Sunday, March 13, 2011

The Blob that Ate America

When doctors were asked:  "When patients come to you with information they have gathered on their own, are they generally more likely or less likely to end up getting screenings, treatments, or interventions they don’t really need?"

63% said such patients were MORE LIKELY to get unneeded screenings, treatments, or interventions they really DON'T NEED.

Aside from the fact that there are risks to medical treatments and screenings, and that in medicine, "the more you do, the more you do," (quoting one of my best teachers ever--lives in Ann Arbor, MI), there are much greater concerns here:  Patients pursuing unneeded treatments increase traffic on the road, are unable to be perusing the DSP blog, and are missing time in their backyard looking at the birds while listening to the DSP show.

However, the DSP blog was briefly encouraged when it realized a benefit to patients pursuing unneeded treatments--what better way to simplify one's life?  For if you are going down the path of unneeded treatments, your life consists of one of two things, a) arming yourself with info that will lead to unneeded treatment; or b) pursuing the unneeded treatment; or c) talking about it or blogging about it.  I suspect most of the time would be spent in category b, driving all over the kingdom in order to get forms filled out, blood drawn, unneeded surgery performed, resulting in back pain from all the driving around, which would lead to category a...

Because the DSP blog suspects some reading this may be "serious readers" (the DSP blog acknowledges the disturbing possibility that serious readers who stumbled across this blog's clip of Sarah Palin interview may have unfairly put it in the category of total buffoon and decided not to return), it offers the following:

1)  One health care expert, Jack Wennberg, (whom, by the way, the DSP blog met when he visited its professor's house in Champaign, IL, where the DSP blog learned that pistachios are best eaten after the shell has been removed (somehow, I had missed that memo, and had to learn this lesson by putting a handful of these disgusting things into my mouth, and then trying not to appear uncouth while amongst many learned professorial types), and also had the unpleasant experience of eating one of said professor's mom's cookies in front of the professor, only to realize, while it was in my mouth, that some of said professor's mom's hair had been baked into the cookie), has suggested that for many medical decisions, there is no clear winner re the "right treatment"

A perfect example would be prostate specific antigen screening, which the USPTF suggests it is just not clear whether this test should be pursued.  This could result in a situation where a patient gathers information on his ("or her" clearly unnecessary here) own and decides to get the PSA test, which the doctor feels is unneeded.  In this type of case, the DSP blog thinks this is not a horrible outcome at all--in these cases where the right strategy is unclear, if the patient should decides to pursue an intervention that the doctor thinks is unnecessary, does it really matter?  The only truly horrific outcome in this scenario would be the exam accompanying this screening test (the DSP blog formally apologizes for that image now running through your mind).

But alas, the above suggests that the DSP blog has clearly slipped back into its pollyannish ways (except for the part about the exam).

2)  To the extent that "informed patients" increase their doctors' fear of malpractice is driving unneeded pursuit of screening tests or interventions--this is bad and sad, and because I lost an hour last night due to daylight savings time, I don't have the emotional capacity to deal with that right now.

3)  If you just take it at face value--and the DSP blog thinks this might be the best approach--that doctors think (?correctly) that patients are informing themselves into unneeded interventions, then really the biggest take home point is this:

At this current time, patients in the driver's seat (in general) are seemingly looking at the wrong manuals and/or interacting with the doctor in the passenger seat in such a way that they are getting their oil changed too often, getting diagnostic testing they don't need, seeing mechanics they don't need to see, and in the end, this is causing them to spend too much time and money in the car and/or in waiting rooms talking to others about their adventures taking care of their car....

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