Does Good Treatment Mean Better Treatment?

“Are good doctors bad for your health?" is a question posed by Dr. Ezekiel Emanuel in a New York Times opinion article about our natural response to want the "best doctor" we can find in a medical crisis (11/21/15).

As a young man, I grew up in a family of doctors.  They are a heady blend of academics, medical - research and clinical - doctors, artists, mathematicians, physicists, and for balance, quite a few blue-collar workers like my Dad, who was a printer.  Weekly, we ate dinner together.   Regularly our family doctors received, most often just after dinner, a collection of calls from distressed friends and family members asking advice on a variety of medical issues.  HIPPA restrictions were not in place when I was a kid, and so cases were discussed over dessert.  Some of these calls were benign, inconsequential calls asking whether a sprained ankle or wrist needed ice or heat.  But others, were more serious, where interpretations of blood tests and cancer treatment options needed to be explained and considered.   Inevitably, the more serious calls, also came with requests, "what doctor and hospital would you recommend?"

I learned at a young age what is coming to light today in medicine: does more treatment mean better treatment?  In an article published in the JAMA (Journal of the American Medical Association) - yes, I do read it - research suggests that doing less, even doing nothing, can produce better results.  To some people, this can seem counter intuitive.   

Every test, every intervention, can go wrong.  Even less obvious, is that many senior, famous or soon-to-be-famous doctors that specialize in cardiology and removed from clinical practice and centered on groundbreaking research have a higher mortality rate than physicians recently out of training.  

I know this is very shocking, but the new data suggests that your cardiac survival rate increases when you have an acute, life-threatening cardiac condition and the senior cardiologist at the hospital is out of town ornot on call.

The research suggests that this is only true for cardiologists.  But my family dinner conversations point me in a different direction, although it is not validated by the research.  And that is:  you always have a better chance of a successful outcome if the hospital you go is a teaching hospital and staffed with reliably trained junior physicians, just out of training.

This is important, so let me repeat it again if you have a choice between a teaching and non-teaching hospital, always choose the teaching hospital.  The reason is simple: they are more clinically adept.

Other questions to always ask your doctor is will the test, and results change your approach?  And if the answer is yes, ask how much improvement can you expect?  Will the improvement prolong life?  Reduce risk?  Or, can this new approach create another problem?  How severe will the side effects be?  If the answer is no, then you must assess if the intervention and, or test is right for you.

No one likes to be second-guessed or have to justify their decisions, doctors included, but studies show that when patients have all the information, know both benefits and risks, they tend to consent to fewer interventions and tests and feel more informed about their decisions.  

None of the doctors in my family ever made a medical decision for anyone who called.  What they gave each person they knew, and sometimes loved, was information, benefits, and risks.  

It's hard to tell someone bad news.  It's especially hard when someone is acutely ill and doing nothing is the best medicine of all.