In 1975 an interesting story broke in the New York and the national press. Two brothers died in a very strange way. They were Physicians. They would twins they were in their forties. They were very handsome. They were very popular. They were very talented and they were very famous in their field. They had written a textbook. In fact on the control and the treatment of infertility problems. They had a vast clientele. I will continue to see them till their dying day. The strangeness of the story was that they died of drug addiction. And their practices had deteriorated over several years before their death. Many patients were well aware of the the fall off in the practice and they and the carelessness with which They carried out their profession and many positions with whom they worked in the hospital also aware of this in Factory one operation. One of the twin Physicians had taken the anesthesia mask off a patient's face and put it on his own to get himself a little with the drug that he craved and yet nothing happened and nothing was done to curtail these men's practice and treatment of patients. It was a true scandal. Likes of which New York medicine has not seen in many years. Except a few years earlier when another physician. Strange practice was exposed. This was a dr. Max Jacobson who was better known as dr. Feelgood. He was known as dr. Feelgood because that's what he did for patients. He made them feel terrific and he did this by injecting amphetamines into them. Only he called them vitamins. However, every physician who knew dr. Max Jacobson practice knew that no vitamin ever gave patients the kind of Rush that his patients walked around with. Dr. Jacobson head very famous patients. They numbered among them a president of the United States Jack Kennedy and many of his associates Senators Senators wives. actresses and actors artists it was even a death from an overdose of amphetamines. The photographer the family photographer for the Kennedy family. And yet nothing was done about Max Jacobson until his practice and his gory details were exposed in the New York Times. Patients continue to go to him after all he treated the president's he must be something special. These two cases illustrate I think two very important and very unfortunate facts about American medicine one is that there is very poor regulation of Physicians and the practice of medicine how they practice medicine. The other is the extraordinary gullibility of the consumer of Medicine. The Marcus Brothers the twin Physicians was supposed to be top-notch doctors Max Jacobson was supposed to be almost a magician who claimed the very prestigious clientele. And so people continue to go to him. Now I don't want you to think that these things are unique to New York. Prompted by these cases the New York Times decided to investigate just how common or how uncommon such things may be and what is done to rectify these kinds of situations what we found is that although the vast majority of physicians in the United States are confident and practice. Good medicine. and in fact The best medicine in the world today there is still a lot of room for improvement. These were not isolated cases. We found that at least 5% that is 16000 physicians in the United States. Currently in practice were grossly unfit for their profession. They were alcoholics. They would drug addict. They were mentally ill in a severe way when they were hopelessly empathetically out of date. Yet these 16000 Physicians each year treat seven and a half million Americans in some fashion. Probably not confidently. Very few of this 5% lose their licenses. Doctors are unwilling to report their colleagues. Patients would rather just forget the whole thing or switch doctors or or file a malpractice suit, then report an Aaron's doctor to the proper State authorities. Yet none of the measures that patients take commonly take stop other patients from being similarly harmed by the same physician. Far more common than doctors who are grossly unfit to practice of those who practice carelessly scientifically unsound medicine outmoded medicine. These are a lot harder for the average person to recognize. In a little while. I'll try to give you some tips on to help you avoid incompetent medical practices and to ensure that you and members of your family get Quality Medical Care. But first, let me tell you why I think it's important for you to do so. We have a problem of unnecessary surgery. Of the approximately 20 million operations that are done in this country each year 2 million are unneeded operations. I'm going to tell you where they most commonly come up. You will see why it's so important to you. 40% of hysterectomies 70% of tonsillectomy 10 to 30% of Gallbladder operations need never have been done. They were other ways to treat the problem or the problem didn't even exist. All operations are dangerous. 1 and 5000 patients suffered a fatal anesthesia reaction 10000 patients each year die from operations that they never needed to have in first place. Yet if a patient is told that needs an operation rarely questions his doctor's judgment. and the doctor rarely tells the patient once the death rate from an operation Falls below 1 + 100. I mean suddenly wants you to the doctor one and a hundred may not be a very great risk but to you one in a thousand maybe in a risk that you're unwilling to take for an operation that is questionably necessary to begin with. Did the similar problem with drugs? There are approximately 300,000 adverse drug reactions in the United States each year and 30,000 patients die from such reactions. Yet needless prescriptions are extraordinarily, We live in a highly overmedicated Society. Patience you and me and everyone who goes to the doctor expects even Demands a prescription. for example You have a bad cold that lingers on you. Have a very sore throat. And bad enough to want some medical attention and if you don't work out of that office either with an antibiotic and hand or a prescription for an antibiotic. When in fact 90% of sore throats and all colds and all flu caused by viruses for which there is no drug cure, which antibiotics is totally worthless. Even in the hospital approximately 20% of antibiotics are prescribed without any medical justification. The rate of unnecessary antibiotic prescription is very much higher outside of hospitals. Many doctors are pill pushers admittedly. I know one right down my block who no matter what you come in for you get tetracycline doesn't seem to matter whether your back hurts or you have an ingrown toenail. Many doctors are poorly informed about the drugs that they prescribed. They don't know exactly what they're for. They don't know exactly what their risks are and they don't know exactly what precautions to advise their patients about taking them. And many patients is I've already indicated think that drugs or some kind of a magic solution. For example of friend of mine from Minneapolis who I was suffering from a severe back pain went to the orthopedist. help unexpected Was disappointed when he told her to get to bed and take aspirin every four hours. for 10 days See how she was after that and she was hoping for some magic pill that was going to make her back. Well and somehow aspirin wasn't good enough aspirin didn't seem right and it's not because she's stupid or stubborn. But the expectation of the patient is that there is a pill out there that will make everything right no matter what it is and simple treatments like aspirin and bed rest Fall by the bye and seemed like inadequate medicine. This is a vicious cycle that we really must break patients have to stop insisting that their doctors give them drugs and doctors have to stop thinking that every patient who comes to them demands expected drug, and if he doesn't get the drug won't come back for another visit. What can be done about this kind of thing these problems of unnecessary operations adverse drug reactions Bad Medicine? Malpractice suits are clearly not the solution. All they do is increase the cost of your medical care. They lead to a lot of unnecessary procedures because doctor start practicing defensive medicine to make sure that they're not going to get sued and the doctor patient Rapport goes down the drain. Mirror acceptance on the part of a patient of what might be called The Physicians inevitable fallibilities is also not a solution because many medical errors and probably most medical errors are avoidable. Not all of them certainly doctors, like all of us are human and human beings make mistakes. But many mistakes do not have to be made. And that's what I'm going to try to tell you how to avoid. Another thing that can be done is that the medical profession itself can clean its own house and indeed it is trying to do that. There is in the last several years been an increase in the number of doctors who've been brought up on charges who have lost their licenses. There has been a tremendous mushrooming of refresher courses and a demand that certain groups maintain an expertise in an up-to-date practice in order to keep their accreditation as specialists. But my view is that the most potent force in this matter is you every one of you and every one of you out there who isn't here today, but consumer of medical care you hit the doctor where he lives you hit him in his pocket and you hit him in his ego. And you can have a great influence on how medicine is practiced. Not only now but in the future you can educate the doctor you can change how he carries out his practice. I'll give you an example in the 1940s. The pap smear was developed. And doctors didn't want to do it. It was sort of Yaki that fooled around with women Services. They think it just didn't seem like the right thing to do when less a woman was pregnant. You didn't put fingers where they didn't belong. An article started appearing in in women's magazines all over the country. Telling women about this test and what it could do for them and what it might mean how life-saving it could be. And women started walking into their doctors offices waving his article saying why haven't you done this? Why haven't you told me about this? I want this test and by golly doctor started doing it and the pap smear quickly became routine gynecological practice much to everyone's benefit. To do all of this. You need to know a few things and how to put them into practice. The first and most important thing you need to know is how to choose a doctor you have to start somewhere. You should select your doctor while you're healthy the worst time to try to get a doctor's when you're falling down Sick and you're desperate and you just take anybody who helped you with the moment. Your family doctor should not be a specialist who zeros in on one organ system or one part of the body to the edge expensive. All the rest should be a generalist like an internist or family practitioner and not a surgeon surgeon is not a first-line physician a surgeon is someone that your family doctor sends you to if he thinks an operation may be necessary. You should check out your doctor's credentials is Hospital affiliation. Is it a good Hospital don't rely on just the recommendation of friends or relatives. Although these are important because they can tell you something about how you the doctor interact with his patients and whether you might like them If you're stuck, you can call you got terrific University Medical Center here. You can call the the Medical Center. You've got a lot of them in fact in the Twin Cities and ask for advice. For a family practitioner or internist whose practice is open and can accept new patients. Failing that the medical society can often help. When you find this doctor, you got to ask some important questions before you decide that you want to be as patient. What are his hours? Maybe they're not convenient for you. What are his fees? If you really get incense by how much she charges you may not respond very well to the carry gives you is there a long wait for appointments if you're very busy you may not want to sit in his office for 3 hours or you may not want to wait 2 months to get an appointment. If does he make house calls out now? This is a rarity these days but for people who are invalid, for example, who can I get to the physician? It's important to know if the position can on certain occasions gets you throw some red herrings to watch out for just because a doctor is famous and treats famous patients as Max Jacobson will so clearly show. You doesn't mean he's a good doctor just because he's very busy. Doesn't mean he's a good doctor. The busiest doctors are not necessarily the best. You may not have adequate time for you. He may not. Have time to keep up with his with his practice to to learn what new things are happening. Okay now assuming you have this position who? You liking this confident from what you can tell on by his record. How do you deal with this doctor once you get him or her It's very important not to be intimidated by the fact that he was somebody who knows a lot more than you do that a lot more training who has a officious manner or what have you? The back of the doctor is busy that he knows more than you do is not an excuse to keep from asking the questions that you feel you need to know. We all of us want somebody who sort of omniscient when we're sick. We want the all-knowing Healer. But the all-knowing Healer has an obligation to tell you what he knows to. And don't be embarrassed to tell the doctor everything that is relevant to your care. We all want the doctor to think well of us. We don't want him to think we're stupid. We don't want him to think that we're not nice people. And so we refrain from telling things like we're doing terribly in our jobs. We have marital problems your spouse or you or involved in extramarital Affairs your problem Drinker. What have you the Spiel you to tell your doctor these kinds of information can often lead to the wrong diagnosis and you have nobody to blame but yourself. It's very important that you don't let the doctor play God and that you don't treat the doctor as a god. You the patient must participate in your own care for your own good? also for the doctors good when the patient is involved in what's happening to him when you are a participant in the decision-making when you know the pros and cons and you have put in your two cents. Then you're less likely to Sue that doctor when things don't turn out quite the way everyone had hoped because you know, that medicine is an art as well as a science. And if somebody had shared that fact with you if the doctor has shared to decision-making with you, then you're not going to turn around and say you did this to me and I'm going to get you for everything I can. malpractice goes down the drain Malpractice suits go down the drain when the patient is involved in this care. The only way that you can be involved is if you talk to the doctor the doctor talks to you that may seem very obvious but it doesn't happen that way very often. The doctor does not need to be your best friend, but it should be your she should be somebody that you feel an empathy with that you feel understands. You will listen to you and you feel comfortable with telling intimate details about your life. Somebody who sees you as a whole person not a collection of organ systems. Now, what should you talk about your talk to your doctor? You should be able to check out your understanding of the diagnosis and treatment. Doctors often use jargony words words like hypertension when they really when you understand high blood pressure, most people. In fact, there's a survey done most people think hypertension is stress. They don't have any idea that it has something to do with the pressure of the blood that courses through their blood vessels. The doctors usually don't do this deliberately to obfuscate your understanding. It's more of an inadvertent thing, but it's your job to say hey, wait a minute. I don't understand what that is. Explain to me. What you mean? You also need to know when to let the doctor know to take you seriously. For example a friend of mine had a terrible sore throat could hardly swallow. It had been lingering and getting worse over course of a week. Finally called an ear nose and throat doctor hit into previously. I told the receptionist about the problem was given an appointment for 3 weeks later. Told to go down to the emergency room to get a throat culture and to call up in four days when the throat culture results would be mailed to the doctor. Define. If we need an antibiotic will needless to say before those four days were up his throat was so raw that he had to go to somebody else who didn't do a culture but who gave him an antibiotic now it turned out he did have strep throat and an antibiotic was appropriate, but the second doctor didn't know that he just guessed. And the first doctor didn't take care of his patient properly and the patient didn't impress upon the doctor's Personnel that he needed immediate treatment. Not an appointment 3 weeks later. You must tell your doctor your full medical and family history. You should get ready for your visit. Beforehand observe the details of your problem and be very specific about them write them down. Not my stomach hurts, but I have a pain on the left lower side of my abdomen and it hurts worse when I cough and it feels better when I lie down. Those are the kinds of details that can help the doctor zero in on an accurate diagnosis. If you have something delicate to talk about rehearse it beforehand. Say it's your mirror. What's your pillow? What's your husband or your wife? Somebody that you can try it out before you have to tell it to a relative stranger. And have your questions written down because your chances are you will forget in the course of the chaos of a regular medical examination. Make sure you get an explanation of the risks and benefits of the treatment that the doctor has prescribed and that you know what the alternatives are. If this doesn't work, what else can we do? Is this the best way to approach it? Is this the least hazardous way to start? When you need to know when to tell a doctor the things aren't going well that what he gave. You isn't working quite a new hope. But not for you to change the treatment or abandon the treatment because the side effects were unpleasant. when to ask for a consultant if work sample the doctors unable to make a diagnosis of your problem within let's say two or three visits. If you're told that you have a chronic or potentially fatal illness such as multiple sclerosis or cancer. A consultant should confirm that diagnosis before changes your entire life. If you're told you have a very rare disease and it's very easy to make a mistake and the disease that a doctor only sees once in a lifetime. If you're told that your problem has an emotional basis. Many many problems do in 2/3 of more of people who go to Physicians have an emotionally induced illness or an illness with a very strong emotional component. But if you have a serious problem and it is just dismissed as well. It's all in your head Theory. Somebody else should make sure that that's correct and that there was not underlying it a correctable treatable and organic disease. The other time that you should ask for a consultant is when surgery is recommended as part of the diagnosis of your condition or treatment for the condition now when I talked about it, and I don't mean that you should go shopping around for Doctor Who tell you what you want to hear. But somebody who will make sure that what your first doctor said is, correct? You should also feel comfortable about telling the doctor when you're unhappy with how either he or she is treating you or how the office personality answering service of what have you or treating you if you feel that you cannot talk to your doctor if you have no Rapport, whatever get another doctor. Now for some specifics when a doctor prescribes a drug, you should know the diagnosis the purpose of the medication what it what it supposed to do for this problem the name of the drug, you'd be surprised how few people walk out knowing what it is that they're going to be taking four times a day for the next 8 days and what are the side effects? What are the most common side effects that may happen to you? And which ones are serious? Which one should you tell a doctor about a faker? How and when should you take this drug and write it down even though it's on the in hieroglyphics on the on the medication label is very often not quite enough information to help you take it properly. What are the precautions does this drug interact with things for example, tetracycline should not be taken with milk cheese in it and and MAO inhibitors can cause of potentially fatal reaction anticoagulants and certain antibiotics can lead to over sitting in the blood. These are things that you should know about your drug. It's your job. You have a job to in this business to take the drug exactly the way the doctor prescribed it. Several studies have been done is What patients do with their prescriptions half of them? Don't take them at all and many of the rest. Don't take them the way they were told to take them. They may stop taking it before with it soon as they feel better not realizing that just because they feel better doesn't mean that the organism that causes a problem is out of your system. And you also have a responsibility not to take a prescription that was prescribed for somebody else or for previous illness of your own unless your doctor tells you that that's okay. When you're given a prescription before you given a prescription your doctor should know everything that is relevant to your possible reactions to the truck. Do you have some kind of drug sensitivity that you may know about an allergy? Are you pregnant or might you be pregnant? Do you drink alcohol lot of drugs interact badly with alcohol and can cause dangerous problems? is the schedule that he gave you to take this drug on Impossible or extremely difficult for you to follow if you can't do what if you can't take it every 6 hours around the clock because for some reason I rather you you're simply not there or you sleep for 10 hours and you're going to miss that dose in between the doctor should know and make and probably can make some adjustment. Most important you should have pressure your doctor into giving you a drug that he feels is inappropriate. No medicine is very often the best medicine the doctor who says take two aspirin and call me in the morning. May not be giving you a brush-off. He make me giving you the best of Medical Care. Now if the doctor recommends surgery, what should you do? first of all your first doctor should be the non surgeon someone who is not a surgeon surgeon is seen as a consultant and that's urgent ideally should be board certified in the appropriate specialty if it's a gynecological problem a board-certified OB-GYN if it's an orthopedic problem of board-certified orthopedist, Surgery a lot of surgery in this countries practice by physicians who I'm not expert in the technique now general surgeons are are very well trained for many types of surgery, but they are board certified in general surgery. What is the surgeons Hospital affiliation if you have a many Community Hospitals do absolutely excellent Medical Care and I do not mean to put them down at all. I wouldn't. But if you have a very difficult unusual problem a very demanding thing if the course of your recuperation is going to be extremely challenging. You may want to be in a teaching Hospital in the University Hospital in in some place where the most up-to-date equipment and knowledge can be brought to your care. You are supposed should certainly know the diagnosis of your condition and how the doctor arrived at it. How does he know that what he thinks is wrong with you is really wrong. What are the benefits and risks of surgery many patients going to surgery thinking it's going to cure them not realizing that surgery can be only palliation some cases. And I certainly are as I mentioned before about the risks doctors are reluctant to tell patients that sometimes you may die from this operation. You have a right to know beforehand, especially in an elective operation. What's the chances are that this kind of thing may happen or certainly the far more common complications? And what are the alternatives to surgery? Is there a more conservative kind of treatment that you can try beforehand before you give up and go in for an operation. For example of a fellow I know in the midwest was told that he needed a Carne bypass operation. He did not have any pain. It was found that his arteries were clogged up through a fortuitous Examination for something else. He was in the hospital checked in. Ready for surgery when the night before the surgery came around to see how he was to say hello. And he's the current to him to ask the doctor what benefits might he get out of this operation and the doctor told him Point Blank. We cannot say that the surgery will prolong your life. We simply don't know. On hearing that patient checked himself out of the hospital went home to get on a good diet and a regular exercise program and it's been doing fine now for three years without any pain or any now that's not to say he won't suddenly have a heart attack related to his clogged arteries, but he had a right to know whether this strenuous operation. He was about to undergo was going to do to him what he had hoped which was to lengthen his life. What is the surgeon's experience with this particular operation? You want a skilled doctor? Who knows what he's doing, but you don't want somebody is putting you on an assembly line and doesn't know you from patient aid from patient Z. What's involved in the operation? How long would you have to be in the hospital? How long are you going to have to recuperate who's going to administer the anesthesia? And what kind of anesthesia? How much is it going to cost? If you get a bill for $4,000 when you were expecting one for 400. Now they took the benefits of that therapy can rapidly go down the drain with the aggravation that then in suits. Is there some other way to treat the problem to have the operation without being an inpatient in the hospital? Can you have a local anesthetic instead of a general local anesthetics usually being safer and easier to tolerate can it be done as an outpatient procedure can it be done as an office procedure? You're better off outside the hospital if you don't have to be in the hospital hospitals are places for very sick people. A bubble when they don't recommend your own unnecessary operation. You would be astonished to know how many people are dissatisfied with the doctor who says who could I don't think an operation is called for in this case then go to another doctor and another doctor another. It was visually if you're determined you will find somebody who operates was not everybody is equal the ethical not everybody is equally confident to make the Judgment as to what's necessary and unnecessary. Okay. Haven't heard all of this. I now have my great surprise message. You should trust your doctor. Believing in the treatment believing in the person who administers the treatment is an extremely important aspect of the success of that treatment. But your trust must be based on facts not faith. It's so easy to be caught in an aura of Blind Faith sucked into that. Halo of omniscience that surrounds many the medical profession and doctors It is dangerous to be so soccer team. You can and you should help to destroy. The negative medical Mystique the Mystique that works to your disadvantage and to the disadvantage of every other patient. There's a limit to what Physicians can do on their own to improve Medical Care the patient must participate. Indeed the patient must help to force Improvement. To me the patient's role is the fastest and best way. To reduce the number of medical mishaps and malpractice suits and to assure that you and your family and your friends and future Generations. Get the best possible care. From a medical system that overall is the best in the world today. Thank you.