The Antidote

Counterspin for Health Care and Health News

Friday, March 16, 2007

It's not just me.

According to a Wall Street Journal survey, I'm not the only one who:

- has thrown prescriptions in the trash (27%)
- has thrown lab slips in the trash (13%)
- thinks doctors offer interventions (a) out of fear of litigation (52%), (b) to make more money (45%), or (c) to meet patient demands (44%)
- has switched doctors because they consider their doctor's recommendations overly aggressive (7%) (but what do I know?).

It's good to see the flip side to the conventional wisdom that patients demand x, y, and z from their docs, and will switch docs when they don't get what they ask for.

But what does all this say about communication between patients and caregivers? Maybe a Meyers-Briggs-type instrument is what we need, so that we can match patients and doctors by their aggressiveness-of-care/CYA personalities and beliefs.


At 8:48 PM, Blogger said...

Hi Emily,

I wanted to let you know that I've been reading your blog for a little while now and I love it!

I own an anti aging review site that I was hoping you'd be willing to write a small blog post about. Of course I'm willing to pay. How much would you charge for a sponsored blog post?
Please email me and let me know.


At 10:29 AM, Anonymous Anonymous said...

Ditto. Great blog. I've linked to mine.

At 10:47 AM, Blogger Emily DeVoto, Ph.D., said...

Paul, thanks very much! If I don't have a link to your blog already I will add one now.

Scott, thanks for the comment but I don't think I can do sponsored blog posts.

At 11:38 AM, Anonymous Diora said...

Just found this blog via link from Kevin. Great.
I've done the same in some cases.

I wonder how much of the "public demand" is really demand and how much is doctors' perception of the demand. I think - and it is completely anecdotal - that sometimes doctors assume that we want to rule out a tiniest probability of us having something bad, so they might order a test without even asking because they think that's what we want. Some of it can be explained by "defensive" reasons, but not everything. Not when a test USPSTF recommends against (urinalysis, pelvic ultrasound to detect ovarian cancer, etc.) is ordered for a symptomless person who hasn't specifically asked for the test (personal experience, yes it is anecdotal).

I also think that much of public's demand for tests (perceived or real) is due to ignorance. I think the demand would wane if only media and popular internet websites provided more accurate information on benefits and risks of all tests, even those that are recommended. When was the last time any of us heard word "overdiagnosis" on TV? When was the mortality benefit of screening or preventive drugs expressed in absolute rather than relative numbers? When was any doctor interviewed on TV explained the difference between survival and mortality? At the same time, you look on the web and you see the head of ACS talking about how survival is longer when a particular cancer is found earlier. Does this doctor too stupid to understand lead-time bias?

The deliberate misrepresentation of information on TV by doctors cannot be explained away by the fear of lawsuits. Nobody has ever sued a doctor for giving advice on TV.

Case in point. A popular TV show is Fox' Sunday Housecall. Some years back the doctor there listed PSA for men as recommended and didn't bother to explain the risks. Another time, the same doctor recommended lung cancer screening for smokers. Last Sunday, a woman called saying that her ObGyn suggested she stops pap smears because she had total hysterectomy for benign condition. After a few disclaimers as to how he is not an ObGyn, but how he talked with ObGyns, and they brought up the issue of vaginal cancer, and that it is rare but is a possibility. And here is a journalist sitting nearby, nodding, and saying how it is better to be safe. Of course, the little detail of no evidence that this type of screening does any good for vaginal cancer or that USPSTF recommends against paps for women who had hysterectomy for benign conditions never gets brought up. So now, this woman is going to mistrust her own ObGyn who was actually trying to practice evidence-based medicine. Can this type of TV advice be explained away by the fear of lawsuits?

At 2:25 PM, Blogger Emily DeVoto, Ph.D., said...

Diora - fabulous comment, just fabulous. I agree with everything you said. Thanks so much, and please keep in touch!

At 10:26 AM, Anonymous Diora said...

Emily, thanks. This was nice of you. I am just a layperson - although I do have some math background (not that I remember much of my undergrad probability/statistics) - but I was interested, so I read a lot on the subject and have some strong feelings about it. Some things that I hear on TV just make me angry.


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