Navigating Your Healthcare System

Inevitably, each of us is faced with a scenario where we decide it is necessary to engage the services of a Health Professional. Maybe you are not feeling well. Maybe you have injured yourself in a fall, or a car crash or while playing sport. Maybe something just feels off- so we seek help. Sounds easy enough… But where do you begin? And how do all the different health professions work together to serve your health needs? Do you need to see a GP, or a Specialist? A Physio or Chiro; An Osteopath or Massage Therapist? A Podiatrist? Occupational Therapist? A Dietitian or Nutritionist? What about a Homeopath, Naturopath, Herbalist or Chinese Medicine Practitioner?…… the list goes on and on. There is certainly no shortage of choice for you if or when you decide to seek out treatment for whatever ails you.

In Australia, the safest first port-of-call for your symptoms, in my view, is your GP. I say this despite the fact that there are many other Health Professionals within Australia who are qualified and educated to function in a Primary Care Setting. These include Chiropractors, Dietitians, Exercise Physiologists, Mental Health Workers, Osteopaths, Podiatrists, Psychologists, Speech Pathologists, Occupational Therapists and Physiotherapists. You can read more about the specific roles of each of these professions and others, within context of Primary Care through this link.

I argue that your GP is the safest first option because, although many symptoms may not be serious and may be greatly relieved by a range of treatments offered by a range of professions, the value in seeing your GP is that he or she has received training and education to determine if there is or isn’t something more sinister driving your symptoms. While it is true that other Health Professions have also received training to identify signs and symptoms that are indicative of a need for medical interventions, the key to your health in my view, is the inclusion of your GP in the delivery of your health services. Effective communication between your GP and any other Health Professionals you choose to engage the services of is important to ensure that your symptoms are appropriately assessed and that you receive the most appropriate treatment(s). Ultimately, the biggest beneficiary of open, clear and collaborative communication between GP and other Health Professionals is you, the patient.

It follows then, that when communication between the range of health professions you choose to access is closed, unclear or non-collaborative, there is a risk that the quality of your treatment may suffer. This is more commonplace than you may have realized. Of particular interest in modern healthcare, are the interactions between conventional healthcare providers, and Complementary & Alternative Medicine (CAM) Providers. Examples of CAM include Homeopathy, Traditional Chinese Medicine, Naturopathy, Herbalism, Energy Medicines, Mind-Body Medicines, Holistic and Nutritional Therapies.

The excerpt below, from an article by Dr published on www.theguardian.com/au, speaks to the communication challenges that exist between a Medical Doctor (in this case an Oncologist) and a CAM provider.

“If you don’t believe me, ask a GP or an emergency physician, the other professionals asked to salvage these patients.

What do an oncologist and an alternative therapist talk about when a patient like (Jessica) Ainscough dies? Do we defend our individual art, ponder medical ethics or credit individual autonomy above all else?

 

 

I asked this question of several doctors and the answer was unequivocal. “We don’t talk.” As in, we never talk.

 

 

Oncologists and alternative health practitioners move in different spheres though plenty of evidence suggests we end up looking after the same patients. When I discover (usually belatedly) that my patient endured the broken promise of an unproven cure, I feel dejected. The more expensive, extreme or exotic the treatment the messier seems the ending.”

In the case of Jessica Ainscough specifically, and Oncology generally, the stakes are high, as cancer, obviously, can be a fatal. Srivastava writes intelligently about the communication dearth that exists between CAM providers and her medical profession.

“Does the natural therapist, coffee enema prescriber or wave therapy expert ever discuss patient care with an oncologist? Not in my experience. There is never written correspondence or a phone call, not even when a patient is desperately ill and it might help to know if some unconventional treatment has

led to reversible toxicity.”

The CAM provider’s role in healthcare is by definition contradictory. Their identity is swept up in the confused notion that their services can complement conventional medicine, while also functioning as an alternative to it. Therein lies the communication conundrum faced by any CAM provider if/when he or she contemplates reaching out to a medical doctor or allied health professional. How would such a conversation unfold?

CAM Provider:

Hi Dr Medicine, I’d like to discuss the progress of my patient with you, but before we do, you should know that I am cynical about evidence based medicine, I find it to be close-minded and limiting. I prefer to rely on my intuition, confidence and experience as a base upon which to decide how to proceed with my patients. Sometimes I offer my services to patients as an alternative to your treatment methods, while other times I offer it as an adjunct to your treatment methods. I do not base such decisions on any particular piece of objective data.

Conventional Provider:

Hi CAM provider, I’d like to discuss the progress of my patient with you, but before we do, you should know that there exists no scientific evidence to support the methods you utilise. Additionally, there is evidence to suggest that the method you advocate for interferes with other treatments that have demonstrable effects under randomized controlled trial conditions . I prefer to rely upon a broad understanding of multiple lines of evidence as a base upon which to decide how to proceed with my patients. I have no idea how you can possibly safely vet your patients prior to proceeding with your treatment methods. Nor do I have any idea how you can possibly claim that any clinical outcomes you observe are in any way related to your treatment in a cause and effect manner.

CAM providers have a lot at stake when it comes to sharing doubt, seeking advice or negotiating compromise with conventional providers, because the CAM provider’s way is, by definition, an alternative to science based practice. Theirs is by definition, an approach to providing health services that falls outside of the bounds of scientific inquiry (if it had been subjected to scientific inquiry, and if evidence had been generated, it would form part of science based medicine). Theirs is fundamentally a belief based system of care that can never be integrated into science based medicine, because its very identity is dependent on being defined as something other than that which is a product of scientific inquiry. To share doubt in a system of care that is solely built upon empirical evidence, misattributed clinical outcomes and confirmation bias, is to share doubt about the validity of the entire system. This places the CAM provider in an impossible dilemma with regards to communicating, or collaborating with science based practitioners about relative risk, or data from competing hypotheses. The CAM provider will never be able to meaningfully communicate your health needs or status with any science based Health Professional.

And therein lies the risk for you, the consumer of health services. It is potentially dangerous for you to access the services of a CAM provider, because in today’s world of fast moving fads and rapidly spreading (mis)information, it is easy to presume that the author of that popular new book is an authority on a given health topic. It’s easy to presume that a new or popular health regime is capable of thoroughly assessing, diagnosing and treating you, while also mitigating any risks that may be relevant to you.

When the issue at hand is cancer, the outcomes of this communication chasm can be disastrous, possibly fatal. In my field, the field of injury, pain and human movement, the stakes are lower. No one dies from Reiki healing or a Reflexology session, but the fundamental problem remains- there is a disconnect between CAM providers and science based practitioners. Fundamentally, this is a product of the CAM provider’s tendency to proceed from a platform of belief, driven by confirmation bias and post hoc errors. Conversely, the science based provider’s tendency is to proceed from a platform of acknowledged uncertainty, relative risk assessment and the weighing up of divergent sources and lines of evidence. Further complicating matters is the tendency from a proportion of those within science based professions to fall victim to the seductiveness of confirmation bias and the delusion of post hoc errors. Susceptibility to these trappings is a birthright of being a human being, and it manifests in healthcare as CAM treatment, and as pseudoscientific treatment by conventional practitioners who should know better.

So where does this leave you, the consumer of healthcare? In short, I think it means that navigating your healthcare system is damn hard. I don’t think we live in a culture where you can afford to simply take what your healthcare provider says at face value. I think that increasingly, there is a need for you, the consumer, to be better informed about your health needs. I would encourage you to have the courage to ask questions of your healthcare providers. You are paying good money for their expertise… it is reasonable that that expertise is unpacked in a manner that leaves you thoroughly informed. Don’t be afraid to make your healthcare provider work hard. Providing healthcare shouldn’t be a walk in the park for the healthcare professional. Ask your CAM provider, or Doctor, or Physio to explain how your symptoms led them to the diagnosis they provided you. Ask them to explain how they ruled out other diagnoses. Ask them about suggested treatments, and how they work. Ask about other treatment options, how they work, and why one might be favoured over another. Ask about anticipated short term and long term effects of the treatment. Ask about side effects, and any risks associated with the treatment. Ask how these risks are weighed against the benefits. Ask for the evidence the provider uses to guide their assessment and treatment of your health. If the answers sound like bullshit… they probably are.

If you receive answers that are evasive, or dismissive in any way, I would move onto another provider. If you receive answers that boil down to a confident “trust me… you’re in good hands” response, I would move onto another provider. If the answers you receive are overtly certain, or absolute in terms of the confidence in a particular outcome, I would be suspicious, and would suggest getting a second opintion.

If the answers you receive are described in terms of clearly stated benefits, and are weighed up against clearly stated risks, and if the provider is comfortable telling you that there is no absolutely definitive cause or treatment for your condition, and if he or she can direct you to additional reading material, I would give the provider a chance. Take the opportunity to read the material provided to you, and vet it against other sources. Being informed is really the best way for you to manage your health.

If however, you are comfortable with the answer – “trust me, I got this, don’t worry about the details”, by all means continue with the provider. It may only ever manifest as a superfluous or possibly worthless expense for you, with no other adverse impact on your life. At worst though, poorly informed, blind faith in a particular provider’s advice can have dire consequences if or when serious disease or pathology strikes you or your family.

Feel free to leave a comment or a question below.

 

Pat

 

 

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