October 27, 2011

Part 1: When Making Health Care Decisions, Should We Switch the Default from "Just Do It!" to "Watchful Waiting"?

On Monday, we reviewed the federal task force recommendation against routine PSA screening for men, regardless of age, since the test tended to lead to other treatments that didn't prolong life and even impaired quality of life.

In Tuesday's post, we considered other common tests and procedures that researchers have challenged for similar reasons.

This research made me think about how I've tended to make my own health care decisions. My decision on how to deal with the finding in 1994 that I had prostate cancer is a good example. As I said, consultation with my urologist, and my own research, narrowed the options for me:
  • Surgical removal of the cancerous prostate, with the known risks of erectile dysfunction and/or incontinence.
  • "Watchful waiting" -- we take no immediate action, but carefully monitor developments.
It was an easy decision for me, given my tendency to favor doing something when the options are "act" and "do not act." I had the surgery.

Looking back on that 1994 decision, and on what's happened since, I wonder if the quality of my life might have been better if I'd opted for watchful waiting instead of surgery.

The Case for "Watchful Waiting"
I remember a conversation I had years ago with my boss and good friend Bill Beltz. He talked (not for the first time) about my tendency to shoot from the hip and charge off in some new direction. And he explained how he'd come to believe that problems often have a way of resolving themselves... in time. I was surprised that the successful president of our company would even consider such a passive approach to problem-solving.

Now I wonder. Looking back on several of my recent health-care decisions, I could have saved myself both anxiety and money if I'd done nothing. I suspect that  my "Fix it!" default position on problem-solving is more in line with our society's approach than Bill's "Let's wait and see."

Would we be better off if we'd taken Bill's approach when confronted with the problem of Saddam Hussein?

I know these musings are simplistic. But they help me rethink my tendency to "charge full-steam ahead" and consider instead a more thoughtful approach: "Is this test or procedure really necessary?"

If I'm going to become more involved in questioning my health care providers, I need to become better informed. Fortunately, my love of internet research and the wealth of information available there make this process easy for me. Just clicking on these two websites can make any of us better informed:
There is much, much more information out there.

But, even if we all become better informed and more willing to assume active roles in our health care decisions, we still won't go very far toward reducing the billions of dollars spent on needless and potentially harmful tests and procedures.

On to Part 2 that follows....

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