Is Your Doctor Skimping On Giving You The Best Advice?

Doctors have traditionally taken the Hippocratic Oath to pledge their loyalty to practicing medicine ethically and to the best of their knowledge. One of the first tenets reads "I will prescribe regimens for the good of my patients according to my ability and my judgment and never do harm to anyone."

But in today's day and age -- when one-seventh of the entire U.S. economy is devoted to health care -- one has to wonder whether this oath still holds true.

A New York Times article recently reported that:

Doctors misdiagnose fatal illnesses about 20 percent of the time, according to studies of autopsies.

Millions of patients are treated for the wrong disease.

The rate has not really changed since the 1930s, according to the Journal of the American Medical Association.

Could it be that, as Joseph Britto, a former intensive-care doctor, suggested in the New York Times article, that doctors may not be putting their "all" into helping and curing patients because they have no real incentive to do so?

Dr. Britto brought up a good point. In the airline industry, pilots insisted that errors be studied and, as a result, airplane crashes are rare.

"Unlike pilots," Dr. Britto said, "doctors don't go down with their planes."

Of course, doctors are human and they do make mistakes. But making a mistake is one thing. Knowingly not advising a patient because of:

Not enough time

Thoughts that the patient will not comply

Fear of malpractice

... is another. So when you go to visit your doctor, how likely is it that you're getting the best health advice you could receive?

The Annual Physical is "Almost Worthless"

About 78 percent of patients expect it, and 65 percent of primary care doctors believe, according to an Archives of Internal Medicine survey, that an annual physical exam is useful.

But donning the blue paper gown every year while your doctor listens to your heart, performs some routine blood tests and looks in your eyes, ears and nose is almost worthless, according to many studies.

Nonetheless, people and doctors are reluctant to change. "Most of us haven't had the guts to get rid of it," says Dr. Fred Heidrich, a physician at Group Health Cooperative in Seattle and clinical professor at the University of Washington.

"Myths fall hard," says Dr. David Sobel, medical director for patient education and health promotion for Kaiser Permanente Northern California. "Patients come in to see me and they're smoking, they're overweight, they've got a poor diet. But what they want is some chest X-rays, a complete exam: 'Reassure me.'"

"We sometimes ignore the most obvious things," he says. "They may not have the magic of medicine but they have the biggest impact on health."

Are Doctors Recommending the "Obvious"?

Most of us know that certain lifestyle changes, eating more vegetables, not smoking and exercising, for instance, are good for us. However, doctors typically do not advise patients to adhere to these most basic health principles.

And although we may already "know" them, hearing our doctor recommend it can make a big impact. One study found, for example, that 5 percent of smokers quit because of a doctor's advice.

"Dietary changes reinforced by a doctor's recommendation will make it even easier for patients to make simple changes that could add years to their lives," said Amy Joy Lanou, an assistant professor of health and wellness at the University of North Carolina and a senior nutrition scientist with the Physicians Committee for Responsible Medicine.

A study in the Archives of Internal Medicine really illustrates this point. Upon looking at survey data regarding obesity that had been collected by state health departments and the Centers for Disease Control and Prevention, the researchers found:

Health care providers advised fewer than 15 percent of all patients to lose weight.

Patients considered overweight (based on body mass index) were advised to lose weight only 10-20 percent of the time.

Patients considered obese were advised to lose weight over 40 percent of the time.

As one researcher pointed out, doctors may miss out on opportunities to help patients manage their weight before it spirals out of control and leads to health problems.

"In many cases, patients come only for tests and procedures. Simple things like discussing health behavior fall off the radar screen easily. And most doctors report they don't feel comfortable counseling patients, and if you don't feel confident and comfortable in it, you're less likely to do it," the researchers said.

Another study found that the main reason doctors cited for not discussing exercise with their patients was a lack of time.

Other reasons why doctors aren't discussing lifestyle behaviors with patients include:

Lack of training for one-on-one patient counseling

A medical culture that promotes testing and drug/surgery solutions rather than talking and advising

Is the Future Bright?

How likely is it that one day a trip to the doctor's office will arm you with advice on what foods to eat to build your immune system, how to avoid exposing yourself to potential toxins in your environment and what stress-relief exercises you should be doing daily?

"The medical community has been slow to address lifestyle as a means of disease prevention," said Dr. JoAnn Manson, chief of preventive medicine at Brigham and Women's Hospital in Boston, and co-author of a report that urges doctors to counsel patients on exercise and weight control.

However, at at least one U.S. hospital, doctors (in a partnership with hiking enthusiasts) have begun writing "prescriptions" for exercise.

"The idea is to make a more specific explanation," said Dr. Charles Brackett, director of the program at Dartmouth-Hitchcock Medical Center in Lebanon, N.H.

"You can say, 'Walk this trail near your house twice a day,' as opposed to, 'You're supposed to exercise more."'

"If a prescription for medication could reduce the risk of heart disease, stroke, type 2 diabetes and osteoporosis by 40 percent, everyone would be clamoring for it. Well, a prescription for brisk walking has the potential to do just that," said Dr. Manson. "A prescription for exercise may be the most important prescription a physician writes all day."