Customer Reviews

Patient, Heal Thyself: How the "New Medicine" Puts the Patient in Charge

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I'm surprised this book hasn't gotten more attention and suspect the title is to blame. The book really isn't about the way patients are empowered, i.e., the fact that we now have consent forms and releases. Instead, Veatch makes a case for viewing doctors as "patient assistants." I prefer the term "tech support." They can tell us our options, based on what they know, and but they cannot make the decisions.

The theme of this book resonated as I remember a short conversation from many years ago. I once met a man on a plane who had gone to a doctor for the first time in years. He was a very large, inactive smoker. The doctor wanted him to cut back on work, food and travel.

"Doc," he said, "I've done 99% of what I want to do in life. I work long hours and I will not stop. I'm not going to do this."

And then, he told me, the doctor came up with a totally different set of recommendations. That's what this book is about: fitting the recommendation to the client's values, not the other way around.

This theme connects the chapters of the book. Veatch argues that doctors should not have a decision-making role because (a) they simply don't have all the information, (b) they are not qualified to make decisions involving resource allocation and (c) they cannot override an individual person's values.

Veatch illustrates with cases apparently used in medical school teaching environments. For example, a young man is diagnosed with liver disease. His HMO decides he is not a candidate for a transplant, but nobody tells him about options elsewhere. He dies soon afterward. He's wealthy so he might have chosen to pay for his own transplant elsewhere.

Veatch focuses on the individual physician's moral dilemma. The real question is, "Can we rely on just one source for expertise?" People still get advice to "Ask your doctor." We'd do better to be told, "Search the Internet." The real conflict comes from the typical physician's arrogant attitude combined with the customer's need to fill the gaps on his own. .

I particularly like Veatch's radical proposals, such as giving people autonomy to buy their own prescriptions. I've known many people who have to make repeated visits to a doctor to get refills of routine prescriptions. They tell me the doctor usually doesn't do anything.

Even worse, in many states, eyeglass prescriptions cannot be renewed after two years. It doesn't make sense: if you don't break your glasses you aren't forced to do anything. I call this the "Optometrists Relief Act." Our legislators need to read Veatch's book.

Veatch also points out the limits of actual medical expertise. His chapter on overweight reminds me of Gina Kolata's Rethinking Thin. We really don't have evidence that fat people die sooner and researchers tend to confuse correlation with causation.

The downside of this book is that it doesn't seem to have a target audience. Telling institutions like "the medical profession" they "should" do seems futile. There's little guidance for individuals. I love the patient manifesto (shouldn't we stop referring to ourselves as patients? we're customers). But if I am forced to see a doctor, I'm not sure how I would translate these ideas to demanding care. Doctors don't like customers who cite sources and question their pronouncements. After reading this book, most of us would.

This is a fascinating book that is right on about the future of medicine and the essential role of patients in their care. Any one learning any health professions should be reading this and thinking about the joy of their future practice when they get to be less paternalistic and more partnering with the people they will care for.