Prominent physicians are beginning to speak publicly about medical overuse they themselves have experienced. These public expressions give legitimacy to concerns about medical treatment that does more than good. They may spark an awakening among listeners and invite others to reflect on their own experiences and talk about them. Telling the truth about the unspoken is courageous, and courage is contagious.
Dr. Don Berwick, president and CEO of the Institute of Healthcare Improvement, is revered nationally and internationally for his work to help health-care professionals learn how to improve the care they provide to patients. In a speech to several thousand physicians, nurses, hospital CEOs, and other leaders in American health care, he shared the story of the unnecessary and excruciating surgery to repair his right knee, which he had injured while playing soccer as a medical student. His kneecap became dislocated, reset itself, and later became dislocated again. A surgeon operated on the knee. The recuperation was agonizing and the operation unsuccessful. The young medical student’s kneecap became dislocated once again.
Looking back on his painful ordeal, Dr. Berwick reflects, “As it happens, I don’t think I ever needed surgery on my knee in the first place. I certainly didn’t need the extensive, painful, since-discredited procedure that this guy tried on me for his first time. The . . . problem I had was pretty minimal, and now I think that a brace and some exercises would have been enough.
“I think I fell into the very trap that . . . in health care, supply drives demand without regard to the quality for outcomes of care. . . . Do I believe for a minute that that kind surgeon secretly rubbed his hands together greedily and cackled, ‘hee, hee, hee—another knee I can make money on.’ Not on your life, I’d bet my life—actually I did bet my life, didn’t I—that that surgeon believed he was going to do me good. I am sure of that."
“But the fact remains: now I know that I had useless surgery for a nonsurgical problem. My surgeon and I didn’t know that then. I have a screw in my knee for no good reason at all. My knee got screwed unnecessarily.”
The prescription for good care—and the avoidance of unnecessary and inappropriate treatment—is the routine and systematic collection of objective information by doctors about their patients’ outcomes. When this information is examined in an unbiased way, shared among doctors, and publicly reported to patients, doctors will know whether their work has benefited their patients. More important, a fund of knowledge will be built about what medical interventions are effective and what are not. And that knowledge can be applied for the benefit of many.
Socrates once said, “The unexamined life is not worth living.” It may also be said that “unexamined medical practice is not worth practicing.” A thorough examination of the medical care provided to patients is one of the best prescriptions for your health.
Your doctor tells you that you have cancer. Or your doctor says you have a ticking time bomb in your chest and at any moment could suffer a fatal heart attack. Imagine that you have surgery and find out later that you never had cancer or heart disease. A medical mistake, such as a mislabeled test result for another person, was not the cause. How can this happen?
Reprinted with permission from Ivan R. Dee, publisher.
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