How to get the right treament
Primum non nocere. First, do no harm’’. For doctors and nurses this is one of the main principles that underpins our everyday practice. It means that for every pill, syrup, cream, therapy, procedure or operation we recommend, we should always consider and discuss the possible ill-effects as well as the potential benefits.
A few years ago, my father was suffering from excruciating hip pain, due to osteoarthritis. He couldn’t sleep, he couldn’t work, he couldn’t play any of his beloved tennis, or even walk his dog without being in agony.
The wait for an appointment in the NHS in the UK where he lives was so long that he went to see a private orthopaedic surgeon, at great expense. He met the young, charming surgeon in his smart office, and was told that there was a revolutionary new technique available that would give him a far better outcome than the oldfashioned type of hip replacement he had been thinking of.
You can probably guess where this story is heading – despite my concerns about his plan, my dad was in so much pain he went ahead and had the surgery.
It turns out the new procedure was not the miracle my dad had been sold. He ended up seeing another, far more experienced surgeon, who recommended a removal of his ‘‘re-modelled’’ hip, followed by a total hip replacement, done the ‘‘oldfashioned way’’.
A year after the original surgery, he was back to normal – living without pain, but wishing he had paused before signing the consent form the first time.
This story, and others like it, saddened me. Do I think that the drug company responsible for this new resurfacing technique was hoping to cause harm? No, absolutely not. Do I think that the young surgeon wanted to create more pain for his patients? No. But do I think that errors were made and that arrogance, overconfidence, inexperience and an unwillingness to listen to colleagues or scientific evidence led to bad clinical decisions? Yes.
Over the past few months I have listened with similar sadness to the stories told by New Zealand patients harmed by surgical mesh procedures. Thankfully, in no small part due to the hard work of a very dedicated lobby group, there has now been a recall of some of these products, but not before tens of millions of dollars have been paid out by ACC in recognition of the damage caused by this type of surgery.
So in a world full of baffling medical choices, what can you as a patient do to try to ensure you are not at the receiving end of treatment that causes you more harm than good?
Firstly, consider carefully what it is you are seeking treatment for. Obviously, in my dad’s case, his symptoms were so severe, doing nothing wasn’t an option. But in other cases, that is often an option – and sometimes doing nothing might actually be the best choice.
Many conditions will get better on their own with time, and if the treatment could potentially be worse than the symptoms, it could be worth waiting to see how you feel in a few months’ time. This advice doesn’t apply to lifethreatening conditions, but does apply to other diseases or health issues, where the treatment is often labelled ‘‘elective’’ (you choose to have it done, you won’t die without it).
Make sure you have a proper discussion about the treatment, and other possible options. Doctors have a duty to ensure that when you say yes to a medication or surgical procedure, you have been fully informed – not only about the pros and possible cons of that treatment, but about the other options that might work for you as well.
Doctors are busy, but if you write a list of things you want to know (and even think about emailing it to them ahead of time) and book an appointment to have this conversation, it is money well spent.
A good GP or specialist should never be afraid to seek another opinion – if I don’t know enough detail about a certain medication, I use our specialist pharmacists to enlighten me, ensuring that I can pass on all my patient needs to know before making their choice. If the doctor you are dealing with doesn’t seem to want to consult anyone else, or ask advice if it is outside their expertise, I would be nervous about engaging with them.
Try to make sure someone has enough experience or knowledge in your specific area of health. This can be tricky, but for example you can ask how many operations of this kind a surgeon has done before, which might reassure you. GPs will often have a ‘‘feel’’ for which surgeons are better experienced than others.
If the treatment you are being offered is ‘‘new’’, check that it has been robustly tested. Good scientific trials take time, often decades, to prove that a procedure or medication is effective and is safe. If something hasn’t been through this process, I would be wary of the possible risks. Again this is something that your GP should be able to find out for you.
Make sure the doctor is providing you with unbiased advice – the brochure my dad was given was written by the drug company, which was heavily incentivising the surgeon to use it. This obviously leads to bias. If you’re not sure, ask for another opinion or get your GP to do some research for you.
Make sure you understand what the treatment is supposed to do. If your expectations differ from your doctor’s, you will never be happy with the outcome – for example, the doctor might know that a procedure on your nose will help reduce sinus problems, but not have an impact on your snoring.
Write things down as you discuss them. People typically only remember a certain amount of what is told to them during a doctor’s appointment, so writing it down, and asking for some written information, is a good idea.
Doctors overwhelmingly want to do the right thing by their patients: yes, there might be exceptions, but I would strongly argue that most doctors are in this business out of a desire to help ease pain, suffering and disability, and improve the quality of life of those they look after.
It is in our best interests, as well as yours, to make sure that any decisions you make are safe, are made freely, and are the right ones for you.
Doctors have a duty to ensure that when you say yes to a procedure, you have been fully informed.