Monday, September 8, 2008

What doctors don't tell you -

Physician David Newman has written a book about the secrets your doctor keeps from you. But he's not talking about "secret cures" that sell books on alternative medicine. Instead, his new book, Hippocrates' Shadow: Secrets From the House of Medicine (Scribner), is all about the secrets that hide in plain sight in medical journals and hospital hallways:

•Doctors don't know as much as you think they do. For example, they don't know what causes most cases of back pain or what makes it better.

•Doctors do know that many of the tests, drugs and procedures they order and prescribe either do not work or have not been proved to work. Case in point: They keep prescribing antibiotics for colds and bronchitis.

•Doctors disagree, often, about everything, including whether that chest X-ray you just had really shows pneumonia.

•Doctors like ordering tests better than they like listening to you.

"These doctors are not bad human beings," says Newman, a New York City emergency department physician who also has studied philosophy, worked as a paramedic and served at an Army hospital in Iraq. He now trains medical students and residents at Columbia University and St. Luke's/Roosevelt Hospital Center.

Time limits, lawsuit fears and the demands of insurers deserve some blame for the truth gap, he says, but medical training and traditions play big roles.

Take the antibiotic problem. Studies show half of patients who go to a doctor with a cold are prescribed an antibiotic. Colds are caused by viruses; antibiotics kill only bacteria.

"Doctors think patients want a prescription," Newman says. They also know, he says, that patients feel better once they get that "magic pill."

But doctors should know, he says, that patients are just as satisfied when physicians take a few minutes to listen, explain why antibiotics won't help and suggest some symptom relief — relief that won't come with side effects such as diarrhea, yeast infections and allergic reactions.

Likewise, he says, doctors don't like to admit that many test results are not as black and white as they appear. Communicating shades of gray is harder, he says, and not taught in medical school. And while patients assume doctors rely on science, "it's not uncommon for the decisions we make to be entirely based on opinion," Newman says.

Letting patients in on secrets like those would allow them to make better, more healthful choices, he says.

Other doctors will argue with some of Newman's views. For example, he says routine mammograms don't save lives, a conclusion at odds with those of the American Cancer Society, the National Cancer Institute and other medical groups.

But the idea that Americans get worse medical care than they realize — often because they get too many, not too few, tests, drugs and procedures — is gaining ground.

Think about this summer's recommendation from the U.S. Preventive Services Task Force that men over 75 should stop getting blood tests for prostate cancer (because they are more likely to be harmed by prostate cancer treatment than to die from the disease). Or read Overtreatment, a 2007 book by former health journalist Shannon Brownlee, just out in paperback. She writes that the biggest problem is doctors and hospitals "get paid more for doing more."

Whatever the causes, part of the cure must be straight talk, Newman says: "There is a lot of personal responsibility in this. It's all about patients and doctors communicating."