WEBVTT

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I am a neurosurgeon,

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and I'm here to tell you today
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
about a patient of mine.

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This was a woman in her 50s,

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she was in generally good shape,

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but she had been in and out
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
from a cervical disc,

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giving her radiating pain of a tense kind,

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out into the right arm.

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Looking at her MRI
before the consultation,

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I decided to suggest an operation.

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Now, neck operations like these
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
past the trachea,

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the esophagus,

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

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(Laughter)

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Then you bring in the microscope,

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and you carefully remove
the disc and the prolapse

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in the nerve root canal,

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without damaging the cord
and the nerve root

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lying only millimeters underneath.

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The worst case scenario
is the damage to the cord,

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which can result in paralysis
from the neck down.

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Explaining this to the patient,
she fell silent.

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And after a few moments,

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

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"Doctor, is this really necessary?"

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(Laughter)

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And you know what I realized,
right there and then?

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It was not.

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In fact, when I get patients
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,

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this prolapse was so delicate,

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I could practically see myself
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,
I wanted to operate on her.

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I'd love to operate on her.

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Operating, after all,
is the most fun part of my job.

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(Laughter)

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I think you can relate to this feeling.

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My architect neighbor says
he loves to just sit and draw

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and design houses.

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He'd rather do that all day

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than talk to the client
paying for the house

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that might even give him
restrictions on what to do.

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But like every architect,

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every surgeon needs
to look their 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
for the person having the operation.

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And that might sound easy.

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But let's look at some statistics.

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The tonsils are the two lumps
in the back of your throat.

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They can be removed surgically,

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and that's called a tonsillectomy.

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This chart shows the operation rate
of tonsillectomies in Norway

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in different regions.

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What might strike you
is that there is twice the chance

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that your kid --
because this is for children --

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will get a tonsillectomy in Finnmark
than in Trondheim.

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The indications
in both regions are the same.

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There should be
no difference, but there is.

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Here's another chart.

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The meniscus helps stabilize the knee

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and can be torn or fragmented acutely,

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topically during sports like soccer.

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What you see here is the operation rate
for this condition.

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And you see that the operation
rate in Møre og Romsdal

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is five times the operation
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 in Møre og Romsdal

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play more dirty
than elsewhere in the country?

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(Laughter)

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Probably not.

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I added some information now.

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What you see now
is the procedures performed

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in public hospitals, in light blue,

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the ones in private clinics
are light green.

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There is a lot of activity
in the private clinics

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in Møre og Romsdal, isn't there?

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What does this indicate?

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A possible economic motivation
to treat the patients.

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And there's more.

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Recent research has shown
that the difference of treatment effect

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between regular physical therapy
and operations for the knee --

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there is no difference.

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Meaning that most
of the procedures performed

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on the chart I've just shown

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could have been avoided,
even in Stavanger.

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So what am I trying to tell you here?

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Even though most indications
for treatments in the world

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are standardized,

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there is a lot of unnecessary variation
of treatment decisions,

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especially in the Western world.

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Some people are not getting
the treatment that they need,

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but an even greater portion of you

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are being overtreated.

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"Doctor, is this really necessary?"

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

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My colleagues say they never heard
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
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 about the same "no" rate

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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
or suggests something

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that is completely unnecessary.

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And you know what they claim
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
for medical advice.

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This is a sporty guy,

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he does a lot of cross-country skiing
in the winter time,

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he runs in the summer time.

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And this time, he'd gotten a bad back ache
whenever he went jogging.

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So much that he had to stop doing it.

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I did an examination,
I questioned him thoroughly,

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and what I found out is
that he probably had a degenerated disc

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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 instead of jogging,

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there was really nothing to do,

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so I told him, "You need
to be more selective

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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 of my back."

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"Why do you want an MRI?"

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

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"Come on," I said --
he was also, after all, my friend.

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"That's not the real reason."

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

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"When did you start interpreting
MRI scans?" I said.

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(Laughter)

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"Trust me on this.

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You're not going to need the scan."

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"Well," he said,

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and after a while, he continued,
"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,

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he got to see one
of my colleagues at work,

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telling him about the degenerated disc,

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that there was nothing to do,

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and that he should keep on swimming
and quit the jogging.

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After a while,
I met him 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
with the same symptoms had an MRI?

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And what if all the people in Norway

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had an MRI due to occasional back pain?

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

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And you would all take
the spot on that list

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from someone 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, sometimes,

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an opportunity
to get diagnosed or treated.

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"Doctor, is this really necessary?"

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I know this can be
a difficult question to ask.

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In fact, if you go back 50 years,

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this was even considered rude.

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(Laughter)

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If the doctor had decided
what to do with you,

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that's what you did.

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A colleague of mine,
now a general practitioner,

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was sent away to a tuberculosis
sanatorium 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
had been negative all along.

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

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No one had dared or even considered
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 patient
health care service.

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

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This is great progress.

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But it also puts more
responsibility on you.

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You need to get in the front seat
with your doctor

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and start sharing
decisions on where to go.

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So, 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 in my female patient's case,

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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
attached to this operation?"

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Well, five to ten percent of patients
will have worsening of pain symptoms.

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One to two percent of patients

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will have an infection in the wound
or even a rehemorrhage

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that might end up in a re-operation.

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0.5 percent of patients
also experience permanent hoarseness

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and a few, but still a few,

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will experience reduced function
in the arms or even legs.

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"Doctor, are there other options?"

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Yes, rest and physical therapy
over some time

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might get you perfectly well.

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

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It's not recommended,

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but even then, there's a slight chance
that you will get well.

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Four questions.

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Simple questions.

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Consider them your new toolbox 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
wants to send you to an MRI,

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when he prescribes antibiotics

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or suggests an operation.

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What we know from research

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is that one out of five
of you, 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 have made your life

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a whole lot easier,
and probably even better,

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but the whole health care sector

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will have benefited from your decision.

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Thank you.

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(Applause)