Speak Up: Patient Preferences in Medical Care

Patients should feel empowered to ask their doctors about choices in their medical care, even if their choice goes against a physician’s opinion.

Does your doctor diagnose your preference along with diagnosing your health condition? Patient preference and patient-reported outcomes are hot topics in the medical industry. Four years ago, The King’s Fund, a health care not-for-profit in England, published The Patient’s Preference all about why choice of care matters to patients and how, in many cases, when given choices and questions are answered, the patient will sometimes make health care choices that the doctor didn’t predict.

Some insurance companies are requiring that patient preferences be included at every step of care. So speak up! Ask your doctor for options. You both might be surprised at what happens next. And read the following stories for inspiration.

Sudden Fracture or Osteoporosis? The Patient Decides

In this New York Times article, some doctors bemoan the reluctance of patients to use Fosamax, an osteoporosis drug. Patients are apparently hesitant to use it because they have heard about the side effects of sudden femur breaks, jaw necrosis after dental work, and (not mentioned but also very real) esophageal erosion if you don’t follow instructions precisely.

Doctors the writer interviewed are quite certain that “the science” (whose quality is not addressed) should trump personal experience and that the majority of patients are better off risking dire, but allegedly rare, side effects than the possibility of soft bones — which can have very real and life altering effects as well. Ninety percent of patients don’t agree, according to the article. I find that both interesting and heartening, if true. It shows that publicizing risks does work (even if not for doctors).

It doesn’t help that many people are pointing to a wave of overdiagnosis of osteoporosis. When it seems like everyone you know (as you age) has osteoporosis, or pre-osteoporosis, it’s natural to feel more casual about it, which leads to under-caring for those who might really need it. Check out the website Show More Spine for more about overdiagnosis and unnecessary medical interventions.

Most of Us Are Using Supplements, But Should We Be?

Since 1999, just over half of all Americans take supplements. In the early 2000s, vitamins E and C were the most popular. Now the buzz is about omega-3 fatty acids and vitamin D.

Unfortunately, rigorous clinical trials don’t support the benefits of most supplements (not all supplements have been studied). vitamin E, for example, was touted as a heart protector. Studies found that any heart protection was outweighed by the much higher risk of hemorrhagic (bleeding strokes). Folic acid and other B vitamins, “were once believed to prevent heart disease and strokes,” noted Harvard’s Women’s Health Watch, “until later studies not only didn’t confirm that benefit but actually raised concerns that high doses of these nutrients might increase cancer risk.”

The takeaway? The source of your vitamins and nutrients matter. As much as possible, get your nutrients from whole foods, and don’t overload on any one supplement without proof from solid medical studies.

Seniors Decide to Supplement

The number of seniors taking supplements is going up, which is a problem because many supplements interact and might interfere with meds they commonly take. A study in JAMA found that 63% of seniors are taking supplements and many of them might not be telling their doctors about it because many people think supplements are harmless.

The authors of the study, “express particular concern about the common combo of statins, which are used to lower cholesterol, and dietary supplements like omega-3 fish oil, the combination of which could make a person’s cardiovascular problems worse,” according to a CNN report.

The bottom line: Medicines and supplements don’t always mix well.

Suzanne B. Robotti

Suzanne Robotti founded MedShadow Foundation in 2012. Learn more about Su and her mission.

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