Doctor’s Tip: How to minimize risk in the health-care system
Last week’s column was about the third leading cause of death in the U.S.: medical errors. As mentioned, more than 250,000 people die every year from hospital errors, hospital-acquired infections, misdiagnoses, side effects from pharmaceuticals and complications of surgery. Today’s column provides tips for patients to minimize these errors.
The September issue of the AARP Bulletin had an article titled “12 Ways The Health Care System May Be Harming You,” which included ways patients can be proactive in preventing medical mistakes. Dr. Michael Greger’s book “How Not to Die” has a chapter about how not to die from doctor-caused harm. “How Doctors Think” is a thoughtful, eye-opening book written by oncologist Jerome Groopman about why doctors make diagnostic errors. Based on these sources and my 42 years of family practice, here are some tips for patients to help prevent medical errors:
1, Be sure your doctor is compassionate, thorough, up-to-date and competent. The latter two qualities are more likely if he or she is board-certified.
2. The most important factor in making a correct diagnosis is the history the patient gives. Your doctor will want to know what your symptoms are, when they began, if anything makes them worse such as eating or exercise. Present your story in a concise manner, and use notes if you need to so you don’t forget important facts. To allow your doctor to focus on your primary issue, don’t take up office visit time with unhelpful, extraneous data.
3. A thorough doctor will want to know about your medical history, family history of pertinent medical problems that might have a bearing on your issue, and a social history (e.g. smoking, alcohol use, exercise and eating habits). So if your mother died from colon cancer at age 50, your doctor needs to know that, but taking up office visit time talking about a cousin who died in a car crash won’t be helpful.
4. I always had patients bring their prescription meds, over-the-counter meds and any supplements they were taking to office visits. Often patients weren’t taking exactly what I or they thought they were taking.
5. Have a clear understanding about your diagnosis. Go home and look it up on the internet and be sure that the diagnosis jibes with your symptoms and that the plan of treatment seems reasonable.
6. If you aren’t getting better, make an appointment for a recheck and ask your doctor if it is possible you have something else. Ask for a second opinion if you are left with unanswered concerns.
7. Keep in mind that tests are not always accurate. For example, you can have a normal fasting blood sugar and still have diabetes. Even X-ray and biopsy reports can be inaccurate (for example, the biopsy needle can miss the cancer).
8. If tests that involve radiation are recommended, such as CT scans or nuclear imaging, ask if there are radiation-free alternatives (e.g. MRI instead of a CT scan). Radiation is cumulative and harmful, and especially if you are seeing more than one doctor, nobody but you is keeping track of how much radiation you are being exposed to over the years.
9. Health-care providers including doctors fail to wash their hands about half the time when they should, which contributes to the 99,000 deaths that occur every year from hospital-acquired infections. So especially if you’re in the hospital, if a provider is about to examine you without washing their hands, request that they do so.
10. Seven-thousand people die annually in hospitals from being given the wrong medication. If you’re hospitalized, be sure that the nurse checks your identification bracelet before giving you anything by mouth, by injection or IV.
11. Side effects from medications given in the hospital result in 106,000 deaths annually, so before being given anything, ask what it’s for and understand the necessity.
12. Outpatient prescription drug side effects result in some 199,000 deaths every year. So if your doctor recommends medication, ask if there are alternatives such as lifestyle modification (e.g. exercise and plant-based nutrition can reverse type-2 diabetes). A large percentage of antibiotic prescriptions that are written are not appropriate.
13. If a doctor recommends surgery and the situation is not an emergency, consider a second opinion. Surgery is never the perfect answer, because complications such as postop infections and even death can occur. If you have acute appendicitis or a perforated bowel, there is no question that surgery can save your life. But many hysterectomies, many back surgeries, fixing small hernias and repairing degenerative meniscus tears in the elderly are examples of operations that are much more questionable.
Modern medicine offers us cures that we never dreamed of years ago, and we are lucky it is available when we need it. But the history of medicine has a dark side in that many standards of care in the past were later found to be harmful and unnecessary. For example, decades ago, enlarged tonsils were sometimes treated with radiation, which was later found to cause cancer of the head and neck.
Doctors used to remove the whole meniscus when a small tear occurred, which caused arthritis. Radical mastectomies, a very disfiguring operation, were done for years for breast cancer, and were found to be unnecessary. Currently, cardiac stents and coronary bypass surgery are done frequently, even though they have never been shown to save lives (the exception being a stent in the setting of an acute heart attack) or improve quality of life when compared to aggressive medical therapy and/or lifestyle modification. Bypass surgery in particular can result in serious complications including death.
The very best thing you can do to avoid doctor and hospital-caused deaths is to avoid need for medical care by exercising regularly and eating an optimal diet. Seventy-five to 80 percent of the chronic diseases we suffer from in Western societies are preventable by lifestyle modification, and most are reversible. We’re talking here about obesity, hypertension, high cholesterol, diabetes, cardiovascular disease, dementia, autoimmune diseases, inflammatory diseases, osteoporosis and even many forms of cancer. These account for the large majority of doctor and hospital visits and of the $3.2 trillion (!) spent in 2016 on health care in this country.
Dr. Feinsinger, who retired from Glenwood Medical Associates after 42 years as a family physician, now has a nonprofit Center For Prevention and Treatment of Disease Through Nutrition. He is available for free consultations about heart attack prevention and any other medical concerns. Call 970-379-5718 for an appointment. For questions about his columns, email him at email@example.com.