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Old 10-19-2011, 12:51 AM
 
Location: Ohio
3,441 posts, read 5,354,863 times
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But those type of articles fail to list the percentages of the deaths would have occurred without medical intervention, not to mention the numbers just don't add up.
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Old 10-19-2011, 06:14 AM
 
52 posts, read 71,427 times
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Originally Posted by suzy_q2010 View Post
The first country --- actually more of a small city --- on your list is Monaco, with a population of a little over 30,000 and the highest per capita income in the world. Unemployment is zero percent. There is very little crime.The country has mandatory state funded health care. I venture to say the reason for the high life expectancy is a reflection of access to medical care and is not because people in Monaco reject allopathic medicine.
my point wasn't that they live longer becuase they reject anything, only that dispite being the top consummer of meds by a huge diff we dont live much longer than anyone els so.. the amount of meds we are taking as a nation is really unnecessary and a bit overboard.

besides that was just one country.
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Old 10-19-2011, 06:59 AM
 
Location: Durham UK
2,031 posts, read 4,850,067 times
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Quote:
Originally Posted by suzy_q2010 View Post
Anyone has the right to decline treatment or testing at any time.

However, you supposedly are going to a physician in order to take advantage of his knowledge and expertise. Why bother to go if you do not wish to follow his advice?

It also seems a bit dishonest to just toss the script.

Why not ask the doc, "What will happen if we do not follow this line of treatment at this time?"

For example, many people put off having a colonoscopy because they dread the prep and they find the procedure embarrassing. The consequences of not doing the test can be a cancer down the road that could have been prevented by removing a polyp.

As far as procedures in the over 90 age group are concerned, keep in mind that not every person in that age group has dementia. Some are even still living independently or semi-independently. For such a person, the insertion of a pacemaker could be very worthwhile with a significant improvement in quality of life.

Some tests are done for diagnosis, such as a colonoscopy in someone who has had bleeding, and some are done for screening, such as a colonoscopy in someone with no symptoms at all.

Blood tests done for screening often come back normal, which is good. You would never find out about diabetes if you never had your blood sugar tested, though.

The fact that a test comes back normal does not mean that it was not indicated.

At the end of every visit to your doctor, you should understand what your diagnosis is, the alternatives for treatment, and what to expect if you do or do not have the treatment that the doc recommends. This requires a dialog. If you just sit there, take the script, and then throw it away, you mislead the doctor into thinking you understand his reasoning. If you never ask what the rationale behind his thinking is, you may make a decision that would be different from what you would have made if you asked a few more questions.

Then you can make an informed decision that you and the doc both agree on. Be prepared, though. If you are confrontational, challenge everything the doc says, and refuse things the doc feels are reasonable and prudent, you may be asked to find another physician because the doc does not want to deal with the potential fallout of your decisions down the road.
Doctors come in all shapes and sizes and, like any other prfessions,there are good ones, not so good ones and bad ones.
They work for private companies, that are often for profit, and do have a certain amount of pressure on them to generate income.
Therefore it's always difficult to know exactly what they have in their mind when they are prescribing investigations and interventions.
Are they following the most up to date evidence based guidelines?
What difference does this make to me.personally.
These are 2 of the questions I ask myself and that people should ask a Doctor.
No two people are the same-everyone has different risks- for particular disease development BUT also for side effects/complications of investigations and interventions.

If I was recommended to have a colonoscopy then I would first want to have a sample of faeces taken for occult blood. Depending on the result of that then maybe I would decide.
It should all be about taking a good history and trying to assess the individuals risk BEFORE doing investigations.They should never be a substitute for a GOOD HISTORY and my opininon is that often they are.

I actually cancelled a colonoscopy that my PCP referred me for.
I went to the Gastro for an office visit and was in and out in 5 mins.Actally it was 45 mins, but 40 mins of that was waiting for the Dotor!
His history taking was minimal and he explained nothing about the procedure. I asked if it was done under sedation and he said "no-we use MAC" as he was wlking out the door. Now I'm a RN but from the UK and I didn't have a clue what MAC was till I googled it.
I was VERY peturbed that the only info I was given was by the person that scedules the appt. I asked about polyps and she said "they'll remove them there and then".
The combination of the fact that I was going to go there with no pre-op assessment , be asked to sign a consent form and have a general anesthetic for a minor preocedure that doesn't require one, plus the fact that I felt I was low risk helped me to decide not to have it done.

I never received a letter saying that they strongly recommended I have the colonoscopy and my PCP never mentioned it next time I visited him.

You can't compare a blood test for diabetes with a colonoscopy under GA.
The first is almost risk free and minimally invasive,however the second isn't.

Doctors are not gods!

There's recently been some articles around regarding the PSA blood test for prostate cancer that are interesting.
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Old 10-19-2011, 07:23 AM
 
Location: Durham UK
2,031 posts, read 4,850,067 times
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Quote:
Originally Posted by Jellybean50 View Post
Exactly.

If you dont feel comfortable enuf to talk to your doctor about everything, then you need a new doctor. You shouldnt accept a prescription just to throw it away, or act like you are going to do what they tell you to and then DONT do it. They have your health in mind. Tell them you dont want to take the pills, or that you'd rather discuss a better treatment plan.

My family doctor asks me so many questions every time i go in, before he even physically examines me. There ARE good doctors out there. If you dont like your doctor, please find a good one. They get paid to take care of their patients. Dont fool them into thinking they are taking care of you if they are not. YOU have to take the initiative to be proactive when it comes to your health.

WTS, each pill i'd try for my arthritis pain - i'd try for the amount of time necessary to see if it worked, and if it didnt i wouldnt take it any more and i'd tell him. I guess that's the extent of treatment i've 'refused' so far. I have also refused dental work until i had the money to pay for it - becuz it costs so friggin much!

My mom was getting chemo in her 80's, and had a weak heart. She had to stop it about midway thru due to weakness. She just could NOT take it anymore, and the family agreed with her decision. She did get a letter from the cancer specialist 'scolding' her for doing it, and warning her that the cancer may come back. We were apalled as a family that he would do that to a woman of her age (altho we thought maybe it was done for legal reasons). My sister wrote him a fine letter back, though


The problem here was his initial decision to prescribe chemo in the first place.I wonder what figures he gave you regarding the mortality/survival rate of the cancer without treatment (in your mothers particular case) VERSUS the risks/benefits of the treatment?

I am staggered by the fact that many cancer docs here will prescribe aggressive courses of NON-CURATIVE treatment following diagnosis of very aggressive, metastatic cancer.
The person and family ends up spending the last 3-6 months of their life undergoing unpleasant, invasive treatment with a very poor quality of life
and a horrendous bill for the privelage
The alternative is maybe 1-2 months of palliative care with a better quality of life for all concerned, including the family.

Do you know that the US has one of the lowest rates of cancer survival in the developed world-despite all the screening and treatments?
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Old 10-19-2011, 09:45 AM
 
Location: Georgia, USA
25,337 posts, read 30,148,995 times
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Quote:
Originally Posted by NomadQueen View Post
my point wasn't that they live longer becuase they reject anything, only that dispite being the top consummer of meds by a huge diff we dont live much longer than anyone els so.. the amount of meds we are taking as a nation is really unnecessary and a bit overboard.

besides that was just one country.
But the life expectancy calculation includes things that cannot be influenced by medications, like murders and birth defects. So the rankings really do not mean anything.

And in the US, prescribing can be consumer driven. People go their doctors and ask for medications they have seen advertised. That is a double edged sword. It is helpful if people have a condition for which they had been unaware there was even a treatment available. But it may lead to a demand for a product that is more expensive and not necessarily better. Then there are the drugs like Viagra. Not medically necessary at all, but I venture to say many men find they really improve quality of life.

Not every medication is for a life threatening condition. Those will not increase the average life expectancy of a country at all.

I just used Monaco to show how the list is comparing apples and oranges. A wealthy "country" of about 30,000 people is very different from the USA. You really need to compare similar populations.
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Old 10-19-2011, 10:16 AM
 
52 posts, read 71,427 times
Reputation: 77
Quote:
Originally Posted by suzy_q2010 View Post
But the life expectancy calculation includes things that cannot be influenced by medications, like murders and birth defects. So the rankings really do not mean anything.
no atctually they dont calculate those things in life expectancy, thats average life span. 2 diff things. i know because i have to as a student in the health field. thats why life expectancy in the 1800s is diff than average life span in the 1800s. life expectancy is the age you are expected to reach if you are allowd to grow old & dose not include accidents.

im not saying all meds are bad but 40% of the worlds drugs being used by 5% of the worlds population is huge.
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Old 10-19-2011, 10:20 AM
 
Location: Georgia, USA
25,337 posts, read 30,148,995 times
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Quote:
Originally Posted by Whatsthenews View Post
Are they following the most up to date evidence based guidelines?
If you are over 50 (or sometimes even younger with a family history of colon cancer or polyps), then recommending colonoscopy is evidence based.

Quote:
If I was recommended to have a colonoscopy then I would first want to have a sample of faeces taken for occult blood. Depending on the result of that then maybe I would decide.
The problem is that by the time you have blood in the stool, You may already have a cancer. The precancerous polyps seldom bleed. The whole idea of colonoscopy is to get the polyps before they become cancers, not wait until you are actually going to diagnose a cancer.

Quote:
It should all be about taking a good history and trying to assess the individuals risk BEFORE doing investigations.They should never be a substitute for a GOOD HISTORY and my opininon is that often they are.
With colonoscopy, the only risk factor needed is age over 50.

Quote:
I actually cancelled a colonoscopy that my PCP referred me for.
I went to the Gastro for an office visit and was in and out in 5 mins.Actally it was 45 mins, but 40 mins of that was waiting for the Dotor!
His history taking was minimal and he explained nothing about the procedure. I asked if it was done under sedation and he said "no-we use MAC" as he was wlking out the door. Now I'm a RN but from the UK and I didn't have a clue what MAC was till I googled it.
I was VERY peturbed that the only info I was given was by the person that scedules the appt. I asked about polyps and she said "they'll remove them there and then".
The combination of the fact that I was going to go there with no pre-op assessment , be asked to sign a consent form and have a general anesthetic for a minor preocedure that doesn't require one, plus the fact that I felt I was low risk helped me to decide not to have it done.

I never received a letter saying that they strongly recommended I have the colonoscopy and my PCP never mentioned it next time I visited him.
So you made a decision based not on the scientific evidence for the value of the procedure but because you felt the doctor did not spend enough time with you explaining things. The dialogue was not to your satisfaction. You did not speak up and ask what MAC was. If you had, you could have said you would be happy with conscious sedation. The interesting thing is that the gastroenterologist probably did have your history. Were you not asked to write it down the minute you came into the office? Every new doc I see has a form to fill out. You hand the receptionist your insurance card and ID, she hands you a clipboard and a pen. If this visit was to schedule the procedure, the other things you feel were neglected would probably have been addressed at some time before it was actually done. But you did not ask, did you?

This really gets to the gist of the issue that stepka has raised with this thread, that many people decline care because they do not understand the reasoning behind the recommendation.
Quote:
You can't compare a blood test for diabetes with a colonoscopy under GA.
The first is almost risk free and minimally invasive,however the second isn't.
I never said they were equivalent. I was just explaining the difference between a diagnostic test and a screening test.

Quote:
Doctors are not gods!
No they are not. They are just highly trained human beings, most of whom know a lot more about medicine than the average patient.

Quote:
There's recently been some articles around regarding the PSA blood test for prostate cancer that are interesting.
Which mostly revolve around cost effectiveness and the fact that many men will develop subclinical prostate cancer as they age but die from something else. It is a very good example of the need for a discussion of what the test can and cannot do, so the patient can decide whether to have the test or not.
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Old 10-19-2011, 10:40 AM
 
Location: Georgia, USA
25,337 posts, read 30,148,995 times
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Quote:
Originally Posted by NomadQueen View Post
no atctually they dont calculate those things in life expectancy, thats average life span. 2 diff things. i know because i have to as a student in the health field. thats why life expectancy in the 1800s is diff than average life span in the 1800s. life expectancy is the age you are expected to reach if you are allowd to grow old & dose not include accidents.

im not saying all meds are bad but 40% of the worlds drugs being used by 5% of the worlds population is huge.
I do not think you can evaluate life expectancy in a country without including all of the deaths. Otherwise, the number has no meaning at all.

See here:

Does the U.S. Lead in Life Expectancy? - The Numbers Guy - WSJ

"However, two economists have argued in a recent book that life expectancy is a lousy way to compare two countries. Murders, suicides and accidents can have a big effect on life-expectancy stats because their victims die younger, on average, than victims of disease. And, they argue, the health-care system can’t do much to prevent those kinds of deaths. After adjusting for those kinds of deaths, the U.S. ranks at or near the top of developed nations in life expectancy, health economists Robert Ohsfeldt (of the Texas A&M Health Science Center) and John Schneider (of Health Economics Consulting Group LLC) write in “The Business of Health (http://www.aei.org/books/bookID.859,filter.economic/book_detail.asp - broken link),” a 2006 book published by the conservative American Enterprise Institute think tank."

And my point about the US using 40% of the world's drugs has to do with access to those drugs.Huge areas of the world do not use them because they are not available to them. They would use them if they could. Third world countries are not worried about heart attacks. They are worried about food and clean water. They are worried about infectious disease.

Edited to add: access to good mental health care can reduce suicides.
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Old 10-19-2011, 11:03 AM
 
Location: Georgia, USA
25,337 posts, read 30,148,995 times
Reputation: 31528
Quote:
Originally Posted by Whatsthenews View Post
[/b]

The problem here was his initial decision to prescribe chemo in the first place.I wonder what figures he gave you regarding the mortality/survival rate of the cancer without treatment (in your mothers particular case) VERSUS the risks/benefits of the treatment?

I am staggered by the fact that many cancer docs here will prescribe aggressive courses of NON-CURATIVE treatment following diagnosis of very aggressive, metastatic cancer.
The person and family ends up spending the last 3-6 months of their life undergoing unpleasant, invasive treatment with a very poor quality of life
and a horrendous bill for the privelage
The alternative is maybe 1-2 months of palliative care with a better quality of life for all concerned, including the family.
In many cases, the decision to treat is driven by the patient and the patient's family. Desperate folks are often willing to try anything. If the doc suggests hospice, the patient just goes to another doc. The option to treat has to be just as valid an option as hospice, once the patient has all the facts.

Dialogue, dialogue, dialogue.


Quote:
Do you know that the US has one of the lowest rates of cancer survival in the developed world-despite all the screening and treatments?
Could you cite a source for that statement? Keep in mind not all cancers are the same. It appears that US rates for common cancers are better than or comparable to those in other countries.

Cancer Survival Rates Vary by Country

US rates vary by race and state. This probably reflects access to care and is an indicator that things need to improve. Many, many people are trying to do just that, such as improving screening and treatment in African Americans.
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Old 10-19-2011, 06:28 PM
 
Location: Washington County, ME
1,554 posts, read 2,515,301 times
Reputation: 1880
Quote:
Originally Posted by Whatsthenews View Post
[/b]

The problem here was his initial decision to prescribe chemo in the first place.I wonder what figures he gave you regarding the mortality/survival rate of the cancer without treatment (in your mothers particular case) VERSUS the risks/benefits of the treatment?

I am staggered by the fact that many cancer docs here will prescribe aggressive courses of NON-CURATIVE treatment following diagnosis of very aggressive, metastatic cancer.
The person and family ends up spending the last 3-6 months of their life undergoing unpleasant, invasive treatment with a very poor quality of life
and a horrendous bill for the privelage
The alternative is maybe 1-2 months of palliative care with a better quality of life for all concerned, including the family.
My mom was pretty healthy - aside from that damn colon cancer.

She let it go way too long, and when the tumor was removed, if she didnt get the chemo she would have not lived long at all. I dont remember the exact times mentioned - or how they worded everything, but it was all explained to her and us.

She had even had a pacemaker put in a few years before that, becuz she enjoyed life (basically) and was becoming dizzy and passing out from a heart condition. We couldnt believe she wanted the pacemaker put in, and it ended up being a very easy operation with a really quick recovery - she felt awesome afterwards.

After she stopped the chemo, i believe she still lived about 3 years. She DID want to give it a try - but it just became too much on her. She also had heart disease at that point - her heart was just weakening due to old age. I think until we are that age - or faced with such decisions (as i've said before, my sister has been treated for breast cancer twice, the first time at age 42, went over 10 yrs without it and now has bone cancer and is getting treatments, enjoying life and traveling the world at 65 yrs old) - we dont know how WE would decide. Sometimes the will to live is very strong!

If you MAY be one of those who lives 20 more years, you just might go for it. I personally dont believe there is a 'cure' for any cancer. She thought she was cured the first time - and that one little cell stayed in her body...
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