New Reasons Why You Need a Second Opinion

Ownership interest in dealers of medical devices can encourage doctors to recommend surgeries that are not medically necessary.

Most consumers view their doctor as a professional who will treat their illness in an objective and unbiased manner.  Unfortunately, some doctors have conflicts of interest of which their patients may be unaware.

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The Wall Street Journal reports a new study that shows that  some doctors invest in dealers or distributors of medical devices used in surgery.  The doctor profits on sales of surgical products.  The profit motive may cause the doctor to refer patients for surgery more often than is medically necessary.(1)

The idea of medical conflict of interest isn’t new, but has traditionally focused on the relationship between doctors and drug companies.  The American Medical Association set for guidelines for doctors to follow regarding conflicts in 2009.(2)  However, there is no measure of how well doctors are following those rules.

A “conflict of interest” is a situation in which  someone who has to make a decision in an official capacity stands to profit personally from the decision”.(3)  Regardless of legality, anyone who makes a  decision when there is a conflict of interest is acting in an unethical fashion.  Judges are expected to recuse themselves (reassign a case to a different judge) when a conflict arises.  Ethically, that’s what every public official or business executive should do.  In practice, most don’t.

At the very least, officials should disclose possible conflicts and let the consumer or patient decide how to deal with them.  Licensed financial advisors are required to do this.  Others should be, but are not.

You don’t want your health to be compromised by a conflict of interest.  Even a successful surgery can have a lasting impact on your quality of life.  That means getting a second opinion on a diagnosis and recommended course of treatment, preferably from someone in an entirely separate medical practice.  If the doctors disagree, you may need a third opinion.

If your doc has a conflict of interest and doesn’t  disclose it to you, you need a new doc.  Integrity matters.


Sources:

(1)  Armour, Stephanie.  “Doctor-Device Deals Need Scrutiny, Report Says,”  The Wall Street Journal.  May 10, 2016.  P. A3.  (Yes, some of us still use printed versions of newspapers.)

(2) Institute on Medicine as a Profession.  “Conflict of Interest Overview”. http://imapny.org/conflicts-of-interest/conflicts-of-interest-overview/

American Medical Association, “American Medical Association Conflict of Interest Principles – Councils, Committees, and Task Forces.”  http://www.ama-assn.org/ama/pub/about-ama/our-people/ama-councils/conflict-interest-principles.page?

(3) http://www.dictionary.com/browse/conflict-of-interest

Assertiveness and Healthcare

Someone has to speak up on behalf of the patient.  Most of the time, that may fall on the patient to do that.  If that can’t or won’t happen, someone else has to do it.

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Consider the following:

  1. Medical care is increasingly complex.
  2. Doctors are human, and fill the complete range from awesome to incompetent.  Some are highly skilled and fully current with developments in their field.  Some let their skills rust years ago, and a few never had them.  I don’t envy them.  Keeping current can require hours of reading every day and travel to medical conferences.
  3. The patient is the first person to know if treatment is or is not working, or if something is going wrong.
  4. As researchers at Johns Hopkins iterated this week, medical errors are the 3rd leading cause of death among Americans.  Estimates of the number of deaths from medical errors annually range from 250,000 to 440,000 Americans.
  5. Medication errors at hospital discharge are a major issue, and one cannot count on medical or home health care providers catching the mistakes.

I’ve seen some of these errors.  My wife has an iodine allergy, and virtually every nurse with whom she has had contact has tried to swab her with iodine at least once.  In her case, any contact with iodine causes anaphylactic shock and she stops breathing.

Breathing is something we tend to take for granted, but it really is a nice thing to be able to do, best understood by those who have had problems doing it.

I’ve had to step in as her advocate.  I make sure admissions and staff know about her allergy and look at the color of substances being applied to her skin.  She isn’t bashful about speaking up, but sometimes she can’t see where the nurse if working.  What she can’t do, I can.

Which brings me to two key concepts: the second opinion and the healthcare power of attorney.

(A)  Second opinions.  Often, medical mistakes have to do with errors in diagnosis, and the wrong diagnosis can delay treatment past the point when treatment can be effective.  Second opinions are also valuable regarding the preferred course of treatment.  As in the case of a friend, one doctor may recommend immediate surgery when another doctor has three or four options that should be tried first.  Because surgery itself can have lasting side effects, it often should be considered as a last resort and not the initial course of treatment.

The second opinion should come from a physician in a different practice and preferably affiliated with a different hospital.  You don’t want personal relationships or conflicts of interest mucking up diagnosis or treatment recommendations.

If doctors disagree, it may be necessary to seek a third opinion.  That’s OK, too.   Your life matters.

(B) The healthcare power of attorney.  Someone needs to speak on the patient’s behalf if the patient cannot or is too timid to do so.  This representative must be someone who is trusted, who knows the patient well, will listen to the patient, will be present to observe the patient’s condition and issues, who will respect the patient’s decisions regarding directives and living wills, and has the willingness to “kick ass” when needed.

Whether in a relationship or not, everyone needs someone in this role.  Regardless of your current health, bad things happen to good people.  On average, each American can expect to cede 9 years of life to illness or injury.  If nothing has happened yet, be thankful.  However, to expect that nothing will is sheer arrogance — if you’re that lucky, how many winning lottery tickets have you purchased?

What do you call someone who won’t speak up for him/herself or have someone else do it?  Deceased.

I don’t want you to go that way.

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Sources:

American Association for Justice.  “Medical Errors.”  https://www.justice.org/what-we-do/advocate-civil-justice-system/issue-advocacy/medical-errors

Hospital Safety Score.org.  “Hospital Errors are the Third Leading Cause of Death in U.S., and New Hospital Safety Scores Show Improvements Are Too Slow.”  23 Oct. 2013.  http://www.hospitalsafetyscore.org/newsroom/display/hospitalerrors-thirdleading-causeofdeathinus-improvementstooslow

McCann, Erin.  “Deaths by medical mistakes hit records,”  Healthcare IT News.  18 July 2014.  http://www.healthcareitnews.com/news/deaths-by-medical-mistakes-hit-records

Johns Hopkins Medicine.  “Medical errors now third leading cause of death in United States,” Science Daily.  4 May 2016.  https://www.sciencedaily.com/releases/2016/05/160504085309.htm

Commission on Law and Aging, American Bar Association. “Giving Someone a Power of Attorney For Your Health Care.”  2011.

Rau, Jonathan. “Hospital Discharge: One of the Most Dangerous Times for Patients,” Science Daily. 2 May 2016.  http://www.medscape.com/viewarticle/862715?src=wnl_mdplsnews_160506_mscpedit_wir&uac=153634BV&impID=1087319&faf=1