Dear Earth Citizens,
I do believe the
books and talks of American Physician Professor Nortin Hadler is one of the
best References for Earth Citizens who want to know more about evolution of
Doctor-Patient relationship in recent decades and how a patient may help his
Doctor avoid unnecessary overtesting, overtreating and overpreventing. Few days ago I wrote this email to
Nortin Hadler:
Dear Professor Hadler,
In my blog, I
want to introduce physicians who have concerns about unnecessary interventions
in Clinical Medicine. I do believe you are THE FIRST physician that
should be introduced. I want to write about you and your books in my blog. I
have a request from you. Would you please let me know if you can prepare
a 1-5 minutes presentation as a clip and send it
to me via email responding this question:
How a patient and or his
relatives may help a physician to avoid unnecessary interventions (separately
by Diagnosis, Treatment and Prevention)
Here is his response:
Good morning,
Mohammad
That’s a very
flattering invitation. Rather than a clip, how about this
link:
It is to an interview I
gave for Dr. William Friday on public TV. The late Dr. Friday was President of
the University of North Carolina system for over 2 decades in the late 20th
C and is generally considered one of the greatest educators of his generation.
I was privileged to be one of the first he interviewed by him on this program
in the mid-1970s and the last, this interview, shortly before his demise. The
interview pivots on “Rethinking Aging”.
Best regards, Nortin
Nortin M. Hadler, M.D.,
M.A.C.P., M.A.C.R., F.A.C.O.E.M., is professor of medicine and
microbiology/immunology at the University of North Carolina at Chapel Hill and
attending rheumatologist at UNC Hospitals.
In the past decade, he turned his critical razor to much that is considered
contemporary medicine at its finest. His assaults on medicalization
and overtreatment appear in many editorials and
commentaries and 5 recent monographs (If you have not enough money to buy the
books of Professor Hadler you can click on the names of books-see below- then
you will go to Google Book where you can read most pages of his books even so
some pages intentionally left blank):
McGill-Queens
University Press published The Last WellPerson. How to stay well despite the health-care system in 2004 (paperback
2007).
UNC
Press published:
Les Presses de l'Université Laval /
Les Éditions de l'IQRC is the publisher of French translations: Le
Dernier des Bien Portants (2008), Malades d’inquiétude
(2010), Poignardé dans le dos (2011) – won Prix Prescrire in 2012, Repenser
le vieillissement (2013) and Citoyen et Patient (2014).
Nortin Hadler's latest
book, By the Bedside of the
Patient, is in press and
scheduled for release in the fall. This book is a historiography of the
doctor-patient relationship decade-by-decade since 1950.
Here you can download all
interviews that Nortin Hadler gave for TV of North Carolina University:
About his book,The Citizen
Patient, The University of North Carolina Press asks him:
In your book,
you state that you yourself "never submit to a screening unless the test
is accurate, the disease is important, and something can be done about
it." What knowledge does the Citizen Patient need to make these
determinations?
Dr.Hadler’s response: The Citizen Patient needs to feel empowered to ask a
physician whether the test meets all 3 criteria and to have the abilityto listen actively to the answers. Screening tests are a great idea, but
exceedingly difficult to design to these standards. The degree to which they
fall short is the degree to which they can be harmful. That is a value judgment
that should be made in collaboration with the doctor and not for the
patient.
Also the University Of North
Carolina Press asks him:
You say that, "No
patient should ever again ask, 'Doc, what would you do?' Every patient should
learn to ask, and be empowered to ask, 'Doc, what would you do if you were
me?'" How should the Citizen Patient evaluate their physician's response?
Dr.Hadler’s response: Most clinical decisions are value laden, some overwhelmingly so. There are options and risks and costs to be considered. Clinical decision-making should be a collaborative undertaking. No patient should feel that the physician has a cookbook or self-interested or perfunctory interest in the collaboration. Knowing the patient's values is as important as knowing the science underpinning the options.
Dr.Hadler’s response: Most clinical decisions are value laden, some overwhelmingly so. There are options and risks and costs to be considered. Clinical decision-making should be a collaborative undertaking. No patient should feel that the physician has a cookbook or self-interested or perfunctory interest in the collaboration. Knowing the patient's values is as important as knowing the science underpinning the options.
Hadler says :
I wish I could be optimistic about a smooth transition. However, there is a great deal of entropy in the status quo; the "stakeholders" commandeer >17% of the GDP and would rather keep their Titanic on course as long as they own the lifeboats. But the status quo is unsustainable and the iceberg straight ahead.The Citizen Patient is the design for a new ship of health, one captained by patients and not by stakeholders.
See the full text of the interview here:
I wish I could be optimistic about a smooth transition. However, there is a great deal of entropy in the status quo; the "stakeholders" commandeer >17% of the GDP and would rather keep their Titanic on course as long as they own the lifeboats. But the status quo is unsustainable and the iceberg straight ahead.The Citizen Patient is the design for a new ship of health, one captained by patients and not by stakeholders.
See the full text of the interview here:
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