If your doctor wants to put you on a statin, ask why
First, scroll down and put the video you’re hearing on pause. I couldn’t figure out how to post it without its going off when you log on. I’ll explain what it’s all about shortly. (If someone knows how to get this to play on demand and not every time one logs onto this site, let me know and I’ll fix it.)
I’m sorry I’ve been so dilatory in posting and answering comments. I’ve been up to my eyes in a couple of projects I’ve got going on. I was dragooned into helping MD with her first concert as president of the Santa Barbara Choral Society, which went off terrifically well. The above photo is of MD making her president’s speech to a packed house while waiting for the singers to file in and take their places behind the orchestra. I’ve also been swamped with other projects as well, one of which I’ll blog about later this week. And MD and I are making an unexpected trip to New York for a few days next week, so our time has been telescoped because of that.
Enough whining about all the reasons I haven’t posted. Let’s get on with today’s topic.
There is an outfit called Medscape (a part of WebMD) that sends emails to physicians keeping them up to date on all sorts of medical information. Medscape is run my mainstream physicians and typically presents the mainstream view of whatever it is they’re presenting. I usually give these emails the once over to kind of keep myself aware of what’s going on in mainstreamland. Today’s email I thought worthy of sharing.
It seems that there is a movement afoot to get physicians to be more forthright with their patients. A government agency has gotten into the act and plans to bombard physicians with exhortations to include their patients into the treatment team. (A strange idea indeed!) These governmental folks want doctors to better explain to patients why they are prescribing the medications they’re prescribing and why they are doing everything else it is they’re doing. The message is that patients should never go away from their doctors’ offices without having every question answered.
I’ve always advocated this novel idea of including the patient as part of his/her own treatment team. It would seem strange to leave the patient out. I’ve never told a patient to take a medicine just because I say to take it. I think all physicians should be able to explain to patients why they are prescribing the medicines they prescribe, doing the procedures they plan to do, etc. It’s only fair. It’s nice to know that it’s now becoming part of the mainstream.
Next time your doctor tells you that you should go on a statin costing a couple of hundred dollars per month for the rest of your life, ask him/her why. And don’t accept the old line that statins have been proven to be effective because that’s far from the case. Ask to be shown the data. And ask the doctor to explain it to you.
As you can see from the video below, Big Brother is going to start demanding that doctors explain. So don’t be shy. If you feel intimidated by your doctor and afraid to ask questions, it’s probably time to get another doctor.
Here is the Medscape video and below is the printed content in case you can’t get the video to work. The doctor speaking hits the nail on the head with his first sentence: “Patients should take charge of their own health.” Truer words were never spoken. While you’re watching this video, remember that it’s targeted at doctors, not at patients.
[The video has been disabled. Please see the content below.]
As physicians, we are beginning to see patients becoming more involved in decisions about their care. Even though this is a major change to how we practice medicine, it will, over time, create a genuine partnership between doctors and patients.
Research shows that patients who left doctors’ offices with even 1 unanswered question reported the lowest level of improvement in their symptoms. In addition, these patients reported being less satisfied with their care. Other studies show that patients who ask questions and become more involved in their healthcare are more likely to follow clinicians’ instructions and report better results.
However, many patients are reluctant to speak up — because they don’t want to admit that they don’t understand something, because they are overwhelmed by their illness, or because language, health literacy, or cultural barriers get in the way.
Today, health care providers have come to recognize the importance of clear, ongoing communication, including questioning why a particular treatment decision was made. We need to engage our patients in the same way. To that end, my agency, the Agency for Healthcare Research and Quality, has developed a new public awareness campaign with the Ad Council to encourage patients to take a more active role in their healthcare.
You will soon begin to see or hear public service announcements urging patients to ask questions of all their health care providers. The education campaign also includes a Web-based Question Builder at www.ahrq.gov which helps patients create a list of questions for their next medical appointments.
As physicians, we have an obligation to help our patients understand the decisions that affect their health. While it may challenge our way of practice, it is the right thing to do.
I’m Dr. Carolyn Clancy, director of the US Agency for Healthcare Research and Quality, and that’s my opinion.
There you have it. Go forth and take charge of your own health.
A quick request, Dr. Eades…what do you think of the ideas being propounded on this site?
http://heartscanblog.blogspot.com/
It’s run by a Dr. Davis, a Milwaukee cardiologist who thinks that heart disease can be reversed through a series of interventions including a very low carb diet, complete avoidance of wheat and sugar, Omega 3 supplementation, and perhaps most interesting, Vitamin D3 supplementation.
He’s also an advocate of CT heart scans (but not angiography) as a means of tracking risk level and reversion success.
I’d love to hear your take on his ideas.
Although I don’t know Dr. Davis personally, I’m familiar with his ideas about reversing coronary plaque.
I’m on board with just about everything except the recommendation to limit saturated fat to almost none. It would be none if he could do it. I agree on the wheat and sugar. I’m a little iffy on the recommendation of a ton of omega-3 fats, but I’m completely in favor of large doses of vitamin D3.
I had someone give me his book a while back, but I haven’t read it. Maybe I’ll pick it up over the holidays and give it a look to see if there is more detail than what’s in the website.
Cheers–
MRE
Another OT item that validates your previously expressed view that it’s ok to drink coffee.
http://circ.ahajournals.org/cgi/content/abstract/CIRCULATIONAHA.107.712976v1
Best,
W
They’re singing my song.
Thanks for the link.
Cheers–
MRE
A bit off topic, but here is a long video of Gary Taubes recapitulating his GCBC book for the Berkeley School of Public Health last week:
http://webcast.berkeley.edu/event_details.php?webcastid=21216
He has stuff here not in the book, I think, and it is absolutely worth watching even if you have read the book from cover to cover.
Hey Art–
Gary told me he was going to do this talk, but I wasn’t able to make it up to Berkeley for it. Thanks for the link. Problem is for me that I can’t make it play on my Mac. If anyone out there who is Mac capable can tell me how to do it, I would love to hear from you.
Cheers–
MRE
Your post today reminds me of the recent brouhaha over Dr. Scott Haig’s recent column in Time magazine, in which he painted patients who ask a lot of questions with a broad brush, using a questionable anecdote about nutty, overbearing (by HIS description) woman as a case study:
“When the patient is a Googler” by Scott Haig
http://www.time.com/time/health/article/0,8599,1681838,00.html?imw=Y
The NY TImes posted this Web-only (I think) commentary on the Time essay. My comment is #254. A couple of typos obscured, I think, a couple of my points, unfortunately. I’m not sure I made it perfectly clear that the poor rating I cited at the end of my comment was Dr. Haig’s individual rating.
“A doctor’s disdain for medical Googlers”
http://well.blogs.nytimes.com/2007/11/19/a-doctors-disdain-for-medical-googlers/
As a bonus, you can also read this one:
“Time magazine’s Scott Haig proves that patients need to be Googlers”
http://thyroid.about.com/b/2007/11/13/time-magazines-dr-scott-haig-proves-that-patients-need-to-be-googlers.htm
Interesting. In a way I agree a little with Dr. Scott Haig. There is a patient being a part of the treatment team, and then there is the patient who is a detriment to him/her self and the entire therapeutic process.
I have a mechanic for my 15-year-old Porsche whom I trust implicitly. He keeps my car running – he makes house calls – he never does anything unnecessarily. He’s a great guy. His only problem is that he wants to tell me in excruciating detail everything he has found in need of repair and why it’s important to get it repaired now (or why we can simply wait and watch) and, worst of all, how every single component that needs repairing works by itself and as a part of the whole car. I sometimes want to scream I DON’T CARE HOW IT WORKS. JUST FIX IT AND LET ME LEAVE.
I’m sure there are many patients who feel the same about a doctor they trust; they simply want to be told what to do, what to take and be about there business. But first they’ve got to trust the doctor. It takes a while for patients to develop this level of trust, and it helps if in the early days the doc does a good job of explaining things.
There are many, many diagnostic skills that doctors have developed over their years in practice and their long years in school, and they use these skills from the moment they walk into the room with a patient. When I was in active practice taking care of all comers I could in at least 80% of the cases come up with the correct diagnosis within 30 seconds after walking into the room with a patient I had never seen. Most doctors can do the same thing. All it takes is a lot of training and a lot of experience. After the first 30 seconds the rest of the 15 or so minute visit was spent confirming what I had diagnosed in the first 30 seconds.
If I would have had to explain everything that went through my mind to arrive at that diagnosis, the visit would have taken an hour. Now, if I were to put a patient on a drug that had the potential for bad side effects, I spent a lot of time going over the risk reward and the other options. But for routine stuff, I was as efficient as most doctors who get complained about for being too quick to get and out of the exam room.
I guess what I’m trying to say is that as a patient you need to pick your battles. In other words, if you go in for a sore throat or a sinus infection don’t have a laundry list of questions or your doctor will think you’re a pain. If you go in for something serious, that’s the time to ask your questions.
Cheers–
MRE
You need RealOne Player. Here’s the url for the free download.
Hope it works for you.
http://www.realplayer-plus.com/free-realplayer.html
Hi Miriam–
I figured it out on my own late last night. Thanks for your help, though. I appreciate it.
Best–
MRE
First, I love my doctor. He always listens to me, and patiently answers the entire list of questions I inevitably write down before my visit. Unfortunately, he has a busy practice, and the appointments are never more than 15 or 20 minutes. Still, I’m young (52 is SO young!) and healthy, so maybe I don’t need more time with him.
My complaint has to do with physicians taking care of the elderly and disabled. I have a sister in Michigan who was born hydrocephalic (mentally and physically challenged). She mainstreamed her schooling and graduated, and then worked for the state as a mail clerk for about 20 years before everything caught up with her and she began falling and failing mentally.
She’s now in an assisted-living facility. The food they serve is protein-poor and carb-rich. Hence, now she’s pre-diabetic. She’s 5’2″ and around 210 pounds; she’s gained about 60 pounds since moving there about 4 years ago.
Her physician currently has her on Avandia, Evista, Baclofen, Potassium Chloride, Furosemide, Lescol, Loratadine, Aricept, and Levothyroxine (that’s what I know of; there might be more). I’m not at all sure what all this is for, let alone the side effects. I have read (here and elsewhere) about Avandia and its effects on the heart. I also just read just the other day that it promotes osteoporosis.
No one is questioning these meds. My sister’s friend has been taking her to the doctor, but she has no legal rights to question the doctor on anything (actually, she did once ask about the Avandia and was told “it’s fine”). And I’m 1,000 miles away and certainly am in no position to get involved, nor would the doctor listen to me, either, since my sister is her own guardian.
I just worry about all the people who can’t speak up for themselves.
I worry about them, too. And the people who are too intimidated to speak up for themselves.
My folks live in Michigan, and over the years I have been amazed (in a bad way) at the level of medical care they have received. I’ve always kidded them that the worst doctors in America are in Michigan. Then one day about 10 years ago I got a medical journal in the mail that had ranked all the doctors in the country by a specific set of criteria, and lo and behold, Michigan doctors were indeed rated as the worst in the nation. How long do you think it took me to get a copy of that article to my folks?
It’s all very strange since one of the smartest doctors I know also lives in Michigan. In fact, he lives about a quarter of a mile from my folks house.
I wish your sister well.
Cheers–
MRE
I guess you need a Mac version of the REAL video player.
Go to this URL, pick your operating system, and follow the instructions to download and install a free REAL player.
http://www.real.com/freeplayer?rppr=fed
Since I don’t have a Mac, I can’t confirm that is works, but it shouldn’t be too hard. I’m using the free version of PC REAL to watch the Berkeley video.
Art
Hi Art–
It does indeed work. There is a version of Real Player for the Mac. I figured it out myself late last night. I should have worked on it more before I put out the plaintive cry for help. Thanks for responding, however.
Cheers–
MRE
Watched Gary Taubes last night. 1:00 am til almost 3:00.
It was good to watch without the baiting that happens on the tv shows.
Interesting slides.
I wish my doctor respected me for taking responsibility for my own health – but that is not the case. He just wants me to do what he says, when he says it without regard for my own philosophy/knowledge regarding health care. He became visibly angry when I declined statins and made the comment that “you are putting yourself at risk for sudden death by refusing treatment.” Also, dismissed my concerns about side effects and increased risk of mortality from cancer.
On another subject: There is another aspect of the health industry that I haven’t noticed anyone talking about which troubles me. One hears a lot about the uninsured not getting necessary health care but no one talks about the overuse of medical resources by doctors for the insured patient. By this I mean that doctors are recommending many tests/procedures/ drugs that are not medically necessary or in the best interests of the person (i.e., a person who is in good health and asymptomatic). Relentless testing and treatment has driven all of our medical costs through the roof. It seems that not only is common sense in short supply in the medical profession but that many doctors are driven by considerations other that what is best for the patient and respect for that patient’s viewpoints.
End of rant…..
Feel free to rant here any time. As long as I’m not the object.
Cheers–
MRE
Thank you SO much for that link to the Berkeley lecture. It was fantastic! I’ve read the book cover to cover but this has crystallized my understanding of several key concepts, if not of the entire book. Gary is an excellent speaker. His lecture could be a little more polished, you could tell it was his first, but his explanations were fantastic and his lecture was really well built.
By the end I felt really sorry for him however. You could tell how passionate he is about this subject, and at the same time how exhausted he is. He is trying to move a mountain. He said something rather revealing at the end. He said that when he finished his book he hoped that he would induce some people to read his book, provide them with the science and maybe change their mind. Instead he’s getting the reaction “We’ve read your “What if it has been a big fat lie” article and there is nothing you can tell us. And this is why he is now having to do lectures. Poor Gary.
Yep, the NY Times article was a two-edged sword. On the one hand it got him a nice advance for his book, but on the other it’s now undermining the book because people all think they know what the book is all about.
Cheers–
MRE
Dear Dr E and Joe Mastic,
It’s really hard for me to recommend any classical music (or blues or rock for that matter) because I dearly love it all. But if I can recommend another site (I bet they need the money), go to http://www.monteverdi.co.uk/recordings/bach_cantatas.cfm and check out the best recordings of the best music ever written. The performances are conducted by Sir John Eliot Gardiner and are issued by his own record company (after DG fired him in a moment of corporate shortsightedness). He and his group performed and recorded all 200 cantatas in a single year, a feat that not even Bach himself achieved. So far they’ve only issued about half of the complete set (a mere 26 CDs). If you click on each volume, it will take to a link where you can listen to 4 complete tracks per volume. Go through the whole set and you’ll have about 3 hours of complete tracks to sample absolutely free of charge. The amazing thing is Bach never wrote a dud piece. Every one is a masterpiece! If you must buy only one album from this set, go for volume 8, featuring the hardest and most brilliant trumpet part Bach wrote (Cantata 51) played by the world’s best baroque trumpeter, Niklas Eklund. And then the second disc has the supremely beautiful set of cantatas Bach wrote, for the 16th Sunday after Trinity; the best stuff he ever did!!
If you subscribe — I did and never regretted it — you will eventually have a collection of 51 CDs of, literally, heavenly music. And each CD will be shipped off to you by Lady Isobel Eliot Gardiner at half price, no postage cost. How’s that for service? But you can also order individual volumes (at a slightly higher cost)
Even if you don’t buy, listen to the free samples. They’re a knockout. The album photographs are also brilliant, by Steve McCurry.
Just a suggestion!
Michael Richards
Hey Michael–
Thanks a bunch for this site. I’m listening to a cut in the background as I type this. I spent almost an hour this morning going through these and listening. They are truly magnificent. I haven’t gotten in to the ordering yet because I’ve had such a great time listening to the free stuff. I hope when I do that I find that they ship to the US.
Thanks again.
Cheers–
MRE
Please let’s try again to stop that video from auto-playing – - it happens on the main page and is getting more difficult to find the pause button with each new post!
The trick here is to delay the video-player’s entrance onto the page entirely:
You may have to replace < and > with less/greater-than signs, I’m not sure how it’s going to look in your inbox.
Thanks!
-DC
I’ll do you one better. I just deleted the video. The content of the video is printed below. And who needs to watch this woman who has the demeanor of someone who has overdosed on some kind of anti-Parkinsons drug.
And I deleted your code just to make sure it didn’t do anything nasty once the comment was approved.
Cheers–
MRE
For Joe Matasic:
Here is a starter list of music that you should listen to
1. Brandenburg Concerti – Bach (esp. #5)
2. Piano Concerto #21 – Mozart
3. Romeo & Juliet Overture/Fantasy – Tchaikovsky
4. La Boheme – Puccini
5. Moonlight Sonata -Beethoven (the whole thing not just the 1st movement)
6. Nocturnes – Chopin
7. Claire de Lune and Reverie – Debussy
8. Messiah – Handel
9. New World Symphony -Dvorak
10. Rigoletto – Verdi
This is just a start and it will take you a while to listen through all of this. I’ll be happy to suggest more in the future!
Sometimes it’s good to be the nutty patient. I’ve found that if you want to completely shut down the discussion regarding statins/aces/etc with your internist, simply tell him/her you don’t believe in birth control.
Gets you off the hook till at least mid fifties as a female.
Regards,
Beth, the nutty, with 3 kids under 2.5
ps. Unfortunately valium is also contraindicated in these circumstances! Drat