My Book and Articles
The Secrets of Medical Decision Making:
How to Avoid Becoming a Victim of the Health Care Machine
Oleg I. Reznik, M.D.
Foreword by Colin P. Kopes-Kerr, MD, JD, MPH
ISBN 1-932690-16-6
Published by LovingHealingPress
Available as of January 2006, click on the cover to see the description and comments. Purchasable from Barnes&Noble, Borders, Waldenbooks, Amazon, other stores and online booksellers, and directly from the publisher LovingHealingPress.
I wrote this book with an intention to encourage the reader to be more self-reliant and independent, when it comes to medical decision making. While the book does have an “exposé” tone to it, it was written that way not for the sake of exposé per se, but as a means of illustrating why independent decision making, self-reliance, and respect of one’s own values and judgment are indispensable for anyone seeking health. Each chapter not only illustrates problems, but also the ways of solving them, by the prospective patient or patient’s relative. A shift of an attitude, from that of blindly following a physician and believing in the omnipotence of the system to that of critical examination and personal decision making is the key.
This book is about all the non-medical elements that go into medical decision making of a physician today in the US.
Inappropriate and harmful medical treatment often happens when patients are either unable to make decisions, as in dementia or advanced disease, or they give carte blanche to the doctor to make all decisions for them. Because of the various conflicts of interest that I describe in this book, not many doctors are actually able to act entirely to the patient’s benefit. It is a challenge to the best of physicians. I believe that the patient or family must accept and exercise the responsibility of decision-making. They must not be shy about expressing their preferences or asking questions; they need not be concerned about what someone else will think. They owe it to themselves to articulate their preferences openly and clearly.
You may be surprised to find out what runs through your doctor’s head during an office visit, or while treating patients at a hospital. Besides what one might expect—ideas about what has caused the patient’s suffering and what the appropriate treatment would be—most physicians feel forced to juggle a number of considerations, many of which have nothing to do with benefiting the patient. You may have experienced the signs of this inner conflict in a variety of doctor-patient situations, and may have even encountered some of the unfortunate consequences. It may be seen in relatively benign instances, when you may feel pressured by the doctor to take a certain medication, and in more serious ones when you are being persuaded or convinced to undergo tests, procedures and treatments that will really only make your doctor feel safer and more reassured, while possibly causing you harm. Doctors are secured from liability by following the guidelines of the health care authorities—agencies that create medical guidelines. These agencies are influenced by the medical industry. This industry, while creating many valuable things, operates according to the laws of business, laws that lack compassion. In our litigious age, the doctor feels protected when he’s been following guidelines, regardless of what happens to the patient. Because of this and other reasons, your doctor is no longer simply your advocate.
In this book, among other things, I expose how the industry exerts its influence on the medical guidelines, medical education, and consequently, medical practice. Awareness of this can prevent some of the unnecessary suffering that is inadvertently inflicted by our current health care system. It can also reduce the cost of health care which has been growing out of proportion in our race to fulfill the false hope of making us immortal by the use of technology. Within the framework of the current medical system, the patient’s and the physician’s perspectives are explored, and the impact on society as a whole.
When we seek medical advice we’re hoping that a physician will always offer us what is in our absolute best interest. Indeed many physicians attempt to do that and some actually do. It is my perception however that great many physicians are bound by what I would call the Four Corners of the Medical Box. They are:
- Fear of litigation
- Financial and time pressures
- Guidelines of Health Care Authorities
- The current Medical Model
What propels a physician to leave this box by going beyond the boundaries of personal security? The elements are: genuine compassion, desire to do what is in patient’s absolute best interest, and courage to take the necessary risks. In this book, all of these elements are considered and illustrated with specific examples I encountered in my training and practice. Practical and sobering recommendations are offered for patients and their families. As a family physician practicing general adult and pediatric medicine and doing low risk obstetrics, I am intimately in touch with a full range of medicine from a newborn to an elderly, from an outpatient clinic to an Intensive Care Unit of the hospital. This permits me to explore more closely how the above mentioned boundaries are instilled during training and played out in practice, with their effect on the patient.
In this book I also provide numerous specific examples of the most frequently encountered medical situations such as screening mammography, cervical cancer screening, prostate cancer screening, mode of childbirth, prenatal screening etc. All are described as vignettes of actual patients whom I encountered during my practice and training. I share the thinking process of a physician and offer a practical way of avoiding the pitfalls of the current medical system. I attempt to reveal a more realistic picture and capabilities of medicine, and to remove the myth of medical omnipotence. This myth, developed by the medical industry and popularized by the media, results in a myriad of unrealistic expectations in the public leading to unnecessary suffering and disappointment.
Psychologist, writer, author of several books, and editor Dr. Bob Rich wrote:
The Secrets of Medical Decision Making: How to avoid becoming a victim of the Health Care Machine’ is an important book. It should be read by everyone, because all of us are sometimes in need of medical care. It is an eye-opener, a call to arms and a guide.
Dr. Reznik is convinced that the medical establishment has drifted into a position of having betrayed its mission. He has the courage of his convictions, and is out to slay the dragon of mistreatment that people very often experience once they are caught up in the medical machine. And he tells you how you can fight back on an individual level.
The cost of health care has blown out, and is continuing to rise. Dr. Reznik has persuaded me that much of this money is wasted on useless and unnecessary procedures. Indeed, many of these expensive activities are more likely to harm than to help the patient. He cites impressive authorities to back up his claims. It seems to me that his book should be read by policymakers, who might consider saving several fortunes, both for the taxpayer in general, and the individual victim. Why should patients suffer, and taxpayers slave away, just to ensure the profit of the health care industry?
I consider it an honor to have edited this immensely useful guide to better health despite the worst the medical world can do.
Bob Rich, Ph.D., MAPS, AASH