The art of medicine is generally
a question of time.
— Ovid
If violating any of the laws of wellness were a punishable offense, a large portion of Americans would be in jail. By far the most violated law in this book is the Law of Minimal Medical Invasiveness.
Honor and esteem the doctor who says, “We want to treat you right but do only what is absolutely necessary, and with minimum side effects. We’re going to help your body heal!” Here is a person who understands the Law of Minimal Medical Invasiveness.
Everybody has an explanation for why health care costs so much, in terms of both time and money. Greedy doctors, inefficient hospitals, patients eager to sue for malpractice, unnecessary tests, risk-averse insurers, mountains of paperwork, excessive care for the elderly and the terminally ill. Take your pick.
The bill is huge. Health care costs us a trillion — yes, trillion! — dollars per year.
As I write this, a huge debate rages in Washington between the president and Congress over health care reform. But health care is really a misnomer. The debate is actually about the way health care is financed. What they’re talking about is who’s gonna pay, and how much.
The real health care revolution is right here in these pages! The very concept of total wellness is a revolution. What we should, and must, debate is the efficacy of medicine — the value we get for our health care dollar.
Who is the most important person on your medical team? Do you think it’s your surgeon? Your internist? Your cardiologist or oncologist? Maybe your nurse, a technician, or your spouse?
Understand this clearly: the most important person on your wellness team is you. It is your wellness we are talking about. Your health is at stake. You are the central character. You are in charge.
One of your most important challenges is to ensure that your medical treatment is as minimally invasive as possible while still being appropriate. The facts are startling. Studies show that if you live near a major medical center, for instance, you are more likely to have a prostate operation, a hysterectomy, or any number of other procedures. We have been conditioned to believe that this is good — that quick access to medical care is critical, that these operations are appropriate.
However, the statistics tell us that people who live in rural areas far away from major medical centers and who do not undergo these operations have about the same survival rate as those patients who do have the procedures.
The Law of Minimal Medical Invasiveness does not mean we don’t visit a doctor. It does mean we challenge each and every test and procedure. Too often people surrender leadership to their medical team without knowledge of either the prescribed procedures or the expected outcome.
One of the saddest and most suppressed statistics of our time is that the rate of hospital-acquired infections has doubled over the last ten years. According to the People’s Medical Society, 35 to 40 percent of all hospital patients come to the hospital because of something a doctor did to them. Four of every ten people admitted to the hospital are there as a result of the medical care they received. And if you add up all the deaths in this country that are estimated to have been the result of medical mishaps, errors, and negligence, you come to a shocking realization: health care is America’s third or fourth leading killer!
The Law of Minimal Medical Invasiveness demands that medical patients become medical consumers and assume a new, proactive role in the treatment of illness and the maintenance of health.
This is especially important for women. The American medical establishment seems to consider being a woman a disease rather than a gender description. Countless medical tragedies have been perpetrated on women. Consider the following:
We can’t afford to be passive consumers. We must become active participants in our care. What we need is clinical reform — the reevaluation of all medical procedures based on medical need and effectiveness rather than financial grounds. And minimal invasiveness lies at the heart of clinical reform.
I encourage you to see yourself as the manager of a baseball team (or use whatever organizational analogy you like). Your goal is to keep yourself well, or get well again if you are ill. You’ll want a strong starting pitcher; many times that is a doctor. And you’ll want to assemble other team members: a catcher, infielders, outfielders; equate these with specialists, technicians, family, friends, and a support group, all part of your wellness team. In some cases you may even want a short-term relief pitcher, a surgeon.
But remember who is the manager. You are! You are in charge. You decide who is on the field at any given time.
Knowledge is required to make these decisions. To acquire the facts, we need to study. That’s right, study! Become an expert. That’s what a real manager does. It’s all part of being certain you are receiving the right care.
Know this: the dangers of being overtreated are at least as great as the dangers of being undertreated.
Let’s take the case of Al Marconni, for example. Overweight and suffering severe chest pains, he was pushed into bypass surgery. For several months he felt better. But the weight never came off. He still smoked, had a few Scotch and sodas every evening, and seldom exercised. He’s now battling emphysema.
What did Mr. Marconni really need? It’s clear that heart bypass surgery was way down on the list. He needed to change his lifestyle; diet and exercise would have been a good start. And he needed to throw those cigarettes out the window.
But Al Marconni was looking for the easy way to better health. So he agreed to an operation.
Least invasive — that’s the seminal issue. How can my health be enhanced with the least physically invasive, the least chemically toxic, the least psychologically violent approach?
Vicki Hufnagel, an obstetrician-gynecologist and gynecologic surgeon, reports in her excellent book No More Hysterectomies that hysterectomies are performed in the United States at double the rate for the United Kingdom. “Are we sicker than our Continental cousins?” she asks.
Hufnagel cites the ease and availability of hysterectomies in the United States as the reason for the different rates. She believes the American medical profession must radically change its thinking on elective hysterectomy for benign disease. And patients must become informed, participating in each medical decision. Only then will we be less likely to undergo unnecessary surgery.
The best way to improve health is to change our behaviors. The call goes out for each of us to become better, more informed purchasers of health care. Then we can team up with those who provide health care and demand and get the best, least invasive treatment possible.
Enlightened medical professionals are becoming more numerous. “I learned a lesson twenty-five years ago,” said Michigan dentist Robert Ludwig. “The patient in the chair had severe gum tissue disease. I recommended a visit to the periodontist where the diseased tissue would be cut away. The patient said, ‘Let me try something for six months. If it doesn’t work, then I’ll go through with the surgery.’”
Six months later the patient came back with beautiful, healthy gums. “What did you do?” asked an amazed Dr. Ludwig. “Vitamin E,” beamed the patient. “Every morning and every evening, I’d bite into a vitamin E gel cap and rub the oil into my gums.”
“I was reluctant to share this with my peers,” said Dr. Ludwig. “The dental literature reported nothing of this approach and the accepted practice said, ‘operate.’ But I now believe this has merit in many, many cases.”
Least invasive but still appropriate. That’s the answer. But when you’re a hammer, the whole world looks like a nail; to a hammer, every problem needs a heavy hammer blow. If you’re a surgeon, every problem has a surgical cure. If you’re a radiation oncologist, every problem has its solution in radiation. If you’re a pharmaceutical manufacturer, every problem has a solution in drug form.
The trouble with this approach is that the whole world is not a nail; a hammer blow is not always required. One size does not fit all.
Understand the implications. The Law of Minimal Medical Invasiveness has a corollary that says, “American medicine is first and foremost a business.” This means that the people you are counting on aren’t always thinking of you first. They have payrolls to meet, mortgages to pay. Sometimes this means you’re over-tested, overtreated, and given care that does not honor the Law of Minimal Medical Invasiveness.
Medical consumerism, and a commitment to personally practice total wellness, are necessities if we are to live a full life. The guideline of seeking the least invasive yet still appropriate medical care should be inscribed over the doorway of every medical practitioner’s office. Until that time comes, we medical consumers will do well to inscribe it in our minds.
It’s the Law of Minimal Medical Invasiveness.