December 4

If your doctor wants to put you on a statin, ask why

34  comments

md-speech.jpg
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.


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  1. That’s great, and long overdue, but how are these doctors going to fit this into the 10 and 15 minute appointments? The appts are already much too short, and usually I find that the doc wants to talk about something (like my cholesterol level) that I find inconsequential and a waste of my time, then there is either no time for the questions on my mind (or the doctor has no answer or any idea of what I am asking about).
    I’ll bet this new initiative takes longer to be implemented than widespread statin therapy every did. Oh well, it’s a nice idea.
    Unfortunately, I suspect you are right. It will not be implemented overnight, that’s for sure.
    Cheers–
    MRE

  2. Hi Mike,
    If you follow the link and blunder around for a while (well I did!) you find the “question builder” page);
    http://www.ahrq.gov/questionsaretheanswer/questionBuilder.aspx
    The first set of questions relate to a prescription for medication and most of them are quite sensible (although I’m sure the average MD would be horrified if each and every patient arrived armed with this list and any others relevant to their condition and wanted to ask and understand the answers to all of them!) but you’ll note there are two questions missing – the ones you suggest – why? and what evidence is there that this will benefit me?
    Whist on the subject of questions – I imagine you will have read the latest paper;
    http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=18046594&ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum
    and the nice press release that went with it where Jeff Volek came up with the nice variation on the old line “You are what your body does with what you eat.”
    http://www.eurekalert.org/pub_releases/2007-12/sdmc-ldr120207.php
    The question is about the ‘worsening’ of the n6:n3 ratio for the low carb group – which you would imagine (as they say) would be an inflammatory influence but the inflammatory markers improved significantly more for the low carb group anyway. Was there something about the fat intake of the low carb cohort which caused the change? – either way, I guess they would have done even better if their omega 6 fat intake was restricted?
    Cheers,
    Malcolm
    Hi Malcolm–
    I’m in the middle of a post on the very paper you cited above. I’ll get it finished if I can ever get all these comments dealt with.
    Cheers–
    MRE

  3. Bravo! This is well over due and although I think you’re right about it taking a while to catch on I think that it is great! I am always surprised when someone tells me about medications that their Dr gave them and they have no idea why they are taking them. I don’t know about the rest of you but I have a special relationship with my MD. He tells me the medications he thinks I ought to be taking and I tell him why I am not going to take them. (snort) However, he also knows that when I am really ill I will do whatever we decide is best for the problem.
    I think this might come from years of doing rounds with him though when he was the Medical Director of the facility I used to work at.
    He does make me pay though… when ever I have an appointment I can count on a gaggle of med students in to ask me questions about my Fibromyalgia etc. I once had some fatty tumors removed and had an in office audience of ten people to watch. Hopefully they realized that my ability to give them all a hard time with questions while they were watching is the way they should interact with all of their patients.
    I agree. I hope the med students learned more than simply how to do the procedure.
    Cheers–
    MRE

  4. I think this might be starting in my area already!
    I about fell of my chair yesterday on my first visit to a New Endo…..which I’m sure would have caused someone to order some tests for something having to do with falling off chairs….but I digress.
    I went prepared to defend my position on not taking anymore of those statins, and having just had a heart scan to prove that my arteries are clear, thank you very much, and prepared to defend low carb diet and to demand an insulin pump for finer control.
    She didn’t argue with me at all! In fact she agreeded that some of the symptons that I was having with Lipitor, which have now disappeared thank you very much, were not things that we should have to live with. She also agreeded that I was doing low carb the right way in that I eat from all food groups and don’t just live on Bacon like Atkins, which at this point since I seem to be winning the war I didn’t argue. I also let go of the sides of my chair.
    She also agreeded that I was not a typical Type 2 Diabetic I should not be treated like one! You should have seen her eyes bug out of her head when I described my near miss with fatal lactic acidosis while taking Metformin/Glucophage.
    The paperwork starts today on the insulin pump!
    I just wonder if it will be as stubborn as my computer when I scream at it. Dh says screaming at computers does not help and always wants me to check my blood sugar when I start screaming at the computer. Have you tried screaming at your computer to fix that thingy that keeps talking? I hope your lovely wife will not start making you poke your fingers if the screaming does not work. Running away does help.
    Be well,
    Ressy
    Hi Ressy–
    Haven’t tried screaming yet, but that’s the next step.
    Cheers–
    MRE

  5. My doctor has put me on blood pressure medication. I don’t know what my blood pressure is. At home it runs fine but when I asked him why the medication he said, “So you won’t die.”
    This medication, Lisinopril 5mg, will not be part of my life after this Thursday because I will refuse to take it. It causes my heart to race and almost a kind of panicky feeling. After the first week or so I started taking it once every other day because the reaction is awful.
    (Thursday I’m going back to the doctor, who by the way, hasn’t read and is not interested in reading “Good Calories, Bad Calories”)
    He should have the results of my cholesterol test and if it is high and he suggests Statins, I am out of there. I will find another doctor who isn’t so gung ho on pills.
    Good luck. I wish you well.
    Best–
    MRE

  6. For some reason, my dial-up connection loads your latest blog real slowly!
    My doctor has always made sure that I understood the results of all tests that were performed and what any medication was for and what to expect from it.
    Of course, after he got me off carbs and on to low-carb eating, I haven’t had to see him for 5 years.
    If you’ve got a doctor who makes sure you understand everything and who got you off carbs, don’t let him get away.
    The dial-up is probably slow because of the embedded video.
    Cheers–
    MRE

  7. This sounds more like Big Mother than Big Brother. No teeth towards enforcement and general overcare for the sheeple who don’t care enough to be assertive with a contractor/consultant.
    It has dawned on me that a doc, be s/he a primary care doc or a specialist, is essentially a consultant or a contractor, hired by me to advise and intervene on a project, my health, for a fee paid by me, my agent (United Health Care’s MAMSI Fed program), or some combination of the two. With this realization has come some understandings:
    1- No consultant is right, 100% of the time.
    2- No consultant is even 100% up to date on the broad literature in their field.
    3- It’s perfectly acceptable to ask a consultant to come up with a solution that meets your operating parameters.
    There’s more, but essentially, when you view your doctor as not terribly different from your kitchen remodeler, McKinsey consultant, accountant, lawyer, or really anyone else you pay for their expertise and experience, the better off you’re going to be.
    This approach does not necessarily denigrate the medical profession. Well, unless you believe that all Docs are as Docs prosecuted on Law and Order and have underlying God complexes, in which case I guess it rightfully brings them down a couple of pegs. But this is essentially what Big Mother is upto here.
    (Of course, if you’re a conspiracy theorist and want to follow the slippery slope, a government agency based in the Bush Whitehouse is urging for a more customer friendly approach from doctors. This is the same parent company that is pushing for limited damages from malpractice suits, if not the outright abolishment of the tort system as we know it. Now, benignly, studies show that patients who feel good about their docs are unlikely to sue for malpractice, even when malpractice was done. Less benignly, might this open the door to a doc defending malpractice with some attempt at, “The patient knew everything we were doing and why and still signed off on it, despite being fully informed of the risks,” or worse, “The patient nixed what we wanted to do, which would have avoided this outcome.” Both seem pretty far fetched, but we know that the current configuration of the party in charge of the Exec branch is very anti-tort, with malpractice being second to corporate lawsuits in their ire.
    Hey Max–
    I pretty much agree across the board. I think docs ought to be regarded as healthcare consultants. And I hadn’t thought about it, but I would imagine that including the patient in all decisions and making sure said patient is fully informed would decrease the incidence of malpractice lawsuits.
    Cheers–
    MRE

  8. You’re getting 10-15 minutes with your doctor? Feh! I’m feel lucky if I get five!
    Although now that we’ve moved out to the country, I have to admit, life out here is much slower paced. I hear the doc we switched to even makes house calls. 😮
    Housecalls would be great! Let me know if the doc really makes them.
    Cheers–
    MRE

  9. Thanks for this post Dr. Mike.
    I would guess that many of your regulars have already, partly as a result of the great info gleaned from your books and your blog, resolved to take charge of their own healthcare, but have been struggling with getting cooperation from their docs. So the rest of this is my rant du jour:
    Besides the issue of getting questions answered, and the time factor noted in a comment above, docs also need to alert their patients to all potential side effects of meds about to be prescribed, including those that the pharma companies claim are unlikely to occur except in a small minority of ingesters. So part of “taking charge” also means being extraordinarily alert to what’s going on after one starts taking the stuff. (The pooh-poohing by docs when a patient has genuine complaints by saying, “just accept this as part of growing older” seems in reality to just be another way for the doc to say “don’t bother me, I’m too busy.”) Also, docs need to address the patient’s concerns expressed in advance about starting on prescribed meds (statins being one egregious example) or undergoing recommended procedures without blowing off their concerns and refusing to review materials that the patient may bring along that tend to validate the patient’s concerns. In other words, there must also be a change of attitude by docs who tend to regard their patients as not knowing anything, or being stupid.
    Best,
    W
    Feel free to rant here.
    Cheers–
    MRE

  10. Yipes! Now I’m hearing double!
    They are just NOW suggesting that patients be “allowed” to take part in their own medical care!!!???!! I have been one to ask questions, do my own research, refuse procedures and medications, and otherwise been a thorn in the side of many of my doctors for at least 40 years. And I understand my mother was like that before me.
    If we have to wait that long for low-carb to catch on with mainstream medicine, then heaven help our children and grandchildren.
    Let’s hope we don’t have to wait all that long.
    Cheers–
    MRE

  11. Thanks for the information. Much appreciated.
    I couldn’t help but notice that this post is a little…how to say it…twisted-up over how to portray the content.
    On the one hand, you clearly agree with the recommendations of the US Agency for Healthcare Research and Quality. And who wouldn’t? They are proper and helpful recommendations.
    On the other hand, the fact that it comes from “governmental folks” seems to bother you, for reasons that aren’t clear from the post. You go so far as to really disparage the federal agency – calling it “Big Brother” – even though the agency is just making recommendations (not laws, not demands, just recommendations) and the recommendations are sound.
    What’s up with that? Is this a case of having a pre-existing hypothesis that can’t be shaken by new evidence (in this case, the hypothesis can be expressed as “government=bad”)?
    Hi Rico–
    I’m of the opinion that most decisions those in government make are wrong. But the law of averages militates that once every now and then they’ll get on right, as they did in this case. But just because they got this one right, won’t give me a whole lot of faith in the next decision that comes down the line.
    Cheers–
    MRE

  12. NO FAIR !! You “tease” us with apicture of the choral but then don’t post a video of at least one song. Can you get someone to video and post to utube so we on the east coast can enjoy also. Pretty PLEASE !
    Hi Larry–
    I didn’t figure there would be any interest. Now that you’ve commented, I’m working on it.
    Cheers–
    MRE

  13. No matter how much time the doctor spends with the patient, it’s still the responsibility of the patient to research the medicine before he decides to take it. Yes, doctors usually don’t take enough time to actually talk to the patient, but we can’t put all the blame on the doctor.
    I can’t imagine taking any medicine, prescribed or not, unless I know exactly why I need to take it, and what side effects come with it. Whether the benefits of the medicine outweigh the side effects, or whether putting up with the problem, or trying to correct it with diet, would be a much better option. Just because a doctor prescribes it doesn’t mean I need to fill the prescription without first doing some serious research. We just can’t have the thinking that, because the doctor is trained in medicine, he must be right in prescribing such-and-such a medicine, without our taking the time to ask “why”, or looking into it ourselves.
    Perhaps doctors would have more time to spend with patients if people didn’t run to the doctor for every little ache, pain or perceived illness, demanding medicines they really don’t need because they saw the ad on tv or in a magazine. (Ask your doctor if (insert name of popular medicine) is right for you!) Save the doctors visits for real illness.
    Agreed on all counts.
    Cheers–
    MRE

  14. Well, after reviewing my rant, I probably should have tried to balance it with an acknowledgment that not all the blame here should be placed on practicing physicians. A big part of the problem is the broader medical insurance / services delivery system (I’m not using the term “healthcare” anymore because too many other factors – such as business considerations and $$ – are in play within the system other than the individual’s health) which also includes the legal / conventional tort law system which apparently causes docs to be overly defensive. Another issue, in fairness, is that it seems to be the case that docs, especially those involved in primary care, aren’t really getting paid for the “cognitive” services they provide, such as diagnosis and otherwise thinking about (maybe even researching?) what is best for the patient. Rather, more of the medical $$ go for tests and procedures which seems to mean that docs (surgeons) involved in more invasive activity get more $$, often involving high risk and/or not having much real benefit for the patient. I guess nowadays almost everyone agrees that this system is really badly in need of reform. Maybe some day Dr. Mike when you have a totally free week with nothing to do but play golf (does that ever happen nowadays?), you might wish to blog about this.
    Best,
    W
    Hi Wil–
    I don’t need to blog about it – you’ve summed the situation up pretty well.
    Cheers–
    MRE

  15. Hm, “it’s the right thing to do” sounds nice but … to double the time per patient? Maybe if the lady had said, “if you want to stop the arterial bleeding of educated, engaged patients over to the alternative practitioners, why don’t you do what they do and make it a partnership. Otherwise you will get only the elderly and those who think doctors are gods and those people are dying off and drying up and so will your practice.”
    ??
    Excellent points.
    Cheers–
    MRE

  16. Hi Doc,
    Take the original code:
    and substitute:
    (But be careful of any carriage returns that the blogging software might insert, as these will break the code. Remember: no line breaks, please.)
    And now for something completely different:
    A week ago Deutsche Gramophon put their ENTIRE catelogue online, the first major classical reocrd company to do so, including some 600 recordings no longer available in the shops. URL:
    http://www2.ffm.deutschegrammophon.com/
    Sound quality is exceptional as the bit rate is 320k. The files are also much bigger than iTunes Store stuff. No digital rights management at all! (Yeah!) You are allowed to burn audio CDs for your own use. Genuine HiFi, not your usual iPod quality! Warning: the site is highly addictive! I’ve already bought heaps. And much more convenient than going to the shops. A Java app will download an entire Opera for you and then all you’ve got to do is drag an icon into iTunes and voila! you’ve got the album cover, all the notes and libretto in pdf and everything else. Burning the CDs for your car’s player or your HiFi rig at home is easy peasy.
    Definitely low carb.
    All the Best,
    Michael Richards
    Hey Michael–
    Thanks for the DG link. It has already cost me money. I clicked on and the first thing I saw was Paganini’s 2nd violin concerto played by Salvatore Accardo, which I used to have on an LP record and played until I wore the grooves out while I was taking violin lessons. Now I have it in MP3. This could become an expensive habit.
    Cheers–
    MRE

  17. Help, something happened to the code!
    Here we go again, this time without the naughty angle brackets:
    embed src=”http://video.medscape.com/images/565/951/wve113007.swf” type=”application/x-shockwave-flash” id=”application/x-shockwave-flash” name=”application/x-shockwave-flash” quality=”high” base=”http://video.medscape.com/images/565/951/wve113007.swf” wmode=”opaque” scale=”noscale” salign=”lt” allowscriptaccess=”always” height=”260″ width=”260″
    embed src=”http://video.medscape.com/images/565/951/wve113007.swf” type=”application/x-shockwave-flash” id=”application/x-shockwave-flash” name=”application/x-shockwave-flash” quality=”high” base=”http://video.medscape.com/images/565/951/wve113007.swf” wmode=”opaque” scale=”noscale” salign=”lt” allowscriptaccess=”always” height=”260″ width=”260″ autostart=”n”
    Surround with the two angle brackets.
    I hope my previous post does not mess up the page with an army of “Hello I’m Doctor…..” bots.
    Michael Richards
    No “Hello, I’m Doctor…” bots, thank God. But I tried the code changes you sent in this comment to no avail. The thing continues to play as before. Perhaps what I need is not the appropriate code, but an exorcist.
    Cheers–
    MRE

  18. I hate seeing my doctor. My old one was very on top of things, wanted to see me TOO much I think. He moved and I hate the new one. I’m very proactive in my care. I need anti-depressants and when the old one stopped working at the highest dose I went to my (old) doctor and specifically knew what to ask for because I researched it ahead of time. Another time I asked for Ativan for anxiety. He said he’d give me Xanax, which was okay with me.
    My new doctor…he’s just a way to give the prescriptions I need. He shows zero interest in me as a person. :-p
    Too bad about the new doctor. Maybe you should change to another that you like better.
    Best–
    MRE

  19. Doc, Michael Richards and whomever else has suggestions:
    I’m going to check out the website, but would really have no clue what to buy. I starting to more into classical and opera but basically know nothing about it. I just buy stuff from the “popular” composers and then see if I like it. So, some suggestions would be good on stuff to buy. My collection now is limited to the Nutcracker, Mozart’s “Greatest Hits”, Fantasia, soundtracks and some random stuff. Pretty pathetic for a music junkie with over 1000 cds.
    Joe
    Hi Joe–
    I’ll throw this out so that Michael and others can chime in. I’m in a major time bind right now and I have so many classical favorites that I don’t know where to begin. Classical music is so diverse that it’s tough to make recommendations. I played at the violin for a few years so I’m kind of partial to virtuoso violin pieces simply because I can appreciate the virtuosity. So, for me, almost anything by Paganini (except the 24 caprices of which I’m not all that crazy about), especially his stuff for violin and guitar (because I also play the guitar), the Bach, Mendelssohn, Beethoven, Bruch and Tchaikovsky violin concerti, and any thing by Pablo de Sarasate are what I would start with. Oh, and I forgot, one of my heroes, Fritz Kreisler, whom, had I only know, I could have heard play because our lifespans intersected. I’ll think some more on it.
    Cheers–
    MRE

  20. My doctor is considering putting me on statins, and has no interest in hearing about Taubes et al. He thinks it’s clear that a “calorie is a calorie.”
    I like him, so I just nodded. But I won’t be taking statins, and I’ll keep doing low-carb, to the extent my willpower permits.
    I really think doctors (and, of course, dietitians) are the weak link in good nutrition. Where the rubber meets the road, it’s amazing how little the average GP knows about human diet and metabolism…and how uninterested they are in learning.
    We need a billionaire willing to buy a copy of Good Calories, Bad Calories for every GP and dietitian in the land. (Not that they’d read it.)
    You’ve hit on the problem. You can buy them the books, but you can’t make them read ’em.
    Cheers–
    MRE

  21. 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

  22. 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

  23. 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

  24. 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

  25. 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

  26. 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.

  27. 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

  28. 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

  29. 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

  30. 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

  31. 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!

  32. 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 😉

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