7 Assumptions That Drive Too Much Medical Care - Less Medicine

By Gilbert Welch

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Readers` Reviews

★ ★ ★ ★ ★
hubert womack
Dr. Welch once again does a great job breaking down some of the myths and fallacies of our modern medicalized world and gives physicians and patients a road map for living a healthy and relatively unmedicalized lifestyle.

The writing style is succinct and direct, mixing in humor (often self-effacing) and anecdotes from his professional and personal life. As a fellow physician, I wish all of our colleagues would read this book and gain some understanding of how we may sometimes do harm even with the best of intentions.

My favorite areas of discussion revolve on screening tests for diseases that we do not have and probably will never have. A former mentor once told me, "You cannot make a well patient better, " and Dr. Welch teaches this lesson in spades and draws similar conclusions.

This is a great read for anyone who is a doctor, a patient, or potential patient--that means everyone--to get a greater understanding of how to pursue health and avoid some of the pitfalls in health care.
★ ★ ★ ★ ★
Gilbert Welch's Less Medicine, More Health was a revelation--not so much because of the content (I've felt this way for a long time about the medical-pharmaceutical industrial complex), but for the fact that it was written by a physician.

Welch's contention--and he backs it up with peer-reviewed research--is that many of the cornerstones of the modern healthcare system are deeply flawed and subject patients to far too many tests and procedures, with the risk of inflicting harm that far outweighs any benefit. These tests and procedures lard up the system with unnecessary costs and force invasive interventions on patients, often to no advantage and causing them lasting anxiety and pain. Particularly in his crosshairs is the push for screening of healthy people--it turns up far fewer medical problems than it creates.

And Welch, a member of the Dartmouth medical school faculty,cites the numbers to prove it all.

He also, however, distinguishes between medical overkill and medical necessity, agreeing that there are interventions that are important--just not as many as today's practitioners usually prescribe.

The book is laced with wit and self-effacing humor, as he swims against the tide of most of his colleagues, making it a highly enjoyable read. If you've ever questioned something a doctor has told you, you'll want to read this book.
★ ★ ★ ★ ★
chelsea tilly
Dr. H. Gilbert Welch exhibits an intelligent and critical approach to medical care or too much care in his view. Too much testing and too much information. Consider, for example, his important questions to be put to a doctor in the chapter examining the assumption "It never hurts to get more information". What are we looking for? suggests one should be wary of fishing expeditions. And then if we find what we are looking for, what will we do differently? The bottom line is that if the data won't change what you are prepared to do, don't seek the data. As many people as possible should read the book, to help create more aware and critical citizens where health care is concerned. Too many just go along with what is suggested, creating possible unnecessary harm, anxiety etc. Cost/benefit really is important, and not just as framed by the medical industry.
Stronger Runner with the Revolutionary 3-Run-a-Week Training Program :: Universe Next Door: A Basic Worldview Catalogue :: Revolving Door: Solid Stone :: Job: A Comedy of Justice :: The Fine Art of Limiting Yourself to the Essential...in Business and in Life
★ ★ ★ ★ ☆
laura horne
Devoting an entire chapter for each of the seven problematic assumptions under discussion, Dr. Welch explains what is faulty about a given assumption by citing data that don't support the assumption, and / or pointing out what the assumption fails to properly take into consideration. The doctor then concludes each chapter with parting words of advice on what readers can do to make better decisions (e.g., questions to ask doctors or health care providers, how to weigh available options, etc.), and, thereby, increase their chances of securing better health care outcomes for themselves and their loved ones.

In discussing what's faulty about Assumption #2 ("It's always better to fix the problem"), for example, Dr. Welch provides several examples of how trying to eliminate a problem can be more dangerous than managing one, especially if the proposed "fix" to a given problem involves a potentially unnecessary invasive medical intervention. Not all heart problems require invasive medical intervention, for example. Some can be managed -- with good outcomes -- through medication. In concluding that chapter, Dr. Welch advises readers to always ask questions that would help them understand the nature of the benefits and harms that could come from a proposed intervention, and the extent to which doctors are certain the benefits or harms will be realized (in other words, how "real" are they). Whenever there are more than one treatment options available -- and according to Dr. Welch this is always true because doing nothing is always an option -- it's better to go slow and start with a conservative course of action, one that's expected to produce the least harm to the person seeking medical care, because one could always ratchet things up midcourse or in the future.

Readers can glean a lot of useful information from this book. For example, cancer used to be thought of as a fatal disease no matter what type a patient might have. According to Dr. Welch, however, doctors now know that not all cancers spread aggressively, and early detection of cancer would be of most benefit only to those whose cancer is of the moderately aggressive type. Screening that detects cancers known to have low risk profiles could lead to overdiagnosis and/or overtreatment with consequent harm to the medical care recipient, and screening that detects cancers of the most virulent type does not really move the needle much when it comes to prolonging a patient's life.

Dr. Welch's writing style in this book is conversational, and although his explanations of "technical stuff" such as what's involved in a diagnostic or medical procedure and what could go wrong or harm a patient are comprehensible, they're not always succinct. The provided information and advice, however, are all very valuable.
★ ★ ★ ★ ★
maddy lu
Another remarkable book that adds to the total picture explaining why health care in America is the most costly and the least effective per dollar spent. I can't wait to read this author's other books. More testing, more drugs, more doctoring isn't the answer. It is amazing how so many remedies and procedures and cures are taken for granted with no real proof that they actually make a difference. The famous line from the medical community...an ounce of prevention is worth a pound of cure...was actually stolen from Ben Franklin as he tried to improve fire safety in Philly. It has become the holy mantra for testing even the most healthiest people and scaring us into making choices we really don't need to make.
★ ★ ★ ★ ☆
megan bettis
Not too far into this book, I came across a discussion of a procedure being considered by a loved one, and had some of the drawbacks and contraindications for same presented to me in a cogent way that the medical people offering this as a possible solution had evidently neglected to mention. I'm probably not the first to think that maybe we need neutral ombudsmen/advisors to attend important medical consults and translate the overwhelming amount of information and jargon that patients are supposed to somehow make sense of. Trust your doctor?

And yep, I'm old enough that I can almost, barely, kinda remember when the Primary Care Physician wasn't just the medical consumer's "first line of defense" but the provider most of us saw, for the overwhelming majority of our lives as medical consumers. Now, the adage that "When you have a hammer, everything looks like a nail" has become all too resonant in an age of medical specialists.

Welch takes pains not to discourage needed consults with clinical specialists based on actual diagnosed and health or life threatening conditions. He's obviously distressed enough by the idea that some think his warnings to be scare-tactic profiteering, as he takes a few pages to explain that his payments for his books go to legitimate charities benefitting the needy. But he's resolutely and unapologetically wary even of the ordinary "checkup" for reasons made all too clear in the real life case studies presented here. One patient whose primary fears a belly bulge signals an aneurism of the aorta ends up following a path that tracks all too well with that folk song about the old lady who swallowed a fly. Medical overreach stories are every bit as chilling as those about the deathly ill sent home from emergency with a pat on the head and an aspirin.

I understand that this is Welch's third book on this subject. Given my druthers, authors returning too soon to a subject would have to append their additional thoughts to the original book, perhaps as a PDF available for a nominal fee to current owners of the title. But I haven't read Dr. Welch's previous works, so this was all new to me, and suffered only for maybe giving less advice than he might as to how a reader might prepare him or herself to make an objective decision at a moment of high emotion and vulnerability in the exam or consultation room. As a result I have "Overdiagnosed: Making People Sick in the Pursuit of Health" on hold at my local library. And if it's as good as I suspect it may be, I'll buy it.

I'd say take a look at the preview and reviews for "Overdiagnosed" as well as this book, before making a purchase decision. Not that the good doctor's latest isn't eye-opening in its own right, and in fact I'd echo here some advice given by a reviewer of his previous book: Buy one copy for yourself, and another for your doctor.
★ ★ ★ ★ ★
matthew day
My husband has been saying for years that as long as you avoid the doctor, you can avoid illness. This book does tend to bear that out. I have personal examples of my own that definitely support the author's theory. The book is based on 7 assumptions and the author strongly supports all of them. If you think about it, we cause a lot of our health problems. If you live right and don't cause the health issues (excess weight, excess drinking, etc.), you probably don't need to be at the doctor's office for every little thing. It certainly has worked for my husband.
★ ★ ★ ★ ★
The most relevant, and one of the most engaging, books I have ever read. Substantiated a number of thoughts I had in this area, and introduced me to several new ones. I thought about my mother's poor quality of life for about 2 years after an allergic reaction to Heparin, after bypass surgery, my father dying from an allergic reaction to preventive treatment for CLL, which he had been living with pretty well for years, and my wife recently receiving 3 completely different diagnoses for the same issue.
★ ★ ★ ★ ★
I got this book because I have long felt that the medical profession is less about medical care and more about making as much money as they can squeeze out of a patient. I can't necessarily say that we are being over-diagnosed, however. In my extensive experience with doctors, I'm more of the opinion that they don't actually know how to doctor anymore. Based on what I have been through personally, I would assume that the only thing doctors are taught in Medical school anymore is what to prescribe based on patients complaints and how to scrawl out a prescription. Most of the time, a prescription that, not only isn't what you need, but does more harm than good. Case in point, the way over prescribed PPI's (Proton Pump Inhibitors) and other acid blocking and reducing drugs. Most people think that over the counter acid reducers are safe to take. I'm here to tell you...they are not! Let me tell you a little story about what happened to me.

I had a hysterectomy. I was so happy to have had the hysterectomy because after the problems I was having, I thought I would have a new lease on life. I was wrong. The doctor put me on hormones to combat the terrible hot flashes I was having. An estrogen cream and an oral progesterone. Things seemed to be fine for a while and I was happy about that. However, the happiness didn't last long. The next thing I knew, I couldn't eat, I had terrible nausea and worse heartburn, and I had lost just over 50 lbs in a matter of weeks. I was sent to a gastroenterologist where I was given a Colonoscopy (checked out fine) and an endoscopy which showed that my stomach was inflamed and was "diagnosed" with "Gastritis." This is one of those non-diagnosis. Gastritis is nothing more than an inflamed stomach. A symptom. He also stretched my esophagus while he was in there.
I was put on PPI's, things got worse. I was tried on another PPI, things got worse, then I was given another and another and another, and things always just got worse. I mentioned to the doctor about too little acid, which is common in people with Fibromyalgia and people in my age group, and it causes the same symptoms as too much acid. He wouldn't even listen to me. Just poo pooed it away. He needed to do another endoscopy. So, he did another endoscopy, and stretched my esophagus again! Same thing. Everything looked fine except for the inflamed stomach. More PPI's were prescribed despite my telling him that they only made it worse. I had to put large blocks under the front legs of my bed and sleep almost in an upright position. Every morning I would find my self practically sliding right out of my bed.

I continued to suffer as weeks went by, and...well, hmm, the doctor wants another endoscopy. Okay, now I just happen to have a Hiatal Hernia. WTF! Where did that come from and why didn't I have it when I had the first two endoscopy's? More of the same. Keep taking the PPI's he says. Meanwhile, I have blood work done, ordered by my family practitioner for other reasons, and low and behold, I'm deficient in vitamin D, the B vitamins and other vitamins and minerals. Why? Because of all the PPI's the doctor has had me taking.

I finally said screw the doctor, I'll take care of myself. I stopped all PPI's, started taking spoonfuls of apple cider vinegar to replenish the much needed acid in my stomach, and put myself on probiotics. I also did a lot of research and discovered that oral progesterone can not only cause stomach problems, but can actually cause a Hiatal Hernia! Had my doctors done some real thoughtful educated doctoring, I could have avoided the hiatal hernia since that didn't show up until the 3rd endoscopy. I took myself off all hormones and I am treating my hotflashes successfully and more healthily with black cohosh and ginger. My gut problems improved a great deal after I stopped listening to the doctor and started treating myself the way I thought I needed to be treated. To this day, I am still having issues with my stomach and intestines, but they are not nearly as severe as before. I can now sleep with my bed flat on the floor and I am able to eat again and have gained back the weight I lost. Moral of the story.... The doctor wouldn't have made nearly as much money off me for, not only himself, but the pharmaceutical industry, whom he receives kickbacks from, by prescribing me apple cider vinegar. This is only one of several times I have had to do my own doctoring, my own research and my own self treatment to get myself well because a doctor just couldn't figure it all out, and honestly, never even tried. I feel they were only stringing me along for as long as possible to get the most money out of it. After all, a doctor doesn't make money when people are healthy.

So, do I think they are over-doctoring? Absolutely not. I see no doctoring going on in today's medical profession. Do I think they are over-testing? Absolutely! And I think that's more what this book is about, rather than over-doctoring. To much medical care? I suppose you could call it that. But it's because doctors are in it for the money these days, and not to actually help people. Do I think they are over-charging. Oh hell yes! When a 51-year-old housewife can out doctor them, time and time again, there is definitely something very wrong! Doctors these days are right up there with auto mechanics who fleece their customers by telling the unsuspecting that your car needs this, and this and this and that, when in fact, it only needs an oil change.

Can you tell that I have completely lost faith in the medical profession? This book rings absolutely true to me for the most part. Don't believe everything your doctor tells you. Question everything, and do your own research before making potentially life changing decisions.
★ ★ ★ ★ ★
Just finished this book, it was quite eye opening and well articulated. I've read several books that touches on points that Dr. Welch hits on but I think this book is probably one of the better books I've read that challenges existing assumptions on what medical care does / does not do. I also liked how he ends it's chapter / assumption with practical steps that patients can do to challenge (or at least, not fall victim to) these assumptions for their everyday lives. Kudos!
★ ★ ★ ★ ★
kayla touzin
Tempered with some great humor. Excellent job of addressing the two things chronic care medicine is best at: Instilling Fear and Rushing people into making an Uninformed and Fear based decision.
Summary; Eat healthy, proper rest, move and don't go to doctors unless you absolutely need to!
★ ★ ★ ★ ★
angie dobbs
I've read all of this author's books for the layman and this one follows a similar theme. If you are concerned about the potential for overtreatment then you should read this book. He also pulls in the theme of aging and medical treatment.
★ ★ ★ ★ ★
Dr.Welch reminds me of my father who was also a doctor. My father always told us to never go near a hospital unless you were dying and to always be very leery of taking prescription medications. Only take them if there is an overwhelming reason to take them. I look forward to reading more of Dr. Welch's books.
★ ★ ★ ★ ☆
sharon davis
This book clearly and convincingly explains several (mistaken) assumptions made in the healthcare industry that lead to excessive procedures and "care". I was already a believer in minimizing my exposure to the medical system, and "Less Medicine, More Health" confirmed my opinions, while providing me with scientific evidence and arguments to use on behalf of myself and my family if the need should arise (hopefully not).

I found that although I agree with all the content in this book, the author's writing style is too informal for such a serious topic. This may detract from the book's credibility with readers. I feel like if I gave this book to my doctor, they might dismiss the author as a rogue physician within a few pages and not take it seriously. If the book was written in a more academic style I would have given it 5 stars.
★ ★ ★ ★ ★
tia shamoon
I intuitively knew some of the findings and advice contained in this book even before I read it. However, the author clearly explains how things work in the US medical industry and more importantly why and what we as consumers can do about it. Thank you!
★ ★ ☆ ☆ ☆
sahil raina
I found the author's style of constant cute quips and little jokes annoying. There is very little information or actual facts in this book. In my opinion this book is a waste of time. Too bad because the idea of Less Medicine, More Health is very appealing.
★ ★ ★ ☆ ☆
laura brown
This is an interesting book which offers the point of view that too much doctor intervention can harm the patient. This is true, especially near end of life when a hospital will employ frantic and violent efforts to resuscitate the patient.

This book calls into question whether it is wise to rely on a medical doctor's opinion when one is searching for guidance in important medical decisions. Dr Welch's father died of metastatic colon cancer. He took almost two weeks to die. This could have been prevented by a colonoscopy checkup when he was younger and healthier. Despite having lived through his father's death, Dr Welch is not at all sure that he will have a colonoscopy in the future.

Likewise, Dr Welch believes he is quite likely to get prostate cancer. A simple blood test, the PSA, could prevent him from experiencing the pain of metastatic prostate cancer and yet he proudly asserts that he refuses to get this simple blood test. He "doesn't want that degree of intervention".

Since I personally was saved from a very unpleasant death by having a colonoscopy which permitted me to have colon resection which saved my life, I find Dr Welch's view on this matter to be ridiculous.

I have a friend who took the PSA test and discovered the value was over 100. He received treatment and is now happily alive and well.

When I first started reading this book I thought I could possibly use some of the information and viewpoints contained therein. Now, I am afraid to say, I have decided to not follow Dr Welch's advice because I judge it to be faulty.
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