4 questions you should always ask your doctor
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0:01 - 0:03I am a neurosurgeon,
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0:03 - 0:07and I'm here to tell you today
that people like me need your help. -
0:08 - 0:10And in a few moments, I will tell you how.
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0:10 - 0:14But first, let me start off by telling you
about a patient of mine. -
0:14 - 0:17This was a woman in her 50s,
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0:17 - 0:19she was in generally good shape,
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0:19 - 0:21but she had been in and out
of hospital a few times -
0:21 - 0:25due to curative breast cancer treatment.
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0:26 - 0:29Now she had gotten a prolapse
from a cervical disc, -
0:29 - 0:32giving her radiating pain of a tense kind,
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0:32 - 0:34out into the right arm.
-
0:35 - 0:38Looking at her MRI
before the consultation, -
0:38 - 0:40I decided to suggest an operation.
-
0:40 - 0:45Now, neck operations like these
are standardized, and they're quick. -
0:45 - 0:47But they carry a certain risk.
-
0:47 - 0:49You make an incision right here,
-
0:49 - 0:52and you dissect carefully
past the trachea, -
0:52 - 0:53the esophagus,
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0:53 - 0:57and you try not to cut
into the internal carotid artery. -
0:57 - 0:58(Laughter)
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0:58 - 1:00Then you bring in the microscope,
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1:00 - 1:03and you carefully remove
the disc and the prolapse -
1:03 - 1:04in the nerve root canal,
-
1:04 - 1:06without damaging the cord
and the nerve root -
1:06 - 1:08lying only millimeters underneath.
-
1:09 - 1:11The worst case scenario
is the damage to the cord, -
1:11 - 1:15which can result in paralysis
from the neck down. -
1:17 - 1:19Explaining this to the patient,
she fell silent. -
1:19 - 1:20And after a few moments,
-
1:20 - 1:24she uttered a few very decisive words
for me and for her. -
1:26 - 1:29"Doctor, is this really necessary?"
-
1:29 - 1:31(Laughter)
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1:32 - 1:35And you know what I realized,
right there and then? -
1:35 - 1:37It was not.
-
1:38 - 1:41In fact, when I get patients
like this woman, -
1:41 - 1:43I tend to advise not to operate.
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1:44 - 1:46So what made me do it this time?
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1:47 - 1:49Well, you see,
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1:49 - 1:51this prolapse was so delicate,
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1:51 - 1:55I could practically see myself
pulling it out of the nerve root canal -
1:55 - 1:57before she entered the consultation room.
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1:58 - 2:01I have to admit it,
I wanted to operate on her. -
2:01 - 2:03I'd love to operate on her.
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2:03 - 2:07Operating, after all,
is the most fun part of my job. -
2:07 - 2:10(Laughter)
-
2:11 - 2:13I think you can relate to this feeling.
-
2:13 - 2:17My architect neighbor says
he loves to just sit and draw -
2:17 - 2:18and design houses.
-
2:18 - 2:19He'd rather do that all day
-
2:20 - 2:23than talk to the client
paying for the house -
2:23 - 2:26that might even give him
restrictions on what to do. -
2:27 - 2:28But like every architect,
-
2:28 - 2:31every surgeon needs
to look their patient in the eye -
2:31 - 2:33and together with the patient,
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2:33 - 2:37they need to decide on what is best
for the person having the operation. -
2:38 - 2:40And that might sound easy.
-
2:40 - 2:42But let's look at some statistics.
-
2:44 - 2:47The tonsils are the two lumps
in the back of your throat. -
2:47 - 2:50They can be removed surgically,
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2:50 - 2:52and that's called a tonsillectomy.
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2:52 - 2:56This chart shows the operation rate
of tonsillectomies in Norway -
2:56 - 2:57in different regions.
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2:57 - 3:01What might strike you
is that there is twice the chance -
3:01 - 3:05that your kid --
because this is for children -- -
3:05 - 3:08will get a tonsillectomy in Finnmark
than in Trondheim. -
3:09 - 3:12The indications
in both regions are the same. -
3:12 - 3:14There should be
no difference, but there is. -
3:15 - 3:16Here's another chart.
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3:16 - 3:18The meniscus helps stabilize the knee
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3:18 - 3:21and can be torn or fragmented acutely,
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3:21 - 3:23topically during sports like soccer.
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3:24 - 3:27What you see here is the operation rate
for this condition. -
3:27 - 3:31And you see that the operation
rate in Møre og Romsdal -
3:31 - 3:35is five times the operation
rate in Stavanger. -
3:35 - 3:37Five times.
-
3:37 - 3:38How can this be?
-
3:38 - 3:40Did the soccer players in Møre og Romsdal
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3:40 - 3:43play more dirty
than elsewhere in the country? -
3:43 - 3:44(Laughter)
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3:45 - 3:46Probably not.
-
3:47 - 3:49I added some information now.
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3:49 - 3:51What you see now
is the procedures performed -
3:51 - 3:53in public hospitals, in light blue,
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3:54 - 3:57the ones in private clinics
are light green. -
3:57 - 4:00There is a lot of activity
in the private clinics -
4:00 - 4:02in Møre og Romsdal, isn't there?
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4:02 - 4:04What does this indicate?
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4:04 - 4:08A possible economic motivation
to treat the patients. -
4:09 - 4:10And there's more.
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4:12 - 4:15Recent research has shown
that the difference of treatment effect -
4:15 - 4:19between regular physical therapy
and operations for the knee -- -
4:19 - 4:20there is no difference.
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4:20 - 4:24Meaning that most
of the procedures performed -
4:24 - 4:26on the chart I've just shown
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4:26 - 4:29could have been avoided,
even in Stavanger. -
4:30 - 4:32So what am I trying to tell you here?
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4:32 - 4:37Even though most indications
for treatments in the world -
4:37 - 4:39are standardized,
-
4:39 - 4:43there is a lot of unnecessary variation
of treatment decisions, -
4:43 - 4:45especially in the Western world.
-
4:46 - 4:49Some people are not getting
the treatment that they need, -
4:49 - 4:53but an even greater portion of you
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4:53 - 4:54are being overtreated.
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4:57 - 4:59"Doctor, is this really necessary?"
-
4:59 - 5:02I've only heard that question
once in my career. -
5:02 - 5:06My colleagues say they never heard
these words from a patient. -
5:07 - 5:09And to turn it the other way around,
-
5:09 - 5:12how often do you think
you'll get a "no" from a doctor -
5:12 - 5:14if you ask such a question?
-
5:14 - 5:16Researchers have investigated this,
-
5:16 - 5:19and they come up
with about the same "no" rate -
5:19 - 5:20wherever they go.
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5:20 - 5:22And that is 30 percent.
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5:22 - 5:26Meaning, three out of 10 times,
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5:26 - 5:29your doctor prescribes
or suggests something -
5:29 - 5:32that is completely unnecessary.
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5:35 - 5:37And you know what they claim
the reason for this is? -
5:38 - 5:39Patient pressure.
-
5:41 - 5:42In other words, you.
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5:43 - 5:45You want something to be done.
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5:47 - 5:49A friend of mine came to me
for medical advice. -
5:49 - 5:50This is a sporty guy,
-
5:50 - 5:54he does a lot of cross-country skiing
in the winter time, -
5:54 - 5:56he runs in the summer time.
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5:56 - 6:00And this time, he'd gotten a bad back ache
whenever he went jogging. -
6:00 - 6:02So much that he had to stop doing it.
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6:03 - 6:06I did an examination,
I questioned him thoroughly, -
6:06 - 6:10and what I found out is
that he probably had a degenerated disc -
6:10 - 6:12in the lower part of his spine.
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6:12 - 6:14Whenever it got strained, it hurt.
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6:16 - 6:19He'd already taken up
swimming instead of jogging, -
6:19 - 6:20there was really nothing to do,
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6:20 - 6:22so I told him, "You need
to be more selective -
6:22 - 6:24when it comes to training.
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6:24 - 6:25Some activities are good for you,
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6:25 - 6:26some are not."
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6:28 - 6:29His reply was,
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6:30 - 6:32"I want an MRI of my back."
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6:34 - 6:35"Why do you want an MRI?"
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6:36 - 6:39"I can get it for free
through my insurance at work." -
6:40 - 6:43"Come on," I said --
he was also, after all, my friend. -
6:43 - 6:45"That's not the real reason."
-
6:45 - 6:49"Well, I think it's going to be good
to see how bad it looks back there." -
6:51 - 6:54"When did you start interpreting
MRI scans?" I said. -
6:54 - 6:56(Laughter)
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6:56 - 6:58"Trust me on this.
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6:58 - 7:00You're not going to need the scan."
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7:01 - 7:03"Well," he said,
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7:03 - 7:05and after a while, he continued,
"It could be cancer." -
7:06 - 7:08(Laughter)
-
7:08 - 7:10He got the scan, obviously.
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7:11 - 7:13And through his insurance at work,
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7:13 - 7:15he got to see one
of my colleagues at work, -
7:15 - 7:17telling him about the degenerated disc,
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7:17 - 7:18that there was nothing to do,
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7:18 - 7:22and that he should keep on swimming
and quit the jogging. -
7:24 - 7:26After a while,
I met him again and he said, -
7:26 - 7:28"At least now I know what this is."
-
7:29 - 7:30But let me ask you a question.
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7:30 - 7:34What if all of you in this room
with the same symptoms had an MRI? -
7:34 - 7:37And what if all the people in Norway
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7:37 - 7:41had an MRI due to occasional back pain?
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7:42 - 7:46The waiting list for an MRI
would quadruple, maybe even more. -
7:46 - 7:49And you would all take
the spot on that list -
7:49 - 7:51from someone who really had cancer.
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7:52 - 7:55So a good doctor sometimes says no,
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7:56 - 8:00but the sensible patient
also turns down, sometimes, -
8:00 - 8:03an opportunity
to get diagnosed or treated. -
8:05 - 8:08"Doctor, is this really necessary?"
-
8:08 - 8:12I know this can be
a difficult question to ask. -
8:12 - 8:14In fact, if you go back 50 years,
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8:14 - 8:17this was even considered rude.
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8:17 - 8:18(Laughter)
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8:18 - 8:20If the doctor had decided
what to do with you, -
8:20 - 8:22that's what you did.
-
8:24 - 8:26A colleague of mine,
now a general practitioner, -
8:26 - 8:30was sent away to a tuberculosis
sanatorium as a little girl, -
8:30 - 8:31for six months.
-
8:31 - 8:33It was a terrible trauma for her.
-
8:34 - 8:36She later found out, as a grown-up,
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8:36 - 8:40that her tests on tuberculosis
had been negative all along. -
8:40 - 8:44The doctor had sent her away
on nothing but wrong suspicion. -
8:44 - 8:49No one had dared or even considered
confronting him about it. -
8:49 - 8:51Not even her parents.
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8:52 - 8:55Today, the Norwegian health minister
-
8:55 - 8:58talks about the patient
health care service. -
8:59 - 9:03The patient is supposed to get advice
from the doctor about what to do. -
9:04 - 9:06This is great progress.
-
9:06 - 9:10But it also puts more
responsibility on you. -
9:10 - 9:13You need to get in the front seat
with your doctor -
9:13 - 9:15and start sharing
decisions on where to go. -
9:15 - 9:19So, the next time
you're in a doctor's office, -
9:19 - 9:21I want you to ask,
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9:21 - 9:24"Doctor, is this really necessary?"
-
9:24 - 9:27And in my female patient's case,
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9:27 - 9:29the answer would be no,
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9:29 - 9:32but an operation could also be justified.
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9:32 - 9:37"So doctors, what are the risks
attached to this operation?" -
9:37 - 9:43Well, five to ten percent of patients
will have worsening of pain symptoms. -
9:43 - 9:45One to two percent of patients
-
9:45 - 9:48will have an infection in the wound
or even a rehemorrhage -
9:48 - 9:51that might end up in a re-operation.
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9:52 - 9:560.5 percent of patients
also experience permanent hoarseness -
9:56 - 9:57and a few, but still a few,
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9:57 - 10:02will experience reduced function
in the arms or even legs. -
10:03 - 10:06"Doctor, are there other options?"
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10:06 - 10:10Yes, rest and physical therapy
over some time -
10:10 - 10:12might get you perfectly well.
-
10:13 - 10:16"And what happens if I don't do anything?"
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10:16 - 10:17It's not recommended,
-
10:17 - 10:20but even then, there's a slight chance
that you will get well. -
10:21 - 10:22Four questions.
-
10:23 - 10:24Simple questions.
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10:24 - 10:29Consider them your new toolbox to help us.
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10:29 - 10:30Is this really necessary?
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10:30 - 10:32What are the risks?
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10:32 - 10:34Are there other options?
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10:34 - 10:37And what happens if I don't do anything?
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10:37 - 10:41Ask them when your doctor
wants to send you to an MRI, -
10:41 - 10:44when he prescribes antibiotics
-
10:44 - 10:46or suggests an operation.
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10:46 - 10:48What we know from research
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10:48 - 10:51is that one out of five
of you, 20 percent, -
10:51 - 10:54will change your opinion on what to do.
-
10:55 - 10:58And by doing that, you will
not only have made your life -
10:58 - 11:02a whole lot easier,
and probably even better, -
11:02 - 11:04but the whole health care sector
-
11:04 - 11:07will have benefited from your decision.
-
11:07 - 11:09Thank you.
-
11:09 - 11:12(Applause)
- Title:
- 4 questions you should always ask your doctor
- Speaker:
- Christer Mjåset
- Description:
-
"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.
- Video Language:
- English
- Team:
- closed TED
- Project:
- TEDTalks
- Duration:
- 11:25
Brian Greene edited English subtitles for 4 questions you should always ask your doctor | ||
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