Is Your Doctor Skimping on Giving You the Best Advice?
by www.SixWise.com
Doctors have traditionally taken the Hippocratic Oath to
pledge their loyalty to practicing medicine ethically and
to the best of their knowledge. One of the first tenets reads
"I will prescribe regimens for the good of my patients
according to my ability and my judgment and never do harm
to anyone."
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Many studies have found that annual physicals are almost
worthless, yet most patients still want them and many
doctors still believe in them.
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But in today's day and age -- when one-seventh of the entire
U.S. economy is devoted to health care -- one has to wonder
whether this oath still holds true.
A New York Times article recently reported that:
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Doctors misdiagnose fatal illnesses about 20 percent
of the time, according to studies of autopsies.
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Millions of patients are treated for the wrong disease.
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The rate has not really changed since the 1930s, according
to the Journal of the American Medical Association.
Could it be that, as Joseph Britto, a former intensive-care
doctor, suggested in the New York Times article, that doctors
may not be putting their "all" into helping and
curing patients because they have no real incentive to do
so?
Dr. Britto brought up a good point. In the airline industry,
pilots insisted that errors be studied and, as a result, airplane
crashes are rare.
"Unlike pilots," Dr. Britto said, "doctors
don't go down with their planes."
Of course, doctors are human and they
do make mistakes. But making a mistake is one thing. Knowingly
not advising a patient because of:
... is another. So when you go to visit your doctor, how
likely is it that you're getting the best health advice you
could receive?
The Annual Physical is "Almost Worthless"
About 78 percent of patients expect it, and 65 percent of
primary care doctors believe, according to an Archives of
Internal Medicine survey, that an annual physical exam is
useful.
But donning the blue paper gown every year while your doctor
listens to your heart, performs some routine blood tests and
looks in your eyes, ears and nose is almost worthless, according
to many studies.
Nonetheless, people and doctors are reluctant to change.
"Most of us haven't had the guts to get rid of it,"
says Dr. Fred Heidrich, a physician at Group Health Cooperative
in Seattle and clinical professor at the University of Washington.
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Doctors cited "lack of time" as the main
reason why they don't advise patients on exercise.
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"Myths fall hard," says Dr. David Sobel, medical
director for patient education and health promotion for Kaiser
Permanente Northern California. "Patients come in to
see me and they're smoking, they're overweight, they've got
a poor diet. But what they want is some chest X-rays, a complete
exam: 'Reassure me.'"
"We sometimes ignore the most obvious things,"
he says. "They may not have the magic of medicine but
they have the biggest impact on health."
Are Doctors Recommending the "Obvious"?
Most of us know that certain lifestyle changes, eating more
vegetables, not smoking and exercising, for instance, are
good for us. However, doctors typically do not advise patients
to adhere to these most basic health principles.
And although we may already "know" them, hearing
our doctor recommend it can make a big impact. One study found,
for example, that 5 percent of smokers quit because of a doctor's
advice.
"Dietary changes reinforced by a doctor's recommendation
will make it even easier for patients to make simple changes
that could add years to their lives," said Amy Joy Lanou,
an assistant professor of health and wellness at the University
of North Carolina and a senior nutrition scientist with the
Physicians Committee for Responsible Medicine.
A study in the Archives of Internal Medicine really illustrates
this point. Upon looking at survey data regarding obesity
that had been collected by state health departments and the
Centers for Disease Control and Prevention, the researchers
found:
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Health care providers advised fewer than 15 percent
of all patients to lose weight.
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Patients considered overweight (based on body mass
index) were advised to lose weight only 10-20 percent
of the time.
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Patients considered obese were advised to lose weight
over 40 percent of the time.
As one researcher pointed out, doctors may miss out on opportunities
to help patients manage their weight before it spirals out
of control and leads to health problems.
"In many cases, patients come only for tests and procedures.
Simple things like discussing health behavior fall off the
radar screen easily. And most doctors report they don't feel
comfortable counseling patients, and if you don't feel confident
and comfortable in it, you're less likely to do it,"
the researchers said.
Another study found that the main reason doctors cited for
not discussing exercise with their patients was a lack of
time.
Other reasons why doctors aren't discussing lifestyle behaviors
with patients include:
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A step in the right direction: Doctors at at least
one U.S. hospital has begun writing "prescriptions"
for exercise.
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Is the Future Bright?
How likely is it that one day a trip to the doctor's office
will arm you with advice on what foods to eat to build your
immune system, how to avoid exposing yourself to potential
toxins in your environment and what stress-relief exercises
you should be doing daily?
"The medical community has been slow to address lifestyle
as a means of disease prevention," said Dr. JoAnn Manson,
chief of preventive medicine at Brigham and Women's Hospital
in Boston, and co-author of a report that urges doctors to
counsel patients on exercise and weight control.
However, at at least one U.S. hospital, doctors (in a partnership
with hiking enthusiasts) have begun writing "prescriptions"
for exercise.
"The idea is to make a more specific explanation,"
said Dr. Charles Brackett, director of the program at Dartmouth-Hitchcock
Medical Center in Lebanon, N.H.
"You can say, 'Walk this trail near your house twice
a day,' as opposed to, 'You're supposed to exercise more."'
"If a prescription for medication could reduce the risk
of heart disease, stroke, type 2 diabetes and osteoporosis
by 40 percent, everyone would be clamoring for it. Well, a
prescription for brisk walking has the potential to do just
that," said Dr. Manson. "A prescription for exercise
may be the most important prescription a physician writes
all day."
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Sources
The
New York Times: Why Doctors So Often Get It Wrong
Los
Angeles Times: Let's Get Less Physical
Doctors
Don't Care About Helping Overweight Patients Lose Weight
Science
Daily: Veggie Diets Not Being Recommended
Doctors
Fight Fat With Fitness Prescriptions