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I am a neurosurgeon,

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and I'm here to tell you today[br]that people like me need your help.

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And in a few moments, I will tell you how.

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But first, let me start off by telling you[br]about a patient of mine.

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This was a woman in her 50s;[br]she was in generally good shape,

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but she had been in and out[br]of hospital a few times

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due to curative breast cancer treatment.

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Now, she had gotten a prolapse[br]from a cervical disc

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giving her radiating pain

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of an intense kind out into the right arm.

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Looking at her MRI before the consultation[br]I decided to suggest an operation.

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Now, neck operations like this[br]are standardized and they're quick,

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but they carry a certain risk.

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You make an incision right here,

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and you dissect carefully[br]past the trachea, the esophagus,

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and you try not to cut[br]into the internal carotid artery.

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Then you bring in the microscope,

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and you carefully remove the disc[br]and the prolapse in the nerve root canal

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without damaging the cord and the nerve[br]root lying only millimeters underneath.

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A worst-case scenario[br]is a damage to the cord,

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which can result in paralysis[br]from the neck down.

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Explaining this to the patient,[br]she fell silent.

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And after a few moments,

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she uttered a few very decisive words[br]for me and for her.

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"Doctor, is this really necessary?"

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And you know what I realized[br]right there and then?

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It was not.

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In fact, when I get patients[br]like this woman,

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I tend to advise not to operate.

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So what made me do it this time?

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Well, you see, this prolapse[br]was so delicate

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I could practically see myself[br]pulling it out of the nerve root canal

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before she entered the consultation room.

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I have to admit it;[br]I wanted to operate her.

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I'd love to operate her.

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Operating like this is, after all,[br]the most fun part of my job.

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I think you can relate to this feeling.

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My architect neighbor says

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he loves just sit and draw[br]and design houses.

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He'd rather do that all day[br]than talk to the person,

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the client paying for the house,

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that might even give him[br]restrictions on what to do.

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But like every architect, every surgeon[br]needs to look the patient in the eye,

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and together with the patient,

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they need to decide on what is best[br]for the person having the operation.

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And that might sound easy,[br]but let's look at some statistics.

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The tonsils are the two lumps[br]in the back of your throat;

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they can be removed surgically,[br]and that's called a tonsillectomy.

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This chart shows the operation rate[br]of tonsillectomies in Norway

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in different regions.

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What might strike you is that[br]there is twice the chance that your kid -

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because this is for only children -

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will get the tonsillectomy[br]in Finnmark than in Trondheim.

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The indication in both[br]regions are the same.

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There should be[br]no difference but there is.

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Here's another chart.

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The meniscus helps stabilize the knee[br]and can be torn or fragmented acutely,

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typically during sports like soccer.

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What you see here is the operation rate

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for this condition,

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and you see that the operation rate[br]in Møre og Romsdal

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is five times the operation[br]rate in Stavanger.

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Five times.

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How can this be?

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Did the soccer players[br]in Møre og Romsdal play dirtier

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than anywhere else in the country?

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(Laughter)

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Probably not.

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I've added some information now.

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What you see now is the procedures[br]performed in public hospitals

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are light blue.

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The one in private clinics is light green.

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There is a lot of activity[br]in the private clinics in Møre og Romsdal,

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isn't there?

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What does this indicate?

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Possible economic motivation[br]to treat the patients.

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And there's more.

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Recent research has shown[br]that the difference of treatment effect

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between regular physical therapy[br]and operations for the knee,

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there is no difference.

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Meaning that most of the procedures[br]performed on the chart I've just shown

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could have been avoided,[br]even in Stavanger.

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So what am I trying to tell you here?

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Even though

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most indications for treatments[br]in the world are standardized,

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there is a lot of unnecessary variation[br]of treatment decisions,

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especially in the Western world.

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Some people are not getting[br]the treatment that they need,

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but even a greater portion of you[br]are being overtreated.

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"Doctor, is this really necessary?"

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I've only heard that question[br]once in my career.

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My colleagues say they never heard[br]of these words from a patient.

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And to turn it the other way around,

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how often do you think[br]you'll get a "no" from a doctor

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if you ask such a question?

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Researchers have investigated this,

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and they come up with[br]about the same "no" rate wherever they go,

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and that is 30 percent.

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Meaning, three out of 10 times

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your doctor prescribes[br]or suggests something

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that is completely unnecessary.

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And you know what they claim[br]the reason for this is?

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Patient pressure.

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In other words, you.

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You want something to be done.

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A friend of mine came to me[br]for medical advice.

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This is a sporty guy,

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he does a lot of cross-country[br]skiing in the wintertime,

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he runs in the summertime,

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and this time he had gotten[br]a bad backache whenever he went jogging,

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[br]so much that he had to stop doing it.

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I did an examination,

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I questioned him thoroughly.

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What I found out

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is that he probably had a degenerated disc[br]in the lower part of his spine.

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Whenever it got strained, it hurt.

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He'd already taken up swimming[br]instead of jogging.

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There was really nothing[br]to do, so I told him,

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"You need to be more selective[br]when it comes to training.

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Some activities are good for you,

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some are not."

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His reply was,

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"I want an MRI on my back."

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"Why do you want an MRI?"

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"I can get it for free[br]through my insurance at work."

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"Come on," I said -[br]he was also my friend -

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"that's not a real reason."

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"Well, I think it's going to be good[br]to see how bad it looks back there."

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"When did you start interpreting[br]MRI scans," I said.

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(Laughter)

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"Trust me on this,[br]you're not going to need the scan."

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"Well," he said,[br]and after a while he continued,

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"it could be cancer."

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(Laughter)

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He got the scan, obviously.

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And through his insurance at work[br]he got to see one of my colleagues at work

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telling him about the degenerated disc,[br]that there was nothing to do,

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he should keep on swimming[br]and quit the jogging.

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After a while, I met him[br]again, and he said,

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"At least now I know what this is."

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But let me ask you a question.

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What if all of you in this room[br]with the same symptoms had an MRI?

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And what if all the people[br]in Norway had an MRI

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due to occasional back pain?

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The waiting list for an MRI[br]would quadruple, maybe even more.

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And you would all take the spot

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on that list from someone[br]who really had cancer.

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So a good doctor sometimes says no,

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but the sensible patient also turns down,

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sometimes, an opportunity[br]to get diagnosed or treated.

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"Doctor, is this really necessary?"

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I know this can be[br]a difficult question to ask.

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In fact, if you go back 50 years,[br]this was even considered rude.

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If the doctor had decided[br]what to do with you, that's what you did.

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A colleague of mine,[br]now a general practitioner,

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was sent to away[br]on a tuberculosis sanitarium

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as a little girl.

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For six months.

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It was a terrible trauma for her.

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She later found out, as a grown-up,

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that her tests on tuberculosis[br]had been negative all along.

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The doctor had sent her away[br]on nothing but wrong suspicion.

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No one had dared or even considered[br]confronting him about it.

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Not even her parents.

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Today, the Norwegian health minister

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talks about the patients'[br]healthcare service.

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The patient is supposed to get advice [br]from the doctor about what to do.

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This is great progress,

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but it also puts[br]more responsibility on you.

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You need to get in the front seat[br]with your doctor

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and start sharing decisions[br]on where to go.

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The next time you're in a doctor's office

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I want you to ask,

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"Doctor, is this really necessary?"

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And you might feel in many patients' case[br]the answer would be "no."

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But an operation could also be justified.

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So doctors, what are the risks[br]attached to this operation?

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Well, five to 10 percent of patients[br]will have worsening of pain symptoms.

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One to two percent of patients[br]will have an infection in the wound

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or even a re-hemorrhage[br]that might end up in a re-operation.

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0.5 percent of patients[br]also experience permanent hoarseness,

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and a few, but still a few,[br]will experience reduced function

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in the arm or even legs.

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"Doctor, are there other options?"

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Yes, rest and physical therapy

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over some time might get you[br]perfectly well.

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"And what happens if I don't do anything?"

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It's not recommended,[br]but even then there's a slight chance

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that you will get well.

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Four questions, simple questions.

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Consider them your new toolbox

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to help us.

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Is this really necessary?

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What are the risks?

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Are there other options?

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And what happens if I don't do anything?

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Ask them when your doctor[br]wants to send you to an MRI,

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when he prescribes antibiotics[br]or suggests an operation.

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What we know from research[br]is that one out of five of you,

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20 percent,

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will change your opinion on what to do.

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And by doing that, you will not only[br]have made your life a whole lot easier

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and probably even better,

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but the whole healthcare sector

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will have benefited from your decision.

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Thank you.

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(Applause)