Medical decision making

All patients deserves to know exactly what goes into the decision making process when their lives are in the hands of physicians. Sad but true is the fact that it rarely is a transparent process. You see if physicians simply went by medical guidelines and ordered treatment based on what was best for the patient, their profits would soon begin to decline and for doctors all over the country money is why they got into the health care business. For those of you who think it was to help people - think again.

It's not just the crooked doctors you hear about in the news and on late night talk shows that are doing unnecessary surgeries and procedures on patients either - many of them are well respected and have well run practices. The clues are all in the framework of the doctors decision making. The thousands of cases of unnecessary appendicitis surgery can be easily explained by the vague and deceiving nature of this very common disease. Appendicitis is often diagnosed based upon unspecific symptoms which can be misleading in the process of deciding upon the correct diagnosis. Appendicitis is often mistaken for various other internal disorders that generate resembling symptoms.

There have been hundreds of cases if not thousands where patients have complained of abdominal pain alone and had an appendectomy through an emergency department only to recover with the same exact pain. Often this leas to more surgeries which is even more money for the doctor. Being that the appendix is seemingly benign and removal generally causes no 'harm' to the patient in the long term - it is usually never questioned by patients. In fact often doctors will remove a healthy appendix if a patient is having any other abdominal surgery for the bump in pay, claiming that it was a precautionary measure.

This is only one example of the many routinely preformed yet routinely unnecessary treatments that patients receive frequently. Some others include; removal of skin lesions that are non-symptomatic, the widespread misuse of ADHD/ADD medication, antidepressants, and antireflux medication.

The industry in America is overrun with reps from drug companies, medical suppliers, pharmacies, and even representatives from home health agencies - all trying to sell, sell, sell! They hand out vast amounts of sample medication, boxes of business cards, and all sorts of goodies for doctors to leave around their office. In turn the doctors will almost universally send large numbers of patients their way - and sometimes it's not even intentional: many times if the doctors wanted to prescribe say an anticoagulant (blood thinner) he would simply ask his nurse to prescribe a blood thinner, however if the doctor just met with a pharmaceutical rep who sells blood thinners he's quite likely to mention them by name simply because it's fresh in his mind.

On the other hand, there is quite a bit of intentional patient redirection - often at no benefit to the patient at all. Typical examples are: gynecologists who own ultrasound machines, surgeons who own surgery centers, and so on.

The government has picked up on this in recent years, Medicare and Medicaid have continuously decreased payments for most procedures due to the amount of unnecessary procedures and tests were being ordered on patients. By the time someone with the power to act upon this problem had put the pieces together - the problem was no longer manageable, it had spread throughout the entire health care system across the country.

The financial burden of this problem is bad enough, but worse yet is the damage to people that unnecessary treatment often causes. Perhaps the worst side of this story is the trust most of us tend to have with physicians. If we can't listen to our doctors what are we to do? My advice (for what it's worth) is to just be cautious. If a doctor is recommending treatment it is a good idea to read up as much as you can on the indications, contraindications, and alternatives that exist as well as the benefits and risks. Information is worth more than gold!