There's an article in the New York Times today about patients being overtreated and how they should ask more questions and see if there are alternatives to what the doctor recommends that involve less invasive procedures or fewer medications.
This may be a minority opinion, but I think the article is stupid.
It's stupid because if you need to push your doctor to talk about less invasive options that may be just as effective, or medications he or she prescribed you may not need to be taking, guess what?
You need to find a better doctor.
What the article basically says is you should bully your doctor into ordering fewer tests and letting you stop taking some of your medications.
Which is great advice, until you miss something that one of those tests would have picked up, and you end up in worse shape. If I'm a patient, I don't want a doctor who I have to bully into not ordering a CT scan. I want a doctor who's smart enough to know when a CT scan makes sense and when it doesn't. I want a doctor who knows when he can take me off certain medications. Not a doctor who I can nag until he gives in, and lets me, the uninformed patient, dictate my care whether or not I know anything useful.
If I've learned one thing these past two years, here it is:
All doctors are not the same. All hospitals are not the same. If you go to a mediocre doctor, you will get mediocre treatment, and you will encounter avoidable risks that you may not even know you're being exposed to, whether it's from the wrong medication, the wrong treatment plan, outdated advice, failure to think proactively, or just plain stupidity and carelessness.
Somehow, people understand that there's a difference between a diner and a four-star restaurant, that chefs have different levels of capability, and that if you want the best meal you can find, the diner is probably not the place to go....
And yet people pick a doctor with less care than they choose a restaurant.
People don't ask where their doctor went to school, did their residency, what hospitals they're affiliated with, how many patients with similar conditions they treat, and whether they have a financial incentive to push whatever treatment they're pushing.
If you have an upper respiratory infection and need an antibiotic, most doctors can probably deal with you appropriately. If you're young and healthy, and don't have a bunch of medical conditions, most doctors can probably deal with you appropriately. Beyond that, I'll take the one with the fanciest diploma, thank you. It's not a guarantee-- there are smart people who are bad doctors, and there are certainly people who went to ordinary schools who are excellent doctors, but at least it's something. It's a proxy for some level of competence. I want the smartest person I can find, with the most experience and training, dealing with my medical decisions. The stakes are often too high to risk anything less.
It is incredibly frustrating to see patients who come in with, say, a bleeding ulcer, and they in fact tried to do all the right things-- they went to their doctor, who sent them to a GI specialist, who did an endoscopy... and missed the ulcer completely. Or exacerbated the problem. Or didn't look at what other medications the patient was on. Or didn't check labs before doing the test. And then we get the result-- a patient with a BP of 80/50 bleeding into his intestinal tract. And, no, we may not have done any better if we were the first stop, but we probably would have. You can avoid problems if you start with the most competent doctors you have access to, and don't assume that every doctor is fine, and every doctor will give you the same answers.
If you have to rely on your own skepticism to force your doctor to think about whether he's recommending the best possible treatment, like the Times article assumes, you are in bigger trouble than just needing to ask a few questions. You need a different doctor.
You should not have to come armed with your own independent medical research in order to get satisfactory care. There is something wrong with the system if you need to know more than your doctor does.