In this excerpt from Dr. Robert Pearl’s new book, “Uncaring,” the former CEO of the nation’s largest medical group (The Permanente Medical Group), says patients need to ask doctors some difficult questions. And in the Next Avenue article, “How the Culture of Medicine Kills Doctors and Patients,” he spoke with our Managing Editor Richard Eisenberg about what’s wrong with America’s health care system and how to fix it. All proceeds from the book go to Doctors Without Borders.
As U.S. health care completes its transformation toward a more efficient and effective future in the years ahead, Americans will need to protect themselves and their families from those aspects of physician culture that lead to poorer outcomes and higher costs.
Although patients themselves cannot transform this culture, they can influence physicians’ actions. And that process can begin as soon as patients demand it.
Here are five questions that will help protect you and your family from the negative aspects of physician culture while helping to accelerate the transformation of medical practice:
1. What’s this going to cost me?
In polite society, it’s rude to discuss money. In physician culture, it’s similarly taboo to factor the cost of care into clinical decision making. Physicians believe their job is to treat disease and save a life at any cost, not to offer price comparisons for medications, surgeries or diagnostic tests.
This thinking not only is outdated but also wastes patients’ money. As a result, patients overpay for operations and brand-name drugs and some specialists use out-of-network billing to garner added income, hitting patients with surprise medical bills.
Related questions for the patient: Are you in my insurance network? Is the hospital you are recommending for my procedure in my insurance network? Will all of the doctors be in my network? Are there less expensive medications or ways to address my problem? And if so, how will the outcome be affected (if at all)?
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Doctors may not prefer to provide a detailed breakdown of costs and benefits for the care they recommend. But when patients take the time to ask, the care they receive proves less expensive, yet no less effective.
2. Can I email, text or virtually visit with you?
Doctors have always assumed that the best medical care is provided in their offices. As a result, patients are forced to miss work and endure unnecessary inconveniences when receiving routine medical care.
It took a global pandemic to help doctors and patients realize the benefits of virtual care. Not only did telemedicine keep doctors and patients safer during a viral outbreak (by keeping them apart), the experience helped everyone realize how many problems could be resolved through this widely available and convenient form of technology. Whether doctors continue to offer telehealth solutions in the future will depend partly on whether patients demand these services.
Related questions for the patient: Can I make future appointments online rather than by phone? Is there any way to get some of my care through video rather than in person? Can I email or text you with any questions I have? How can I check the results of my laboratory tests online? How do I access my own medical record online?
Doctors can give their patients relief from worry and stress by offering reliable and private access to online scheduling, video visits, secure emailing and relevant medical information. Patients can acquire these timesaving conveniences, but only by demanding them.
3. Who’s going to coordinate my care?
Doctors assume every patient’s care is well coordinated because they presume all their recommendations will fit together if the specialists involved effectively handle their specific area of expertise.
Unfortunately, this is not the case. In a medical culture that undervalues primary care doctors and preventive medicine, getting well-coordinated health care and avoiding medical errors prove harder than they should be.
Related questions to ask: (To your primary care doctor: How closely will you work with my specialist?) (Or, to your specialist: How closely will you work with my primary care physician?) How will the two of you exchange clinical information to maximize my chances of a successful result? How will you coordinate my medical care with the other specialists treating me, both before and after the procedure you’re recommending?
Asking questions about teamwork encourages physicians to communicate with each other, consider conflicts in treatment recommendations and close any care gaps that might exist.
4. Is this procedure or treatment necessary?
Whether it’s surgery for knee pain or yet another painful round of chemotherapy, patents often undergo aggressive interventions, even when data prove they are potentially harmful or no better than a more conservative treatment.
Patients need to ask for evidence of success rates with related questions like: What evidence can you show me that the intervention (procedure, treatment, or medication) you are recommending will work? Are there less invasive options that may resolve my problem?
5. Can we talk about the end?
Physicians are trained to never let the patient lose hope, even if that means avoiding the truth about the chances of dying or living in agony. For physicians, saving a life is the highest virtue, while losing a patient is tantamount to failure (even when providing more care would have been futile).
Related questions: Can you tell me the full range of my end-of-life options, so I can make a fully informed decision? Will you make sure my quality-of-life preferences are added to my medical record? Will my quality of life suffer if I refuse further treatments? And if so, in what ways? When it’s clear to me that I don’t want any more medical care, will you support my decision and continue to help me? Will you connect me with a hospice center or palliative care expert as soon as I’m eligible?
The desired behavior is to get doctors to tell patients the truth when death is possible, likely or imminent. Most people nearing death want their physicians to be honest and they want assurance they won’t be abandoned by their doctors regardless of the choice they make. These questions help patients achieve both.
Sometimes in life, it is better to remain quiet than to speak up. But in the context of being a patient, silence is risky, dangerous and of no value whatsoever.
This article is excerpted from “Uncaring: How the Culture of Medicine Kills Doctors and Patients” by Dr. Robert Pearl, published by Hachette Book Group.
Dr. Robert Pearl is the author of “Uncaring: How the Culture of Medicine Kills Doctors and Patients” and the former CEO of The Permanente Medical Group, the nation’s largest medical group, and former president of The Mid-Atlantic Permanente Medical Group. In these roles, he led 10,000 physicians, 38,000 staff and was responsible for the medical care of 5 million Kaiser Permanent members. He is a clinical professor of plastic surgery at Stanford University School of Medicine and is on the faculty of the Stanford Graduate School of Business.
This article is reprinted by permission from NextAvenue.org, © 2021 Twin Cities Public Television, Inc. All rights reserved.
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