Health & Fitness

When the worst medical advice comes from the patient

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When the patient plays doctor, good healthcare can be the loser

In the ongoing debate over how healthcare decisions ought to be made, doctors are generally seen as the ones running the show — the ones who decide who does the deciding. But it doesn't always work that way. Sometimes patients hijack the whole process.

True story: A fellow with a cold came to see Dr. John Santa asking for antibiotics. Santa carefully explained that antibiotics wouldn't do the man any good because his cold was caused by a virus, and antibiotics only work on bacterial infections. The patient stomped out of the office, fulminating bitterly as he went: "If you weren't going to give me antibiotics, why did you see me?"

In the doctor-patient relationship, patients, naturally enough, are considered the experts on their own personal beliefs and views, life styles and circumstances, but doctors are generally considered the experts on medical issues. As seen from the antibiotics brouhaha, though, patients aren't always content to stick to their own bailiwick.

And, in fact, Santa's disgruntled patient was far from unique. Every day, in offices all around the country, other patients request antibiotics that will do them no good, and all too often their doctors, unlike Santa, prescribe them. "Sadly, the easiest solution, rather than to just say no and potentially anger the patient, is to do what they ask," says Santa, now the director of the Consumer Reports Health Ratings Center. "That is why antibiotics are overused."

Indeed, statistics show that almost half of the antibiotics prescribed for respiratory infections in the United States are useless because they're prescribed to treat infections caused by viruses, not bacteria. And this is more than just a lucrative boon for drug companies. Over-prescribing antibiotics helps to create resistant bacteria that lead to illnesses that can't be treated. Over-prescribing is a threat to public health.

The belief that antibiotics are something of a panacea is only one of patients' widespread misconceptions. Many of these are inspired by health product advertising, massive doses of which the American public receives every day.

Another way patients can easily go wrong is by relying on unfounded assumptions. For instance, Santa says, "They think more is better, and more expensive is better."

It's an understandable attitude, but it isn't always accurate, and it can lead patients to opt for tests and procedures they don't really need — some of which come with risks they don't need to take. "In the United States, we spend over $2.7 trillion on healthcare, and experts agree that up to 30% of this spending is for avoidable or unnecessary care," says Dr. Pamela Duke, an assistant professor of medicine at Drexel University College of Medicine.

To avoid instigating foolish healthcare decisions, patients can take a simple precaution: Check the facts. The Internet, of course, is a notorious source of misinformation, but it can, if used wisely, actually be a prime place for patients to educate themselves. In his book "Surviving American Medicine," Dr. Cary Presant outlines how patients can navigate safe passage through thousands of tempting but not always reliable sites by sticking to ones that are sponsored by the federal government, national nonprofit healthcare organizations or universities.

The Choosing Wisely site is expressly intended to guide patients away from overly expensive and unnecessary care. Sponsored by the American Board of Internal Medicine, with Consumer Reports as its consumer partner, the site contains information provided by national organizations of medical specialists, including lists of tests and procedures that are often used when they don't need to be. For those who think the site gets a little too far into the weeds, it also links to the consumer-friendlier ConsumerHealthChoices.org.

health@latimes.com

Copyright © 2014, Los Angeles Times
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