How Doctors Should Think

Posted on October 11, 2008. Filed under: 8 Causes of Death, Cancer, Cardiovascular, Diseases, Recommended Medical Guidelines |

Every business forecasts its performance predicated on past experience except medicine. Yet, health care could benefit from that approach because there is statistical probability for everything, including health. Most predictable is the fact that some day we all have to be dead. To be dead, there has to be a cause of death.

To predict our likely cause of death, all we have to do is resort to statistics. For instance, statistics prove that two thirds of all death is attributable to cardiovascular causes, such as heart attacks, strokes, and aneurysms. Because we all know the statistics and the primary risk factors (cholesterol, high blood pressure, smoking, obesity, and stress), doctors should be aggressive in identifying and intercepting those risk factors as early as possible. From that alone, we would reduce our chances of dying of a cardiovascular event considerably.

If we can ward off a cardiovascular problem, we can live long enough to get cancer, the second most-common cause of death. Lung cancer is the number one cause of cancer-related death, even in nonsmokers. All that is required to have this disease is that we have lungs. But the main reason it is so deadly is that the medical profession does not screen for it routinely and effectively. The doctor puts his stethoscope on your chest, and if your lungs sound clear, he assumes you are okay. But here’s the catch: He does not know for certain. By the time lungs are noisy enough to be heard through a stethoscope, you’re likely to already have terminal lung cancer. In all cancers, the key to survivability is early detection. Doctors should anticipate these diseases and thoroughly screen patients for them every year.

The remaining causes of death are chronic diseases, acute diseases, accidents, suicide, war, and murder. We are each going to die from one of them.

If the statistics are so clear, why aren’t doctors more aggressive in checking for those problems? The answer is simple: Medical decision making is based on cost and recommended guidelines, which, in turn, are based on cost analysis and optimization curves rather than optimum health. Those standards engender a false sense of security and can actually injure people. For example, colonoscopies are recommended beginning at age 50. But the evidence suggests that at as many as one fourth of colon cancer cases occur in individuals younger than. I observed firsthand the fallacy of the guidelines when a 22-year-old woman with rectal bleeding came to see me. The first doctor she had seen told her she had hemorrhoids and gave her a cream. By the time I saw her and ordered a colonoscopy, it was too late, and colon cancer cost her life.

When I conduct annual physicals, I verify the health of my patients rather than assume it. I conduct aggressive screening for every possible problem, based on the latest statistics. Many of the tests I use are not included in the standard guidelines, and I apply them at much earlier ages. But that approach is paying off: In my practice in San Antonio, I often have no patients in the hospital — that’s right, zero. We also have a much lower rate of heart attacks and strokes than other practices.

All doctors should verify health rather than merely assume it. As patients, we should not settle for less; we should expect it.

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