injury, while over 8 percent experienced life-threatening issues, such as severe bleeding during surgery.
In all there were over 25 injuries per 100 admissions! In other words you have a one in four chance of getting injured if you are admitted to the hospital, not very good odds by any stretch. Worse still, if you do suffer from a medical error, about one in three doctors may not own up to the mistake, which means you'll have no way of knowing if your new symptoms or health problems are actually the result of inappropriate medical care …

40% of Doctors Believe Their Ties to Drug Companies are None of Your Business …

It's shocking that nearly half of physicians feel they should not have to disclose their financial relationships with drug and device companies to patients, even though it's well known that these relationships can and do influence your doctor's medical advice.
Drug reps are taught tactics specifically to manipulate doctors for industry benefit; it's a standard part of their training because doctors are essentially their "dealers." If you think your physician will be able to see past these persuasive tactics, think again -- and it's not about intelligence or even ethics. Your physician may be very intelligent, and he or she may have every intention of NOT listening to a drug rep's sales pitch. I can tell you from personal experience when I was practicing and actually seeing drug reps, my intention was to be impartial but it was very easy to have my prescription writing patterns influenced by their interactions.
But maybe they just want to take advantage of the free samples they're handing out to offer them to her patients. And there the rep gets a foot in the door, and even if he doesn't say another word is able to keep a certain drug's name upfront in this physician's mind. And maybe they'll drop off a few pens and pads of paper, also with the drug's name, in case it starts to wear off.
Some physicians are even on the drug industry payroll, and make extra money providing lectures to other physicians to recommend, prescribe, and dispense their medications. An ongoing investigation by ProPublica revealed that 12 drug companies paid $761.3 million to physicians for consulting, speaking, research and other expenses in 2009, 2010 and, for some, the beginning of 2011 -- and that represents only the disclosed payments. In all actuality, this figure is probably far too low.
Despite the commonality of this practice, I suspect many Americans would be surprised to learn that many thousands of doctors (and researchers and other medical experts) -- some of whom you probably depend on to provide unbiased information and advice pertaining to your health care -- receive large amounts of supplemental income from drug companies. And it turns out that many doctors would prefer to keep this information quiet as well …

Medicare Fraud Caught on Tape

Some health care providers may not only withhold information, but may be involved in downright fraud. An undercover investigation by ABC News revealed a case where an active 82-year-old woman was diagnosed with medical conditions she did not have, and even labeled as homebound, presumably so the physician and home health care company could bill Medicare for thousands of dollars for (unnecessary) home health care services.
In reality, the woman was healthy, aside from hypertension and arthritis, exercised regularly and even enjoyed line dancing on occasion -- far from the frail, homebound senior she was portrayed as on the paperwork sent to Medicare.
Money can be a powerful motivator when it comes to physicians' decisions regarding patient care. In her book "Overtreated: Why Too Much Medicine Is Making Us Sicker and Poorer," Shannon Brownlee explains that spinal fusion surgery for low back pain is one such example, often recommended as it's one of the "more lucrative procedures in medicine" -- even though the best success rate for spinal fusions is only 25 percent!
Angioplasties and certain types of chemotherapy with similar low success rates are just as prone to be ordered, Brownlee says, because that's where hospitals' investments lie. You see, they have all this equipment and they need to use it to get a return on it – but they also need to get you out of there as quickly as possible, so they can get the next patient in. What ensues is a type of aggressive patient therapy that can end in disaster: according to the Office of Inspector General for the Department of Health and Human Services, 1 in 7 Medicare recipients will be harmed every year as a result of the medical care they received in the hospital.

10% of Doctors Lie to Their Patients …

Even if you give the physician the benefit of the doubt, and assume the lies were "white lies" meant to soften the blow of bad news or give a patient hope, it's hard to excuse this behavior.  The study's lead author, Dr. Lisa Lezzoni, a professor of medicine at Harvard Medical School and director of the Mongan Institute for Health Policy at Massachusetts General Hospital, told ABC News that while some doctors lied for self-protection, others did so for the "patient's benefit." ABC News reported:
"MDs might spare an anxious patient from hearing about the slightly abnormal results of a lab test, for example, if it has no impact on the patient's health. Conversely, the doctor might exaggerate a health result in hopes of motivating a patient to take better care of himself. Doctors who sugarcoat patients' prognoses may do so to soften the blow of bad news and help them remain hopeful about their potential recovery. Also, short office visit times may preclude the long and emotional discussions that accompany the delivery of difficult medical news, so doctors may say what they can to avoid causing the patient pain."
Still, even if well intentioned, health care is not an area where people want fibs and half-truths … Not to mention, being fully informed is an essential part of taking control of your health … ABC News continues:
" … as well-intentioned as their fibs may be, other studies consistently show that patients prefer the truth, and would rather hear harsh news than remain ignorant about a dire medical condition. Being fully informed is a way that patients can cope and prepare for whatever might occur."

Your Doctor is Your Guide, but You're in Control of Your Health

When making health care decisions, you should certainly get your physicians' advice -- that's what you're paying them for, after all. Hopefully you have chosen a health care provider who has similar philosophies about health as you do, and whose expertise you can trust. But remember that ultimately it's important that you, as a medical consumer, be your own advocate when it comes to health care decisions.
You can do this by:
  • Asking questions when your doctor orders tests: what is each test for? Who will do the test? Are there any side effects? What if you don't get the test – how necessary is it to your care? Is the test "just to be sure," or is there a proven, scientific reason for doing it?
  • If your doctor wants to do a procedure after the tests come back, ask the same questions all over again, including: Do you have a definitive diagnosis justifying the procedure? Are there any negative effects that I need to know about this procedure? What is the success rate of this procedure? What is the worst-case scenario if we simply don't do it?
  • If you go ahead with the tests and procedures, and your doctor wants to do a surgery or other type of intervention as a result, ask the same questions once more, and then:
  • Ask, do I NEED these tests/procedures/surgery, or do you simply suggest them – and if so, for what reasons? And, what if I don't get this test/procedure/surgery? Are there alternatives?
I admit some of these questions seem repetitive. But they need to be asked each and every time, for every single test performed on you. Remember, it's not only YOUR decision whether to get any or all of these tests and procedures, but your RIGHT to seek a second opinion somewhere else if you don't feel comfortable with the options you're given.
It's your body and your decision if you want to opt for less medical intervention while choosing a more natural way of healing your body. Ideally, seek a health care practitioner who will help you move toward complete wellness by helping you discover and understand the hidden causes of your health challenges ... and create a customized and comprehensive -- i.e. holistic -- treatment plan for you, one that involves lifestyle changes that empower you to promote health and healing naturally.
If your physician is not open to such options, and only recommends drugs or surgical solutions again and again, it may be time to find one who is. You trust your physician with the most important asset you have -- your health -- so it's crucial that you establish an open and honest relationship from the start.
REFERENCES

Source:  Time Magazine February 9, 2012
Source:  Health Affairs February 2012; 31(2):383-91.
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