WONDERFUL INFORMATION! I've said for years that an individual must be an active patient, one who does not hesitate to question the doctor and who does not look at that doctor as being infallible and omnipotent. I'm a living example of that viewpoint. Had I not gone into "research mode" when I was diagnosed with breast cancer, I doubt if I would be alive today. But here I am, 22 years later, and it's so because I chose my own cancer doctor, rather than the one my primary care doctor recommended.

How to Be a Smart Patient


Calling all patients: beware the standard of care! And never forget: it's your body, your health, your life. The doctor works in your service. Everyone else in the system may forget it, but you shouldn't: you are the boss!

Any number of studies or exposés might be cited to make the case that you must be a vigilant and assertive patient to get reliably good care, let alone the best possible care. But we may satisfy ourselves with just recent research, and recent headlines: one study in JAMA demonstrating that axillary lymph node dissection in early stage breast cancer, though routinely done, does not improve survival; and another study, published in the The American Journal of Surgery, showing that excisional breast biopsies are routinely done when far less invasive, and far less potentially disfiguring needle biopsies would suffice.

Actually, I can't resist -- I'll cite another more vintage example as well: studies demonstrating that rates of hysterectomy vary widely by region of the country, suggesting that the threshold for removing a woman's uterus is a matter of prevailing medical 'fashion,' more than scientific evidence.

As a doctor, I would love to be able to say that these and numerous other such examples (some pertaining to men, too, by the way -- although it may well be that medical mediocrity imposes a greater overall burden on women, more's the shame) are statistically trivial and rare exceptions to the rules of engagement. I would love to say that, but I can't.

I can say -- and hasten to -- that some of the smartest, most dedicated people I know are in the medical professions, and that many docs are tireless in their pursuit of the very best they can give their patients, and the best they can get for them. Altruism truly does rank among the qualities that entice people into the medical field, when they could surely make more money faster and get a lot more leisure time into the bargain doing something else.

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