BCMJ Book Review: The Patient Paradox: Why sexed-up medicine is bad for your health

At the Preventing Overdiagnosis conference last year in Oxford, I heard Dr Margaret McCartney speak. This is a passionate woman, one who advocates tirelessly for patients and follows the motto "Think critically and demand evidence." She is an outspoken leader, holding the NHS, her patients, her peers, and herself to high standards, eschewing conflict of interest and junk science.

I was lucky to meet her and when we talked further, Margaret handed me a copy of her book, The Patient Paradox: Why sexed-up medicine is bad for your health. Travel and work got in the way of me opening it, but when I did, I devoured it, underlining and folding and marking key points that resonated with me.

I have read many essays and a few books in the area of "too much medicine," and agreed with most of what they had to say. This book was different. It gained my trust by talking about things I already knew and accepted (more is not always better in medicine) and pushed me just outside my comfort zone, to question things I take for granted (eg the importance of pap tests). I admire the bold way in which she can push the already skeptical to challenge assumptions we didn't even know we had. Since I felt the need to share this book with others, I wrote it up.

You can read my piece about the book and its message in the July/August copy of the British Columbia Medical Journal (BCMJ).

You can buy the book from the publisher, Pinter and Martin here. If you want to read other reviews or get a copy on Kindle, Amazon.ca can help.* 

If you like the idea of reading more on the subject of "Less is More in Medicine," there are about 20 books in the Read section of the site, ranging in focus from cancer screening or overdiagnosis in psychiatry to patient-centered care, achieving evidence-based medicine, and turning healthy people into sick.




* I don't receive any kickbacks here, just hoping to make it easy to get the book in your hands

Source: http://www.pinterandmartin.com/the-patient...

Just One More “Noninvasive” Test…

"Just one more." You never know what a test could lead to if you don't discuss it with whomever is ordering it. Why is it being ordered? What are the risks? Are there any alternatives?

Marilyn Bauriede, a retired attorney in California wrote about her personal experience with this phenomenon. Making decisions as to 'what to do' when offered options is hard. It's harder still when both the disease being tested for and the test itself can be harmful. In this case, there was a question of heart disease, but it would have to be justified in view of the radiation of the test (cardiac perfusion, AKA MUGA) and contribution that might have to an increased risk of cancer.

Hmmmm... what to do? Lately we've been learning that cardiac catheterization is performed on a lot of people who don't need it, and stress tests might not be as accurate or important as once thought. Heart disease is scary, but some of the tests are invasive, risky, and (for US patients or for Canadian Tax Payers) expensive. Plus, they might lead to MORE tests!

. . . That’s when a light bulb turned on in my brain, as I recalled the cardiologist telling me there was a 70% chance the perfusion test would reveal nothing at all wrong, or at least would not show artery blockage. I thought, “There’s way better than a 50% chance the test will find me heart healthy.” Even my PCP had said the ECG and stress test were not very accurate. That would mean they might have been wrong. And if that were the case, then having the perfusion test would needlessly subject me to health risks and no clear benefits. I needed to put the brakes on to more testing and seek a second opinion.

It's interesting to see from the patient perspective how the facts and uncertainties are explored. Ultimately, the situation was resolved because of a good connection with a physician, a thorough review of history and past tests, and probably a bit of wisdom from patient and doctor alike.

Read more in JAMA.

Source: http://archinte.jamanetwork.com/article.as...

Choosing Wisely Canda: Launch Today!

I can't tell you how excited I am that Choosing Wisely Canada is now live!

Their resources will make discussions between Canadian patients and healthcare providers far more appropriate. The ideas showcased here provide a place for starting a dialogue, inspire patients to ask "why" questions about care, and encourage physicians to think twice about testing and treatment options.

Explore Choosing Wisely Canada.

The first wave includes Top 5 "don't" lists for specialities such as cardiology, family practice, orthopedics, and more. These are evidence-informed guides suggesting avoidance of certain tests and treatments in specific contexts.

The message is not "never" but rather "think twice about," and beware that every test and treatment may bear risks and harms that make it the wrong choice for some patients.

Many of us welcome all the tools we can get for the Shared Decision Making (SDM) approach. This is just Wave 1, and lots more evidence-informed speciality lists will be released soon.

By way of disclosure, I'm a member of the Canadian Medical Association (CMA) and have been involved for just over a year with their work on Health Care Transformation. I was not directly a part of the development of Choosing Wisely. The CMA's role in this timely and important effort is a significant achievement in advocacy and health policy, and I couldn't be prouder to stand with them.