Here’s an unpleasant aspect of patient empowerment: we need to be aware that sometimes our providers will heap treatments on us that aren’t necessary – and, sometimes, treatments we’ve specifically said we don’t want.
Paul Grundy MD, chair of PCPCC, had this happen recently during his own father’s final illness. He commented about it today, on our post Blogging To Save a Father’s Life. He says this happens “well over 50% of the time.”
Not only does this directly violate the patient’s rights (not to mention human decency), it runs up our costs phenomenally.
The subject was also discussed here in July, in reference to Shannon Brownlee’s book Overtreated: Why Too Much Medicine is Making Us Sicker and Poorer. She asserts that 20-30% of every healthcare dollar is overtreatment. In the two trillion dollar US healthcare system, that’s four to six hundred billion a year of waste – more than enough to fund universal healthcare for the entire US population.
Lessons for us as empowered patients and advocates:
- Be aware that this happens.
- Check and re-check that things are being done per your wishes.
- Do not assume that everything they recommend is necessarily established practice. Many studies in the past 15 years have documented very wide variations in how often some procedures are done in different parts of the country. (Brownlee documents this at length.)
- When in doubt about whether a directive will be followed, talk directly to hospital staff, particularly nurses and nursing supervisors on every shift. Do not assume that hospitals have processes in place to keep track of their customers’ instructions reliably. Request that a note be stapled to your chart (folder) where it will be prominently visible to every new person who looks at it. (I had to do this myself, on one occasion, when two nurses in a row didn’t know that I’d made a request.)