A New Start for 2010: Becoming a Smarter Consumer of Health Care


As we turn a new year, I’m starting this newsletter to help friends, colleagues and clients find the best medical care, and avoid the worst.  We’ve learned from the health reform debates of 2009 how hard it can be for patients to get the right care.  I have some tools I think will help. See the articles below.

This will be the first in an occasional series. Feel free to “unsubscribe” on the button at the bottom of this email, but if you find it helpful, feel free to pass this along to people you care about.

Conflicts of Interest: Why Should Patients Care?

Trust is a basic need we all have when getting health care. It’s a scientific fact that a trusting relationship with the care provider helps the healing process.  We like to think all our doctors and nurses look out for us as their No. 1 and  only concern. But we’re learning that isn’t always true. Conflicts of interest are pervasive in health care, with drug and medical device companies spending hundreds of millions of dollars each year to influence decisions by their doctor clients. And fee-for-service doctors can have their own conflicts when they profit financially from aggressive testing and treatment.

So what can we do as patients?

I tell my clients: Trust, but verify.  Ask questions that might show if your doctor has more than just your interests at heart. Here are two questions you can ask just for starters:

  • “Do you (or, Does your office) accept any gifts from drug manufacturers or sales representatives?  If so, what?” (Read an eye-opening news account about the lengths some drug companies have taken to woo doctors here .)
  • “Who owns the equipment that you recommend I be tested on? Do you have any financial stake in my getting this test?”

Whether or not a patient should get an expensive imaging scan or some other elaborate and expensive test is not always clearcut. But what should be clearcut is that doctors should not have a thumb on the scale when they’re balancing harms versus benefits.  A  news story about what happened when a group of urologists in Iowa ordered a new CT scanner for their office sheds light on this conflict of interest issue.  Read more here.

The state of Vermont requires disclosures of drug manufacturer payments to doctors, and patients there may be able to learn these details without having to ask pesky and embarrassing questions to their doctors.  Read more about the Vermont plan here.

A final thought: No practitioner wants to admit that his or her recommendations for your health care could be influenced by ulterior motives. You will hear plenty of rationalizations and indignant denials if you probe into this at your doctor’s office.  Behavioral research proves time and again that even small gifts can create strong if subconscious incentives to reciprocate, and the real proof is the huge sums that medical device makers and drug companies spend on these gifts.

Even free samples of drugs in the doctor’s office carry a hidden cost that makes thoughtful and careful practitioners question their use. Read more here.

So if your doctor accepts no gifts from manufacturers, and doesn’t even use free samples, that’s a good thing.

I have other articles on my patient safety blog about conflicts of interest in medicine. Click here to read more.

The First Step: It Gets Easier

Asking questions of authority figures can be awkward. But when it’s your life at stake, we need to appreciate that silence can be fatal.  It also helps to know that good practitioners welcome questions and are never too busy to give you the complete scoop.  Here are a few tips to get started on becoming a more questioning, pro-active medical consumer. And remember, it gets easier with practice.

  • Do some Internet research at authoritative, reliable websites. I have culled out a few of the best in my book, “The Life You Save,” and you can read the list here on my book’s web site.
  • Write down your questions and take the list with you to the doctor’s office. (You should also always have with you a list of all medications you are currently taking, and if you have a new health problem you’re trying to get diagnosed, it’s very helpful to write a short history of when it started, what makes it worse or better, and other details.
  • Take someone with you and have them ask questions for you.  This person also can be the reality check to help bring out symptoms that you may be too embarrassed or fearful to mention yourself.


Here’s to a healthy 2010!

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Patrick Malone
Patrick Malone & Associates