Monday, January 27, 2014

Whom Can You Best Trust For Good Health Advice?

I recently read a number of articles regarding patients who either second-guess or greatly mistrust their doctors.  Under such circumstances, this apparently increasing number of patients fail to adhere to their doctor's direction(s) and either do not fill prescriptions, take their prescriptions sparingly, or take action contrary to the doctor's advice.

This may not be surprising given the ubiquitous nature of health advice now available through various media outlets, including, TV, radio, print and internet, almost countless newsletters put forth by universities, government, non-profits and commercial entities, and a whole slew of unrelated websites. Scenarios often play out that patients consult such sources prior to the physician visit or immediately thereafter. With many patients feeling that their doctor hardly spends enough time with them, with visits often lasting between 6 and 15 minutes, and with the doctors on average interrupting patients within 26 seconds of explaining why they came in, it isn't surprising that patients are growing more suspicious and turning to alternative sources.

It that wise? The answer is both yes and no. It is wise to become an active participant in your health care and there is beenfit in reading up about your disorder and prescribed treatment. But second-guessing or ignoring your doctor's advice without informing him or her is not prudent. Relying on some alternative generic media source that isn't specifically aware of your medical history, gender, social and family history, lifestyle and diet, stressors, support system, etc. can be outright dangerous. When dealing with alternative practitioners, you could be believing and following the advice of a less qualified and educated person than your physician. Just because they give you the time, and show great compassion and understanding, doesn't make them more capable of helping you.

I'm not saying that there aren't alternatives to prescriptions and that sometimes one is actually better off with such alternatives.  What I am saying is that it's hard to know when you have come across such a viable alternative when such sources usually want to profit from their advice by selling you something (yes, it's true, physicians also profit from their advice, but they usually don't sell things). Even when they don't try to sell you something, the question remains are they strictly relying on science that has been properly vetted or are you just a guinea pig.  My experience is that many of these sources often overstep their boundaries and advocate for unproven or even sometimes repudiated solutions. Worse, they can load you up with a potentially dangerous combination of pills.

A friend of mine, whom I recently helped, was put on a total of ten dietary supplements, some multiple times a day, by a nutritionist for what he said was basically a history of constipation and a family history of diabetes. A thorough review of the supplements revealed that there was much overlap between the products, with some of the nutrients reaching levels more than 50 times the recommended dosages.  Nevertheless, my friend told me that the supplements had solved the constipation. As we continued to speak, he added that he was also taking aloe vela for the constipation, which turns out to have good scientific evidence to support its use for this indication. I explained that he could eliminate all the other products and take the aloe vela alone with some additional fluids to see if that worked for him.

By the way, it took me over 45 minutes to look up and review the ten products, and total the dosages due to the multiple takings, and over an hour to explain to my friend the pros and cons (more cons than pros) of taking the products he was on. The key point I eventually shared was that the risks of combining all these products was unknown and the benefits associated with some of the products were either limited or known to be worthless. The final analysis presented an unknown risk versus limited benefit, and therefore, logic dictated that he should stop taking the pills.

Obviously, you may not have a friend like me who can spend nearly two hours uncompensated reviewing your medical situation with a knowledge of both medicine and alternative medicine,and who can advise you without an agenda.

So what can you do?

I think it starts with finding the right physician, someone who has invested at least a modicum of time in understanding that the prescription pad is not always the first, best, or only solution. Find a physician you are unlikely to second guess and/or with whom you will not feel uncomfortable voicing your concerns. A good physician remains your best bet for getting good health advice as opposed to lots of other people prescribing untested, unregulated, and possibly dangerous alternatives. I know that it's not easy to find such a physician, but it's unlikely if not impossible if you don't look. So instead of spending hours on the internet reading every article you can find about what ails you, invest in a search for a physician with whom you can develop a more trustworthy relationship.

Physicians are not perfect. But at least they are regulated and monitored and if you want to improve your odds of getting good health advice, they are still your best bet.  As Mark Twain once quipped, "Don't take advice from a health book. You could die from a misprint." This advice equally applies to websites, TV doctors, and various other media and print sources. They almost always have a statement disclaiming any responsibility for what happens to you. When was the last time your doctor gave you such a disclaimer?

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