The Treatment Trap

Nursing Book Club

The Treatment Trap

How the Overuse of Medical Care Is Wrecking Your Health and What You Can Do to Prevent it

By Rosemary Gibson and Janardan Prasad Singh (Ivan R. Dee, 2010)
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Reviewed By Christine Contillo, RN, BSN

One of my mantras has always been that you need to be your own patient advocate, and apparently the authors of The Treatment Trap are on the same page. The book is chock full of anecdotes about individuals who were misdiagnosed, talked into testing they didn’t want — resulting in treatment they may not have needed — or just plain frightened into having procedures the patients might never have chosen if they’d had better information.

Unnecessary Procedures

We all acknowledge that medicine is an art and no two doctors may do the same treatment in the same way. However, authors Gibson and Singh focus on the outliers and extreme cases: providers who find a favorite procedure and then market it to an entire community to reap the financial rewards, or paternalistic doctors with an “I know better” attitude who insist on unnecessary or outdated procedures even when the latest evidence points elsewhere.

Two good examples of this are the entire generation of children who underwent tonsillectomies and mothers who had hysterectomies for fibroids despite the fact that there was no research showing that either procedure was necessary. Another example is PSA screening for older men, which may be unnecessary after a certain age, when statistics show that the chances of a cardiac death are considerably greater than mortality from prostate cancer.

Occasionally, a patient will put his or her foot down. Art Buchwald was a Pulitzer Prize-winning columnist for the Washington Post who suffered diabetes, gangrene and a subsequent amputation. He wrote a column about how he decided to live the rest of his life on his own terms, gave up dialysis and lived another full year, ignoring the advice of his doctors. But how many of us are sufficiently well-informed to know that we even have that choice?

A Failing Grade

The authors offer example after example of the ways in which the current healthcare system is failing the American people. Many of the examples are ones we’ve heard before: Madison Avenue markets pharmaceuticals directly to individuals, creating the impression of a need for medication and fostering fear of diseases that were unknown until recently, like restless leg syndrome. Hospitals and physician groups purchase the newest and best equipment and then urge providers to use it frequently, passing the expense along to the patient. Providers order expensive tests and imaging less for medical reasons than to forestall potential legal questions.

Often, preventive measures as basic as an office visit where a physician recommends increased exercise and dietary changes to help patients lose weight are not compensated by insurance companies, while physical therapy and weight loss medication are. And it seems like everyone who snores receives a recommendation for CPAP, even though weight loss may be a less-expensive and easier-to-tolerate alternative that produces more lasting results.

Taking Charge

I found the final chapters to be the most useful. The authors worry that without a significant change in our practices, we’ll end up becoming medical tourists for our surgeries — a frightening thought. To help forestall that possibility, the authors offer a 10-step recovery plan for our healthcare system, followed by 20 steps to help the reader become a better healthcare consumer.

For example, we all know that we should get a second opinion before surgery, but how often do we know to check for conflicts of interest? Many of us look up health information online, but if you have a chronic condition, have you considered finding an online community for support and to exchange the most current information?

The Treatment Trap is extensively annotated and both authors are well-versed in this area. Rosemary Gibson is a senior program officer at the Robert Wood Johnson Foundation, where she has overseen hundreds of millions of dollars in grants focused on improving end-of-life care. Janardan Singh is an economist at the World Bank and has written extensively on healthcare. Together, they’ve written a book that strongly urges you to take a hard look at what you expect from your own healthcare provider and how you can improve your chances of good health.  

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