Less Medicine, More Health: 7 Assumptions That Drive Too Much Medical Care Download Free (EPUB, PDF)
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.
Hardcover: 240 pages
Publisher: Beacon Press; 1 edition (March 3, 2015)
Language: English
ISBN-10: 0807071641
ISBN-13: 978-0807071649
Product Dimensions: 6.2 x 0.8 x 9.2 inches
Shipping Weight: 1.2 pounds (View shipping rates and policies)
Average Customer Review: 4.7 out of 5 stars See all reviews (89 customer reviews)
Best Sellers Rank: #355,861 in Books (See Top 100 in Books) #37 in Books > Textbooks > Medicine & Health Sciences > Administration & Policy > Health Risk Assessment #57 in Books > Medical Books > Administration & Medicine Economics > Health Risk Assessment #192 in Books > Textbooks > Medicine & Health Sciences > Medicine > Basic Sciences > Pathology
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.
As a long-time fan of Gilbert Welch, I was thrilled when this book showed up on my Vine list. I was not disappointed.It's important to understand that Less Medicine, More Health is much less detailed and technical than Overdiagnosed. I liked the technical info and the statistics but it would be too much for some readers. This book definitely appeals to a broader audience. The tone is lighter as well.However, Dr. Welch continues to make the point that much of medicine is not related to health. I really liked the way he attacked 7 common myths, such as the myth that more is better. Unfortunately a lot of primary care doctors either don't know or choose to ignore the realities. Dr. Welch gives an example of an educated person who is hounded by Kaiser Permanente because she chose not to have a mammogram. The nurse put on a campaign by phone and email that would be worthy of a used car sales person. In that case, the woman's doctor seemed to be an outlier in the system. I had an experience with an HMO that was so awful I transferred to a more expensive option to avoid the harassing "reminders" of unnecessary procedures. I've also had the experience of a doctor telling me that certain tests would "add ten years" to my life. Dr. Welch probably would say that's fraud.I particularly like Dr. Welch's realism about longevity. He points out that he's not likely to die from a heart attack and if he gets cancer, he'll avoid dementia and possibly years of incarceration (my word, not his) in an institution. I fit that profile myself. I'd add that after a certain age, many changes in the numbers signal just old age, not danger - a point he makes in Overdiagnosed - yet doctors insist on treating the numbers.
Ever since I've turned 50, I've been inundated by mailings from local and regional hospitals (which is kind of creepy - I don't go to a doctor much, so how do they all know my age and address?) with dire warnings about how my "senior" body is a heart attack/stroke/osteoporosis/diabetes just waiting to happen, and I can prevent this disaster only by taking a series of discounted tests offered at ridiculously low prices by the aforementioned medical provider. (These are very similar to the mailings I get from my local car repair service. One time I got them mixed up and accidently took the coupon for a heart scan/bone scan/glucose check in to Mike Anderson Chevrolet to get an oil change/lube job/tire rotation, but that's another story.) I've always been too suspicious to get the medical tests, since I keep thinking they will dig until they find something wrong and then wrack up a series of expensive and gruesome treatments - and after reading Dr. Welch's book, I realized I am correct!This book is just plain brilliant, and very insightful. Some of my favorite parts are his questioning as to whether it is best to search for problems in asymptomatic people or just leave well enough alone, whether the treatments can sometimes be worse than the conditions treated, and the most profound question - what is the ultimate goal of medical care? Is it to enhance life when necessary, or is it, as with many elderly people, to dominate life and take on a life of it's own, stripping people of all dignity and reducing them to medical projects to the extent that, like many elderly people you see, they are praying for death to release them from the medicalized hell that their lives have become?
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