Making Informed Choices About Your Health Care

I love that we have the NHS in the UK. I can't really understand why american's get so distressed about the idea of free health care. No, it's not the same incredible standard of care that you would get in the best 5 star hotels privatised hospitals, but we have those too, for people who can afford them.

That said, it's no secret that our NHS is stretched to breaking point and can barely afford to run. The staff are exhausted and doing their best, but often dispense drugs based on protocol because let's face it, no doctor is an expert in every single condition that could possibly come up in your life, and with the hours they work, how could they possibly keep up to date with the latest advances in science on every condition?

That's why I firmly believe in empowering people to learn about their own conditions and make informed decisions about their own treatment plans.

David Cameron is complaining about doctors over use of antibiotics, but I can only imagine how many doctors have been hassled by ignorant patients who desperately want a prescription for their virus, having no idea that the antibiotic won't help them get better any faster.

Despite the fact that most ear aches are viral, most parents will beg the GP for antibiotics because we've all heard the scare stories about untreated bacterial infections allowing ear drums to burst.

I'm fairly sure there must be doctors having to make a decision to prescribe prophylactic antibiotics because they aren't sure if the infection is going to get worse, but their appointments are all full for the next few days, so they haven't got the luxury of asking the patient to come back and check in with them again.

Not only that, but the majority of antibiotics consumed by these patients aren't even prescribed by doctors - they're coming through the cheap CAFO raised meat that they consumed, and yet it's the doctors who take the blame.

Every time your doctor offers you antibiotics, ask if it's necessary. You wouldn't believe how often my GP has looked relieved at that question and suggested that he would write the prescription, but ask that I only claim it from the pharmacy if the fever worsens/infection doesn't improve in the next 12 hours/whatever other useful advice they have.

But antibiotic resistance isn't the only concern when it comes to your health care.

In an excellent talk by Daniel Levitin on "How to Stay Calm When You Know You'll be Stressed" he talks about patients making informed consent about their treatment plans. How can you make informed consent if you don't know anything about your treatment?

Here's a long, but very relevant quote from the talk:

"And there's perhaps no more stressful a situation than when you're confronted with a medical decision to make. And at some point, all of us are going to be in that position, where we have to make a very important decision about the future of our medical care or that of a loved one, to help them with a decision. 

6:11And so I want to talk about that. And I'm going to talk about a very particular medical condition. But this stands as a proxy for all kinds of medical decision-making, and indeed for financial decision-making, and social decision-making -- any kind of decision you have to make that would benefit from a rational assessment of the facts. 

6:30So suppose you go to your doctor and the doctor says, "I just got your lab work back, your cholesterol's a little high." Now, you all know that high cholesterol is associated with an increased risk of cardiovascular disease, heart attack, stroke. And so you're thinking having high cholesterol isn't the best thing, and so the doctor says, "You know, I'd like to give you a drug that will help you lower your cholesterol, a statin." And you've probably heard of statins, you know that they're among the most widely prescribed drugs in the world today, you probably even know people who take them. And so you're thinking, "Yeah! Give me the statin." 

7:06But there's a question you should ask at this point, a statistic you should ask for that most doctors don't like talking about, and pharmaceutical companies like talking about even less. It's for the number needed to treat. Now, what is this, the NNT? It's the number of people that need to take a drug or undergo a surgery or any medical procedure before one person is helped. And you're thinking, what kind of crazy statistic is that? The number should be one. My doctor wouldn't prescribe something to me if it's not going to help. But actually, medical practice doesn't work that way. And it's not the doctor's fault, if it's anybody's fault, it's the fault of scientists like me. We haven't figured out the underlying mechanisms well enough. But GlaxoSmithKline estimates that 90 percent of the drugs work in only 30 to 50 percent of the people. So the number needed to treat for the most widely prescribed statin, what do you suppose it is?How many people have to take it before one person is helped? 300. This is according to research by research practitioners Jerome Groopman and Pamela Hartzband, independently confirmed by Bloomberg.com. I ran through the numbers myself. 300 people have to take the drug for a year before one heart attack, stroke or other adverse event is prevented. 

8:23Now you're probably thinking, "Well, OK, one in 300 chance of lowering my cholesterol. Why not, doc? Give me the prescription anyway." But you should ask at this point for another statistic, and that is, "Tell me about the side effects." Right? So for this particular drug, the side effects occur in five percent of the patients. And they include terrible things -- debilitating muscle and joint pain, gastrointestinal distress --but now you're thinking, "Five percent, not very likely it's going to happen to me, I'll still take the drug."But wait a minute. Remember under stress you're not thinking clearly. So think about how you're going to work through this ahead of time, so you don't have to manufacture the chain of reasoning on the spot.300 people take the drug, right? One person's helped, five percent of those 300 have side effects, that's 15 people. You're 15 times more likely to be harmed by the drug than you are to be helped by the drug. 

9:15Now, I'm not saying whether you should take the statin or not. I'm just saying you should have this conversation with your doctor. Medical ethics requires it, it's part of the principle of informed consent.You have the right to have access to this kind of information to begin the conversation about whether you want to take the risks or not. 

9:32Now you might be thinking I've pulled this number out of the air for shock value, but in fact it's rather typical, this number needed to treat. For the most widely performed surgery on men over the age of 50,removal of the prostate for cancer, the number needed to treat is 49. That's right, 49 surgeries are done for every one person who's helped. And the side effects in that case occur in 50 percent of the patients.They include impotence, erectile dysfunction, urinary incontinence, rectal tearing, fecal incontinence. And if you're lucky, and you're one of the 50 percent who has these, they'll only last for a year or two."
Ask your doctor questions, be informed. Make good decisions for you and your family. Take your research with you to your doctor so that you can evaluate it together.

It's off the back of this that I'd also like to point you towards a charity called 'Yes To Life' that I recently discovered. They are the first cancer charity I've come across in the UK that provides support, information and financial assistance to cancer patients who want to use an integrative approach to thier medical care. As Daniel Levitin says, it's hard to make a decision when you are stressed. Having the information collated and people ready to support you is so important.



But all of these are just examples. There are far too many medical conditions to list in a blog post (or even for me to list!) Our bodies are so complex, so intricate, so well designed. That's why you need to put your big girl (or boy) pants on and take some responsibility for your own health.

Educate yourself. This is one of the reasons Restoration Health was born. We post articles about health daily, we try to answer questions and help people on journey's towards healthier lifestyles so that they don't need to see their doctor so often, hopefully relieving some pressure from the NHS. We're also hoping to start monthly healthy living and preventative medicine talks locally soon, so keep your eye out for those.

Remember: Your doctor is there to help you, but not to remove all responsibility from you.

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