We are all patients at some time. Is the medical industry giving us the best treatment possible, at the best price? We all know that it isn't. This new book shows what goes on behind the scenes of the current medical care and how it impacts the patient. Dr. Reznik describes actual cases from his clinical practice showing the most common paths that lead to increased patient suffering. This book offers possible solutions for outpatient, inpatient, preventive, and end-of-life care settings. Learn about: The Medical Box and how it affects the care you receive When to avoid risky and uncomfortable tests Hazards of under-treatment, over-treatment, and mistreatment How to make an informed medical decision in your best interests Cancer and how to approach your treatment Planning for quality of life during end-of-life issues Foreword by Colin P. Kopes-Kerr, MD, JD, MPH, Vice-Chairman of the Department of Family Medicine, and Program Director of the Family Medicine Residency Program, at University Hospital and SUNY Stony Brook School of Medicine, Stony Brook, NY. 'The Secrets of Medical Decision Making should be read by everyone, because all of us are sometimes in need of medical care. It is an eye-opener, a call to arms and a guide.' -Robert Rich, Ph.D., author of Cancer: A Personal Challenge 'Dr. Reznik candidly exposes the conflicting interests inherent in contemporary medical practice. This empowering and insightful book is a must read for healthcare professionals and the patients they treat.' -Beth Maureen Gray, R.N., B.S. 'The Secrets of Medical Decision Making awakens the reader rather quickly with startling revelations about the lack of seriousness the health care industry has towards a society of wellness. If this book at least motivates its readers to become more involved in medical decision making when seeking treatment, it will have succeeded as a critically needed public service.' - James W. Clifton, Ph.D., LCSW 'As a Canadian and a health care provider this book frightens me. This book lays out what our country is headed for if we privatize health care in Canada. A must read for everyone working, or accessing, health care in North America and for anyone who has any doubts that we must take drastic action to preserve Universal Health Care in Canada.' - Ian Landry, MA, MSW, RSW
Physician's Perspective
The term ‘Medical Box‘ is my invention to show 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. I believe it is important for the patient to be aware of them too. Here are what I call the four corners of the Medical Box:
I think most physicians wish to do good and to be genuinely helpful. This wish is impeded by the Medical Box.
Litigation has a potential of disrupting medical practice and increasing malpractice insurance premiums. Being labeled as high risk physician limits one's employability. According to the Association of American Medical Colleges, an average physician who graduated from medical school in 2004 had $115,000 of educational debts! This debt has been steadily increasing. After spending a minimum of eleven years of intense learning, one tends to want to have some degree of comfort, to be able to repay one's debts, and have a feeling of some financial security in order to support a family. All of that is threatened by a lawsuit. Medical mistakes do happen and it is fair to hold the doctor accountable for them. However, the success of a lawsuit does not always depend on the degree or even presence of a mistake on the doctor's part, but rather, on the gravity of the outcome or on chance alone. One of my obstetrical colleagues was successfully sued after her patient's unborn baby died. Though by the standards of medical practice there was no error, it is hard for the jury not to feel overwhelmed by such a tragedy. Consequently, she was deemed guilty, resulting in stigmatization, raised malpractice insurance premium, and a mark on the record that will be questioned whenever she may want to look for another job, or apply for another malpractice insurance.
This record is permanent. It is not surprising that fear of being sued is one of the major forces driving medical decision making in the US today. I attempt to illustrate some of the implications of this in the vignettes of the subsequent chapters where actual patients are described. I am not the only one to believe that the success of a lawsuit does not depend on the presence of an error. Linda Crawford, who is on the faculty of Harvard Law School, where she teaches trial advocacy and has been consulting people on research and evidence-based effectiveness for malpractice depositions, states that five out of six lawsuits involve good medicine, half the time there isn't even a bad outcome (Tracy, 2003). She further states: “Let's talk about brain-damaged children. All of us now go into labor and delivery presuming we will have a perfect outcome. The parents believe it. The family believes it. The community believes it, and frankly the providers believe it; yet, it is still true that we have not made any significant gains since 1965. Five percent of children are born with significant disabilities. There is a gap between what everybody is expecting and the reality. I am all for good relationships with your patients; I think it has a great deal to do with the quality of our professional lives. However, I also look at the specialties and the individual surgeons who are sued, and it often has to do with the expectations of your patients going into whatever the event is.” These expectations are not easily changed and are often the result of a well publicized boasting of the medical system about the great advances we've achieved.
Money and time are intimately related in our society and the medical system is no exception. Beginning in medical school, we (medical students) were repeatedly told that medicine is business. I do not share this opinion but it is now held by the vast majority of physicians. More than that, in medical school we were specifically taught that it is not important for us to care about th
