Recent news on this blog about unnecessary heart stents in Baltimore and overly complex back surgeries across America may give some readers the wrong idea. This malpractice and patient safety blog is not about good versus evil and picking a doctor to trust because you decide he or she is a “good” trustworthy person. Instead, it’s about recognizing that doctors are human too and are subject to the same self-interest as the rest of us — and this can subtly tilt them to make recommendations for treatments that may not really help us.
I was struck by this when reading a letter to “The Ethicist” column in the New York Times Magazine. The writer was a husband whose wife had been told she needed a CT scan, and the doctor sent her to a radiology lab that he owned. The husband said: “I’m OK with this lab — I say you either trust the specialist or you don’t — but my wife is not so sure.”
Columnist Randy Cohen responded by quoting bioethics professor Katie Watson of Northwestern University:
“I trust my physicians not to be criminals who intentionally order unnecessary tests to feed their yacht habits. I also trust them to be human beings, which means they’re vulnerable to subconscious influences and incentives just like the rest of us.”
That’s exactly right.
This is not to excuse those doctors who create conflicts of interest for themselves that they could easily avoid. There’s no reason to buy a CT scanner for your office when there are plenty of others available.
Nor is it to excuse the doctor for failing to disclose up front to the patient that he has an ownership interest in the imaging machine. Patients shouldn’t have to cross-examine their doctors to get this basic information.
But it is to say that patients need to learn how to be sophisticated consumers of the medical industry. This is not a question of “do I trust or don’t I?” And it’s not a matter of trading naive trust for paranoid suspicion. It’s just to recognize that we’re all human, and that the medical industry unfortunately has many built-in conflicts of interest for doctors that require patients to look out for themselves when it comes to getting sound medical advice.
So ask lots of questions, do your own research, and get second and third opinions. You’ll be healthier for it.