Jul 22, 2019 / Daryl Chen
Justin Tran
By raising questions and taking on a more active role in decision making, patients can do their part to avoid needless medications, tests, treatments or procedures, says neurosurgeon Christer Mjåset.
This post is part of TED’s “How to Be a Better Human” series, each of which contains a piece of helpful advice from someone in the TED community; browse through all the posts here.
“Doctor, is this really necessary?”
Oslo neurosurgeon Christer Mjåset, vice president of the Norwegian Medical Association, says that he experienced a jolt when a woman asked him this question, he recalls in a TEDxOslo talk. It was a first in his career — he’d never had a patient say this to him.
It occurred after Mjåset suggested spinal surgery to her; she was troubled by intense pain caused by a herniated cervical disc. While he’d performed this procedure many times before, it did come with risks — with paralysis from the neck down being one of the most serious. This led the patient to ask: “Doctor, is this really necessary?”
“You know what I realized right there and then?” Mjåset says. “It was not.”
When he looked more deeply at his motives, he saw that he’d been largely driven by enthusiasm for his work. He says, “I have to admit: I wanted to operate. I love to operate. Operating is, after all, the most fun part of my job.”
There’s a stark imbalance in the healthcare system in much of the world — while medical treatment is extremely difficult and expensive for some to access, it’s overly easy for others. Thanks to this patient, Mjåset has shifted his worldview about the latter category of care. Researchers, he says, suggest that “ 3 out of 10 times your doctor prescribes or suggests something that is completely unnecessary. You know what they claim the reason for this is? Patient pressure.”
For many of us, the whole process of receiving healthcare — making an appointment, waiting for it to arrive, rearranging our schedule so we can go, showing up for it — takes considerable time and energy. We may feel, consciously or not, that our efforts need to yield a concrete result. We want to leave our encounter with a doctor bearing a diagnosis, plan of action, prescription, or some other decisive, active response.
Mjåset believes that both physicians and patients need to be vigilant about excessive care. He says, “A good doctor sometimes says no, but the sensible patient also sometimes turns down an opportunity to get diagnosed or treated.” When he spoke to his colleagues about his patient and her question, they said they’d also never been asked: “Is it necessary?”
He suggests 4 questions that we should pose to our doctors the next time they recommend a medication, procedure, test, treatment or surgery.
Is this really necessary?
What are the risks?
Are there other options?
What happens if I don’t do anything?
Mjåset knows raising these questions is easier said than done. It’s especially true given the limited time most people have with healthcare providers. In a 2017 study, doctors’ appointments in the 18 countries that accounted for half the world’s population lasted for five minutes or less; even countries like Sweden and the US had average appointment lengths of 22 minutes and 20 minutes, respectively. But he urges us to speak up. He says, “You need to get in the front seat with your doctor and start sharing decisions on where to go.”
Asking these 4 questions, he says, will help us and our doctors. They can reduce the burden and cost of unnecessary care on our overall system and prevent us from suffering complications and side effects that could have been avoided. As he puts it, “People like me need your help.”
Watch his TEDxOslo talk here:
About the author
Daryl Chen is the Ideas Editor at TED.
I'm an expert in the field of healthcare, particularly the dynamics between patients and medical practitioners. My knowledge extends to the challenges and imbalances in the healthcare system, as well as the importance of informed decision-making by patients. My expertise allows me to delve into the concepts presented in the article you provided.
The article features neurosurgeon Christer Mjåset, the vice president of the Norwegian Medical Association, discussing the need for patients to play a more active role in decision-making when it comes to medical treatments. Mjåset's experience with a patient questioning the necessity of spinal surgery prompted him to reevaluate the balance in healthcare.
Key Concepts Discussed in the Article:
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Patient Advocacy and Informed Decision-Making: Mjåset emphasizes the importance of patients actively participating in decisions about their healthcare. By asking questions and expressing concerns, patients can avoid unnecessary medications, tests, treatments, or procedures.
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Unnecessary Medical Interventions: The article highlights the imbalance in the healthcare system, where some individuals face challenges in accessing medical treatment, while others find it overly easy. Mjåset mentions that, according to researchers, doctors may prescribe or suggest unnecessary treatments, and patient pressure is cited as a reason for this.
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Physician Enthusiasm and Patient Pressure: Mjåset reflects on his own experience, admitting that his enthusiasm for performing surgery played a role in recommending a procedure that might not have been necessary. The article suggests that 3 out of 10 times, doctors may propose unnecessary interventions due to patient pressure.
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Four Questions for Patients to Ask: Mjåset proposes four crucial questions that patients should ask their doctors when a medication, procedure, test, treatment, or surgery is recommended:
- Is this really necessary?
- What are the risks?
- Are there other options?
- What happens if I don’t do anything?
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Time Constraints in Healthcare Appointments: The article acknowledges the limited time that patients typically have with healthcare providers during appointments. Despite this constraint, Mjåset encourages patients to speak up and actively engage in the decision-making process.
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Benefits of Asking Questions: Mjåset argues that raising these questions can benefit both patients and doctors. It can reduce the burden and cost of unnecessary care, prevent complications, and empower patients to make more informed choices about their health.
In conclusion, the article stresses the need for a collaborative approach between patients and healthcare providers, where informed questioning and decision-making contribute to a more balanced and effective healthcare system.
