Thursday, September 4, 2014

Medical Interventions You Might Want To Avoid

Female doctor just out of medical school.
"Do you really want that physical exam again this year?"

Medical research findings are always changing and what was proscribed or disallowed maybe four or five years ago, no longer is. For example, just five years ago it was unheard of to treat prostate cancer with just one high dose of radiation. It just wasn't done. You needed at least two separate treatments - we're talking about radiation exposure using Iridium 192 needles inserted into the prostate by catheters - so you had to make ready to stay overnight. No longer. In fact I was one of the first, in Sept. 2012, to receive high dose rate brachytherapy using just one high dose (1920 cGy) delivered at the Univ. of California - San Francisco, Helen Diller Cancer Center. See, e.g.

Now, as reported in New Scientist (June 28, p. 10) other changes have also been noted and circulated. Some of the ones they've highlighted are indicated below :

1) Unnecessary blood transfusions:

New research shows that blood transfusions aren't always indicated, nor are they beneficial. In this particular case, research published in June showed that those entering an ER deemed to have less than a 6 percent chance of dying, who received a transfusion were five times as likely to die as those who did not receive a transfusion. (PLos Medicine,  According to researcher Lee Fleisher of the University of Pennsylvania, receiving someone else's blood can weaken your own immune system.

Something to think about!

2) Staying away from certain days for operations.

This has been in the medical zeitgeist for some time, but now more and more statistical evidence is supporting it: there are certain days it may be best to avoid having an operation or procedure.  In point of fact, those who have non-urgent surgery on Fridays have a 44 percent higher risk of death than those who have the surgery on Mondays.  Patients in general receive poorer post-operative care over weekends since hospitals have fewer staff available.  Also, those who are present tend to be less experienced, more junior staff.

3) Pre -Op shaves

The new skinny on pre-operative shaving is that "hair should not be removed for hygiene reasons" - unless it will get in the way, and then only electric clippers should be used. The old axiom was that the hair was removed using a disposable razor. The problem? It caused the exact thing it was designed to prevent: infection from a wound.  According to one medical researcher at Leicester, UK, "Bacteria from your skin get into the cuts and multiply".

4) Don't be a guinea pig for new hip replacements

Too often, new model hip replacement materials or procedures are touted as the greatest things since sliced bread, but the hard fact is that it takes time to discover if a new model is as effective as older ones. Hence, it is wise not to jump on the "new" bandwagon too early. If you do need hip replacement, request only a tried and true design.

5) General checkups - Not Needed

There was a time not so long ago when it was believed a physical was needed every year. In fact, with special exceptions (e.g. males who are at risk of prostate cancer) this is now passé.  The problem is that ordinarily checkups look for illness or medical problems in people who have no symptoms.  This then leads to unnecessary worry and treatments. The new standard in the UK is now one checkup only every five years - unless, of course, problems are noted.

6) Futile resuscitation

Doctors often get bad PR for failing to resuscitate certain patients, but the new research shows they are more likely to make the opposite mistake and resuscitate those who shouldn't be. While CPR can be life saving for those who experience sudden cardiac arrest, it is pretty well useless for those dying as a result of long term processes whose chances of survival are close to zero.

So, pre-empt matters by making an official declaration (as in a living will) if you don't wish to have special interventions at the end of life.  It also pays to read widely to be aware of medical advice changes, such as recent ones not to have mammograms every year (for a certain age group) or PSA tests every year.

The more we know the less chance there is for medical mistakes, and there are still way too many in this country.

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