A few years ago I was at a picnic with a friend who is an orthopedist. The question was raised about whether advice given by doctors is always in the best interests of the patient.
“Do not quote me,” was how he began his reply. At least that alerted me that he would give an honest opinion.
What followed were a half dozen examples of times he had been forced to adjust his recommendations to patients because a number of hurdles stood between what he would have liked to recommend, and the real possibilities for his patients. Hurdles placed there by:
- The patient’s insurance – which would not pay for my doctor-friend’s preferred recommendations
- The doctor’s practice – because they insisted he maximize his income from each of his patients
- The patient him or herself – because he was afraid they would not adhere to recommended treatment (meaning – they wouldn’t follow through on purchasing an expensive prescription that insurance would not help pay for)
- Pharmaceutical reps – because they had all the statistics on how often he was recommending their drugs and he really hated those conversations
The bottom line, he told me, is that he was no longer allowed to practice medicine the way he wanted to, without all these other pressures, and therefore he wasn’t always sure that that doctors recommendations are in the best interests of their patients.
As I said – it was an honest opinion.
So what can we patients take away from this conversation? Plenty.
For one thing: it puts us on guard that if we don’t participate in our care, there is a good chance we will be getting second-rate care; care even our doctors don’t think is the front line of defense against whatever medical problems we have.
Second, that if we don’t ask lots of questions (one way of participating in our own care) then we won’t always get what we need. Those questions need to be based on clarifying the recommendations made, then comparisons to the alternatives to those recommendations. Here’s a simple way to ask:
“Doctor, if I were your mother (or father), my medical circumstances were the same, and money was no object (meaning – I didn’t have to worry about insurance, and the doctor wasn’t worried about income) – then is this what you would recommend? And if not, what would you recommend instead?”
Third, that it’s incumbent upon us to do all the outside-the-medical-office research we can do to learn about alternatives, and their costs, too. Once we have gathered that intelligence, we can return to the doctor to discuss, if need be.
And finally, that we need to approach our work with our doctors as just that – work WITH our doctors. We don’t accept just their telling. We don’t accept edicts. We request their advice and discuss it with them to be sure it’s the best advice for us – regardless of all those constraints my-friend-the-doctor-at-the-picnic described.
That all sounds rather daunting to do on our own, right? Especially if we are sick or debilitated in any way, it sounds quite overwhelming.
And that’s where an independent, private patient advocate comes in. Ready when you need one. To be sure YOU are getting that honest opinion, and the right choices for yourself, too.