And the buck stops where, exactly?

Also could be titled “Overprescribing, Monopoly Pieces and Reader-Bashing”

Last week I did not have time to write a blog.  I was too busy having a birthday.  So I’m now…er…let’s just say that 50 came and went a few years ago.  And I made an interesting discovery.  Although 50 is often touted as “the new 30”, in the eyes of most service providers, medical personnel, et al – 50 is more like “the new 95”…especially if you’re a woman.

Unless you look considerably younger than your age (which of course I do, anyone can tell you that), people start explaining things to you v-e-r-r-y  s-l-o-w-l-y.  If you’re older, you have to agree instantly, otherwise you’re losing your marbles.  If you’re younger you’re allowed to disagree, or ask for further explanation, without others assuming you are just too ga-ga to understand anyway.

This is true of a whole list of subjects, ranging from your own health to how to use “Word” on the computer.  I’ve noticed it frequently in my own practice – it starts at around 50, sometimes for women it even starts at around 40.  I ask them to tell me what medications they are on.  They produce a list.  I ask whether they know why they are taking these medications.  “I asked the doctor, but he/she wouldn’t explain,” is one answer.  “The doctor said – just take it, it’s good for you!” is another.

“Do you still have the problem?”
“No, it went away years ago…”
“So why are you still taking the drug…?”
“He said I should…he said it’s good for me…” (just assume the “he/she’s” willya, it’s too heavy on the keyboard to be constantly gender politically correct…)

The issue of chronic medications is particularly charged for those aged 40 and over, as the test results requiring chronic medications have changed.  Figures required for prescribing have been lowered to include risk factors.

Now don’t assume this blog piece is about bashing the system.  It’s not – although the system is eminently bashable.  This particular piece is about bashing you, dear reader…so read on, I will eventually make my point.

The issue of current overprescribing, especially in the US, was addressed by Cory Franklin  in The Guardian in June 2011, in an article entitled “America’s epidemic of over-prescribing”.  Franklin notes that “…in an effort to please their shareholders, pharmaceutical companies have done hugely effective marketing campaigns. Skilfully employing influential doctors as speakers and on advisory panels, the companies have expanded the markets for their products.”

It’s lucky Franklin is himself such a prestigious physician (which is why I included a link to his bio), otherwise we’d be hearing veiled – or not-so-veiled – accusations of conspiracy theory and the like.  Terminology invariably aimed at those taking potshots at the flourishing and obviously totally altruistic pharmaceuticals industry.  (Yes, I jest, I do, I do…)

Franklin does not hold his punches.  “These same doctors” he continues, “often write guidelines about who are candidates for drug treatment. The indication between “treating disease” and “expanding market share” blurs when candidates for therapy include not just the sick, but those with risk factors for future disease who might get sick.”

Part of what drives me crazy here is that the system encourages individuals to relinquish power and even responsibility in matters relating to their health.  You can’t possibly understand, the public is told, you didn’t go to med school, you don’t have training.  Just accept the pills I’m giving you, follow the instructions I’m giving you and do as you’re told.

But here’s the problem:  the average patient is caught up in many currents of interest when he goes to the doctor.  There are the drug companies – and I’m not going to go into demonization here (there are others who do it so much better) but I think everyone accepts that they are trying to make money.  There are the doctors who are following training as best they can, or those less pure souls who are following cupidity.  There is the system that wants to process the patient as quickly and cheaply as possible – something that’s only possible through following protocols and not individualizing the patient.  And that’s only the tip of the iceberg.

But through all this, the thing people are forgetting is where the ramifications of poor or inappropriate treatment will play themselves out.  Where will the pitfalls of over-medication become visible.  And to be direct here – the buck stops with you, with the patient, with anyone who puts their health in the hands of any practitioner.  The patient has to take ultimate responsibility for treatment because the patient is the one who will benefit or suffer from it.  The patient’s body is the playing field for the prescribing often based on speculative theories (or, possibly but improbably, greed…) that is being carried out today.

A leading self-help guru, who I won’t quote, wrote in a book several years ago that we should let our doctors take care of our health, that they know what is best for us and it is not our business to worry over.  Nothing could be further from the truth.  It’s our business, it’s our bodies, it’s our health, it’s our lives.  We are the monopoly pieces here.

It is true that the patient does not have the training of the practitioner.  In every field, medical or otherwise, we go to someone who knows more than we do.  So an element of trust will always be essential, otherwise we cannot enlist the help of more knowledgeable others in any field.  But considered trust is very different to blind faith.

It’s crucial to  be more demanding of your health practitioners, conventional and alternative.  It does make life harder for us (speaking as a practitioner) when a patient asks a lot of questions.  But it also keeps all us, conventional and otherwise, on our toes and I believe that is a good thing, however inconvenient.

So unless you enjoy dining out on dinner stories of botched operations, procedures and treatments (some people really love doing this – don’t squirm in your seat if you do, you are not alone…) – unless that’s your thing, ask questions.  Be involved with your health.  Don’t let anyone talk down to you.  Take supportive people with you to consultations if you feel there’s a risk that you will not be heard.  Decide when to trust – don’t be intimidated into it.  Because no law suit will return to you the health that you lose.  Because make no mistake, the buck stops with the patient, nowhere else.

Photo courtesy of Mike_fleming on flickr