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4 questions you should always ask your doctor

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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)
タイトル:
4 questions you should always ask your doctor
話者:
Christer Mjåset
概説:

"Doctor, is this really necessary?" Backed by startling statistics about overtreatment, neurosurgeon Christer Mjåset explains the power of this and other simple questions in the context of medical treatment and surgery -- and shares how patients can better work with doctors to get the care they need.

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Video Language:
English
Team:
TED
プロジェクト:
TEDTalks
Duration:
11:25

English subtitles

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