Oleg I. Reznik, M.D.
The following review was contributed by: Sue Vogan: To read more of Sue's reviews Click Here
In the forward, an interesting question is posed, "where has Marcus Welby, MD, gone -- that prime-time hero of the 1969 medical drama starring Robert Young?" It was a kinder, gentler time, the doctor was a "friend and neighbor to his patients," and we relied less on "bio-engineered pharmaceuticals and high-resolution computerized imaging techniques." "Everything in medicine has changed." The simpler days are gone -- to make way for bio-engineered diseases and high-resolution computer screens.
"The content of medical education has become highly research-based, specialist-oriented, and focuses mostly on secondary prevention (what to do after the disease has already become manifest, and directed only towards those with good health insurance), rather than on the truly life-saving, life-prolonging strategies that comprise primary prevention (steps to avoid the disease in the first place)." Prevention is the best medicine seems to have no place in the health care facility these days. It's another sign that times have changed.
"Physicians are systematically taught to give the same advice to everyone; we do not have the time nor the training to pay attention to individual differences." Dr. Reznik explains how he sees health care; he calls it a "health care machine." He writes that the "race for 'clinical productivity' is turning health care into another form of an assembly line." I suddenly felt like a car part about to be welded.
Reznik uses the term "medical box." It accurately describes the "boxed-in thinking imposed on physicians; the boundaries they need to overcome in order to do what's in the patient's best interest." He lists the "four corners" of the medical box -- "fear of litigation; financial and time pressure; guidelines of health care authorities; and, the current medical model -- disease oriented thinking." Ahh, it's becoming clearer now why doctors behave the way they do. It sure isn't like Dr. Marcus Welby, that's for sure, but I never realized all that physicians have to worry about. I just thought they were there to heal my ailments.
Dr. Reznik presents cases, illustrating the patient/family perspective and offering the same for the physicians, as well. It all started to make sense. Somehow, knowing what the physician sees at my office visits unexpectedly painted a bigger picture, that should provide me with more information with which to make better medical decisions for myself.
Take the case of a "sinking ship," a forty-seven-year-old man with AIDS who was admitted to the hospital because of "fever and cough." The patient's side, "the medical system had helped him on multiple occasions in the past." And, "he understood the seriousness of his condition."
The supervising physician ordered "pulmonary, gastroenterology, and infectious disease consultations." When questioned why so many other consultations, "with a look of a wise man, and after a short pause," he responded, "when your ship is sinking, bring everyone down with you." Reznik explains that the more people on board, whether the ship sinks now or in the future, "responsibility can be diffused or eliminated by transferring it to others." When a physician orders tests, the patient either complies or refuses -- either way, the physician is "protected in either case."
When tests are recommended, Reznik writes, "Don't let him off the hook but inquire about three things. First, what is he trying to find out by testing. Second, how this additional information is going to afford medical management and prognosis. Third, what testing entails, for example, how many blood tests, what are the risks of testing (CT scan contrast can cause kidney failure, angiography can cause a stroke), does the patient have to be kept without food for long periods of time. With this information, one can decide whether additional testing is worth while." The author also recommends, "do not panic and assume that if you let the doctors do everything they want, the best will be done." Remember, the four corners of the medical box -- these doctors have a great deal on their plates. But, "one of the signs of a better doctor is one who gives you true choices about your medical management. A good physician will not impose any measure that can cause harm, even a small chance of harm."
In "The Secrets of Medical Decision Making," you will find many scenarios, all presenting honest, well-rounded perspectives. When we understand the conflicting interests, hazards in the treatment phases, and learn ways to be informed -- it is only a small step to making better medical decisions for ourselves and the loved ones who may depend on us for their medical decisions. "This book offers possible solutions for outpatient, inpatient, preventative, and end-of-life care settings." Not many of us will escape a time for medical decisions and surely, none of us will avoid the end-of-life. But if we are armed with better information, it can only make a better outcome with these situations.
Dr. Reznik "is a Board Certified Family Physician working at the Williamette Family Medical Center and in private practice, on staff at Salem Memorial Hospital, Salem, Oregon."