Less Medicine , More Health : 7 Assumptions That Drive Too Much Medical Care

Order Now - Less Medicine, More Health: 7 Assumptions That Drive Too Much Medical Care









The author of the highly acclaimed Overdiagnosed describes seven widespread assumptions that encourage excessive, often ineffective, and sometimes harmful medical care. 
 
You might think the biggest problem in medical care is that it costs too much. Or that health insurance is too expensive, too uneven, too complicated—and gives you too many forms to fill out. But the central problem is that too much medical care has too little value.

Dr. H. Gilbert Welch is worried about too much medical care. It’s not to deny that some people get too little medical care, rather that the conventional concern about “too little” needs to be balanced with a concern about “too much”: too many people being made to worry about diseases they don’t have—and are at only average risk to get; too many people being tested and exposed to the harmful effects of the testing process; too many people being subjected to treatments they don’t need—or can’t benefit from. 

The American public has been sold the idea that seeking medical care is one of the most important steps to maintain wellness. Surprisingly, medical care is not, in fact, well correlated with good health. So more medicine does not equal more health; in reality the opposite may be true. 

The general public harbors assumptions about medical care that encourage overuse, assumptions like it’s always better to fix the problem, sooner (or newer) is always better, or it never hurts to get more information. Less Medicine, More Health pushes against established wisdom and suggests that medical care can be too aggressive. Drawing on his twenty-five years of medical practice and research, Dr. Welch notes that while economics and lawyers contribute to the excesses of American medicine, the problem is essentially created when the general public clings to these powerful assumptions about the value of tests and treatments—a number of which are just plain wrong. 

By telling fascinating (and occasionally amusing) stories backed by reliable data, Dr. Welch challenges patients and the health-care establishment to rethink some very fundamental practices. His provocative prescriptions hold the potential to save money and, more important, improve health outcomes for us all. Shop Amazon - Top Rated in Health & Personal Care

Author

Dr. H. Gilbert Welch is an academic physician, a professor at Dartmouth Medical School, and a nationally recognized expert on the effects of medical testing. He has been published in the Los Angeles Times, New York Times, Washington Post, and Wall Street Journal, and has appeared on Today. Dr. Welch is the author of three previous books, including the highly acclaimed Overdiagnosed. He lives in Thetford, Vermont.

SOME OF THE CUSTOMER REVIEWS ABOUT THIS BOOK [ SAMPLE ]

1) Pretty much covers the same ground that the author's previous two books covered - This is the third book in a series of books either authored or co-authored by Welch making the argument that we suffer potentially serious consequences from overdiagnosis and overtreatment. I've now read all three of them. The central points Welch makes in all of them are important ones, for both our personal health and the country's fiscal health: overtreatment is rife, dangerous, and hard to avoid. Welch makes the points persuasively, using the right blend of anecdote and (quasi-) technical explanation. (Think VERY hard before you have that prostate exam, that mammogram, that back surgery, and before you sign on to take statins for slightly elevated cholesterol.) But I don't think that it takes three books to make the argument; there is a lot of repetition and overlap. I would certainly recommend reading ONE of the books, and have in fact made that recommendation to friends, students and colleagues. But I can't recommend buying or reading all three: In my opinion, there simply isn't enough material to justify writing three books on the topic all directed at a popular/non-specialist audience. This third book is the most personal of the three books. But middle book, the co-authored OVERDIAGNOSIS, is the best.

By worddancer VINE VOICE on January 13, 2015

2) Glad I didnt't read this book before my mother's back surgery - I wish I wouldn't have read this book. I say that not because the book was bad, but because it was too good. Some of the chapters just hit a little too close to home. One chapter in particular filled me with fear and another filled me with sorrow.

I started reading the book when my 80 year-old mother went in for major back surgery. I breezed through the first four chapters during her five hours of surgery and two hours in post-op care. The chapters were educational and enlightening. Dr. Welch makes a very compelling case about how we are being over-diagnosed and over-treated. The tone of the book was witty, so I was chucking and nodding my head as I read about data overload, U-shaped curves, the general uselessness of screening, the harm that false alarms can cause, the analogy of types of cancers to barn-yard animals: cancer that will never cause a problem are turtles, cancers that can be fought are rabbits, and cancers you can do nothing about are birds.

Then I got to Chapter 5 and the assumption: Action Is Always Better Than Inaction. First Dr. Welch gave some statistics on hospital infections after surgery: 1.7 Million "health care associated infections" associated with 98,987 deaths in 2002. Whoa doggie, my mom was in surgery. Next he talked about "postoperative cognitive dysfunction" after surgery particularly in the elderly. (Getting scare now - does 80 count as elderly?) Then he talked about needless surgery due to back pain, and how the majority of the time it doesn't work. I wanted to cry at this point, was mom doing this all for nothing? But I felt better when I read the statement: "Back surgery should only be done on patients who don't have back pain". My mom's surgery was to relieve nerve compression caused by severe scoliosis. But then the section on "invasive surgery" had me worried again: her cut was 15 inches long. And the section "Inaction = Allowing the Body to Heal" had me second guessing the decision to have the surgery. Talk about a roller coaster of emotions. I had to stop reading at this point.

I started reading again a few weeks later only to begin Chapter 7 and the assumption: It's all About Avoiding Death. The central theme of the chapter is that sometimes the quality of life is more important than prolonging life by a few months. Particularly with painful, debilitating cancer treatments. This chapter had me sobbing with tears pouring from my eyes. It brought back so many sad memories that are still raw and close to the surface. Three years ago my little brother was diagnosed with colon cancer that had moved to his liver. He fought the "cancer" battle for two years (MD Anderson). He went through all the pain and suffering because he wanted to see his son graduate from high school, he wanted to see his daughter go to her first dance, he wanted to go to the beach one last time. During one treatment (they inserted a tube through his groin and were pumping chemo drugs directly into his liver) he went into cardiac arrest. The doctors brought him back, but later he told me he wished they would have let him die. He said the treatments were too much for his wife, his kids, his family, and him; that sometime the quality of life is more important than quantity. He said it is better to quickly die with dignity than to wither away in excruciating pain. All my brothers' words were being echoed back to me by Dr. Welch.

I'm crying again. Excellent book but like I said I wish I had not read it.

By TooManyHobbies TOP 500 REVIEWER on February 21, 2015

Being Mortal: Medicine and What Matters in the End

Order Now - Being Mortal: Medicine and What Matters in the End

In Being Mortal, bestselling author Atul Gawande tackles the hardest challenge of his profession: how medicine can not only improve life but also the process of its ending

Medicine has triumphed in modern times, transforming birth, injury, and infectious disease from harrowing to manageable. But in the inevitable condition of aging and death, the goals of medicine seem too frequently to run counter to the interest of the human spirit. Nursing homes, preoccupied with safety, pin patients into railed beds and wheelchairs. Hospitals isolate the dying, checking for vital signs long after the goals of cure have become moot. Doctors, committed to extending life, continue to carry out devastating procedures that in the end extend suffering.

Gawande, a practicing surgeon, addresses his profession’s ultimate limitation, arguing that quality of life is the desired goal for patients and families. Gawande offers examples of freer, more socially fulfilling models for assisting the infirm and dependent elderly, and he explores the varieties of hospice care to demonstrate that a person's last weeks or months may be rich and dignified.

Full of eye-opening research and riveting storytelling, Being Mortal asserts that medicine can comfort and enhance our experience even to the end, providing not only a good life but also a good end.

Author - 

Atul Gawande is the author of three bestselling books: Complications, a finalist for the National Book Award; Better, selected by Amazon.com as one of the ten best books of 2007; and The Checklist Manifesto. He is also a surgeon at Brigham and Women's Hospital in Boston, a staff writer for The New Yorker since 1998, and a professor at Harvard Medical School and the Harvard School of Public Health. He has won two National Magazine Awards, a MacArthur Fellowship, and been named one of the world's hundred most influential thinkers by Foreign Policy and TIME. In his work as a public health researcher, he is Director of Ariadne Labs a joint center for health system innovation. And he is also co-founder and chairman of Lifebox, a global not-for-profit implementing systems and technologies to reduce surgical deaths globally. He and his wife have three children and live in Newton, Massachusetts. 

You can find more at http://www.atulgawande.com.

SOME OF THE CUSTOMER REVIEWS ABOUT THIS BOOK [ SAMPLE ]

1) This book could be a game changer - This book could be a game changer, if enough people read it and take it to heart. Atul Gawande addresses end-of-life care, and how we're getting it wrong, both within the medical establishment and in our families.

Dr. Gawande's book focuses both on medical procedures and living conditions in later life. Much of the book addresses the reality that as a person nears the end of life, decisions about his or her living situation are primarily aimed at ensuring safety at the expense of retaining autonomy, especially when adult children are making the decisions. "We want autonomy for ourselves and safety for those we love," a friend tells the author. We mistakenly treat elders as children, Dr. Gawande says, when we deny them the right to make choices, even bad choices. People of any age want the right to lock their doors, set the temperature they want, dress how they like, eat what they want, admit visitors only when they're in the mood. Yet, nursing homes (and even assisted living communities) are geared toward making these decisions for people in order to keep them safe, gain government funds, and ensure a routine for the facility.

In addition, Dr. Gawande shows how end-of-life physical conditions are most often treated as medical crises needing to be "fixed," instead of managed for quality of life when treatment has become futile. Life is more than just a stretch of years; it must have meaning and purpose to be worth living, he says. I think we've all heard this before (in fact, I read parts of this book in The New Yorker), but he builds a strong case for reform through case studies, stories from his own life, and examples of how individuals are either becoming victims of, or bucking, the system. He addresses assisted suicide only briefly, but he mentions it in relation to end-of-life care. "Assisted living is far harder than assisted death, but its possibilities are far greater as well," he writes.

The good news is that some people are doing what they can to improve the well-being of elders nearing the end of their lives. He demonstrates the beauty of hospice care in the home. He tells a great story of a doctor who convinced a nursing home to bring in two dogs, four cats and one hundred birds! It was a risky proposal, but the rewards were phenomenal. It made the place, and the people, come alive. I am aware, though, that these movements rely on individuals, and only if enough people have a vision for change will it come about. For that reason, I hope this book makes a big splash!

By N. B. Kennedy TOP 1000 REVIEWERVINE VOICE on September 23, 2014

2) "The End Matters" - I became a fan of Atul Gawande upon reading his first book in 2002: Complications: A Surgeon's Notes on an Imperfect Science. In reading many of his previous books I found he always asked questions: Why do we do things; for what purpose; is this working to achieve the best results for the patient in his physical and cultural circumstance? Gawande tackles the dilemmas of medical ethics by approaching them with sagacious common-sense. I think most of his books should be required reading in medical schools.

In this new book Being Mortal: Medicine and What Matters in the End, Gawande looks at the problems of the aging population and inevitability of death. He points out that you don't have to spend much time with the elderly or those with terminal conditions to see how common it is for modern medicine to fail the people it is supposed to be helping. In speaking of elder care he sadly points out that "Our reluctance to honestly examine the experience of aging and dying has increased the harm and suffering we inflict on people and has denied them the basic comforts they need most". Many physicians are so hell bent on preserving life that they cause horrible and unnecessary suffering.

Gawande points out that sometimes in striving to give a patient health and survival their well-being is neglected. He describes well-being as the reason one wishes to be alive. He looks at the "Dying Role" as the end approaches describing it as the patient's ability to "share memories, pass on wisdom and keepsakes, settle relationships, establish legacies and make peace with their God. They want to end their stories on their own terms." He feels that if people are denied their role, out of obtuseness and neglect, it is cause for everlasting shame.

Gawande shares his deep seated feelings in this book by revealing personal vignettes of how friends and family coped with these powerful and challenging issues. He follows a hospice nurse on her rounds. He discloses how is mother-in-law Alice's life is changed by taking up residence in a senior facility as the only reasonable option. Senior facilities and nursing homes, even the best run, are often sterile institutions that can cause psychological anguish. He includes how he dealt with the final wishes of his father. It is a melancholy yet empowering picture of a man and physician honoring his father.

Atul Gawande provides the reader with an understanding that though end of life care is inevitable there are ways to humanize the process. The patients, their families, the medical professionals are coming to terms with how to better face the decision making processes that will be, in many cases, the last decision. The subject matter is complex and sensitive but the moral of the book is that "The End Matters".

By Miss Barbara VINE VOICE on September 26, 2014

3) An inspiring read that should be mandatory for anyone dealing with patients and families as they age and enter the end of life. - As a fan of Gawande's previous books and someone whose personal life is currently very much about the topics covered here, I found this a much-needed and absorbing read. Its honesty is sobering (and possibly shocking to those not intimately familiar with what passes for "healthcare" today in the United States).

Until you or a loved one are dealing with the healthcare/medical "system" these days, you can't imagine how much it can negatively affect your quality of life, no matter what your actual medical condition is or your life expectancy. We will all face aging, illness and death...sooner or later. But inevitably. We need more humanity and compassion from each and every person in the healthcare/medical system today. (If only they WOULD read this and get trained in how better to deliver the experience that patients---aka "customers" if you want to use the lingo of business, which healthcare has turned into.)

Getting the care you need, care that supports one's independence (as much as possible) and autonomy when health-challenged, as I've learned in my own life, is incredibly challenging, even if you have good health insurance and access to "good" doctors. So much of what is needed is obvious to those who are ill and aging--and to some (though certainly not all) of their families. But getting what you need? Difficult beyond belief.

It is encouraging to see someone of Gawande's success/influence taking on these issues. Real-life stories and experiences fill this book and they are important. You have to believe things can change for anything to actually begin to change. Just reading about the individuals striving to make life better for those in their care is encouraging. It's hard to be hopeful when one deals daily only with resistance to change and with people who don't seem to listen or hear (or maybe even care) what patients want and need. It takes courage for these folks to buck the system and to put their patients first.

As another reviewer noted, this could be a gamechanger. I hope so. We need change and we need to celebrate the people who are making a difference each day, whether in the hospital, doctor's office or nursing home. As a baby boomer, I know most of us will find real issues with how we are treated, and will be treated as we age and as our health fails.

By IRG VINE VOICE on October 1, 2014