Found at:
http://content.healthaffairs.org/content/27/5/1416.full

“In the clinical world, the term difficult is applied to a variety of patients: the noncompliant; the rude, abusive, and manipulative; the malingering; the mentally ill; the skeptical.

In my case, I too frequently challenged my doctors with questions and too often chose a treatment that differed from what they’d recommended. I consider myself to be an assertive patient, but it was clear on many occasions that some providers thought I deserved the “difficult” label.”

” Being difficult was my natural response when my doctor was incompetent, rude, or domineering. I didn’t need a physician to be my “perfect agent” (the phrase from health economics that the physician is the patient’s agent).

I needed a physician to be an additional source of information and insight to support my informed decision making. I wasn’t interested in being told what to do, and I expected my doctors to respect my right to make truly informed choices that were consistent with the way in which I wanted to intervene in my disease and live my life.”

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US Colorectal Cancer Screening Strategy Questioned
Nick Mulcahy, November 9, 2011 — The use of colonoscopy as the primary screening strategy for colorectal cancer in the United States, which has been famously dubbed “going the distance,” might be a case of going too far, suggests an editorial published online November 9 in the Journal of the National Cancer Institute.
[…]
The United States “adopted a primary colonoscopy strategy for [colorectal cancer] screening” despite a lack of strong evidence that its benefits surpass those of other strategies”, they say.
[…]
The “great majority” of findings at colonoscopy are not cancers, but instead are small low-risk adenomas and nonadenomatous polyps, they emphasize. Current practice in the United States dictates that all polyps, regardless of size, be removed. This practice, which has “an uncertain net effect” on the patient, has led gastroenterologists astray, they note. “When our goal changes from reducing [colorectal cancer] mortality within reasonable levels of harms and costs to eradicating every existing polyp, we are taking our eyes off the ball,” they write.
[…]

Read the entire Medscape article

But there are many trails of corn to follow!

I’m going down the rabbit-hole of following the links—- again. I hope others can persevere.

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I’m an RN and while I keep my eyes open, I think I’m more than fair – forgiving, even, to a point. Nevertheless, based on my experiences, I believe we have a serious problem. It’s not just an educate the patient problem, though that’s certainly sorely needed, and it’s not just an “I can’t possibly know everything” problem, though that’s certainly true, as well.

It’s a problem with incompetence! Now I am basing this on my own personal experiences, so I will acknowledge this “error in assumption” right now. You are right that anecdotes and personal experiences are no basis for making generalized assumptions. However, were you me, you might have a hard time remembering that. If I weren’t a nurse and weren’t paying attention, I’d have been in surgery at least 3 times in the last few years when there was absolutely no need for any of them. All were errors in diagnosis. Along with the unneeded surgeries, I’d also have permanent damage from an injury, had I not hesitated before doing the exercises prescribed by the specialist I saw. Thankfully, I did hesitate and got a second opinion. The exercises would have been perfect, except for the small problem that he had completely misdiagnosed the nature of my injury. This kind of repeated experience is very scary. And to make it worse, these doctors were all subspecialists!

In one case, I’m convinced it was a case of needing to make money, with that doctor recommending unneeded surgery and fast. However, the primary problem seems to be poor assessment skills. Here is one striking example. While it didn’t cause me any harm, it certainly got my attention and I’ll wager it will get yours:

I was in the hospital to determine if I had had a heart attack. The ER doctor had listened to my heart and had heard a heart murmur. “Did you know you have a murmur?” he asked me. I told him “No.” He reassured me that it wasn’t a murmur to worry about, so I was glad to hear that. Once in the hospital, I mentioned this murmur to the first of many cardiologists who saw me. After he completed his exam, I remembered what the ER doctor had said and remarked, “You know, the ER doctor said I have a murmur.” He said, “You do?” He bent to listen again, stood up after a bit and said, “Yes, you do have a murmur.” I was surprised by this and I repeated the sequence with the next cardiologist who saw me. Same response. “You do?” He listens again. “Oh, yes. You do.” I repeated this with every cardiologist I saw, and I had a slew of them as “cardiac hospitalists.”

I got exactly the same response from every one. Not a single exception. I was not at risk of harm by this failure on their part, but thank heaven for that! Not a single heart specialist seeing me for a heart problem had assessed my heart sounds well enough to hear the heart murmur. This and my other unsettling experiences have nothing to do with “not being able to remember it all.” They are examples – far too many examples to be encountered by a single patient – of plain old incompetence. And I repeat: These are ALL SUB-SPECIALISTS!

I want to know: what is going on?

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Yikes.

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