“Less Medicine More Health” was published in 2015 by Beacon Press of Boston, Massachusetts. The book is 210 pages plus an introduction and a comprehensive index. The ISBN number is 978-0-8070-7164-9 for the hardback version.
Doctor H. Gilbert Welch is a professor at Dartmouth Medical School and an expert on medical testing. He has been published in many major national newspapers, medical journals and on television. “Less Medicine More Health” is Dr. Welch’s third book.
The main point of “Less Medicine More Health” is that every medical test can have unintended and unwanted consequences and that more testing, or even “better” testing, does not necessarily lead to better health or improved quality of life. Doctor Welch makes the case that most people go to the doctor too often, undergo too many test, receive too much treatment because of those tests and end up with a lessened quality of life.
The author makes a strong argument for visiting the doctor when there is an issue affecting our ability to enjoy our daily activities, rather than on a routine and arbitrary time schedule(an annual physical exam, a biannual prostate exam, etc…). The biggest reason, as with so many other parts of our lives, is that if a doctor is looking for problems(as during an annual pysical exam) he will probably find some. And the harder he looks, the more problems he will find. Doctors are trained to believe that doing something about a problem is always better than doing nothing, so they want to treat all of those problems they find. Or they want to do more extensive and invasive tests to determine the extent and severity of the problems. This “looking for problems when nothing is bothering the patient” chain drives up both healthcare costs and patient anxiety.
Just as important, many tests and treatments can have negative health consequences. Any needle or catheter can lead to an infection. X-rays and CT scans increase radiation exposure. All prescribed drugs have side effects that can sometimes be severe. Anesthesia for any surgery can cause major problems. Many doctors simply don’t do a good job of explaining the possible side effects of suggested tests and treatments to their patients. Most patients don’t ask because they trust doctors and assume they need any test or treatment that might be recommended.
“Less Medicine More Health” lobbies for more informed patients making more informed healthcare decisions in partnership with their doctors instead of blindly doing whatever the doctor suggests. Dr. Welch gives us the information we need in order to ask our medical professionals the important questions about our care. How accurate is this test and what are the possible side effects? What percentage of false-positives does this test produce? What will happen if we do nothing about this problem(because it does not bother me or affect my daily life in any way)?
Doctor Welch believes that medical testing and treatment should be based on improved quality of life rather than on the existence of “problems”. If a condition, say a slightly enlarged prostate gland or slightly above “normal” cholesterol level, is not having any effect on normal everyday life, is it really necessary to start taking a prescription drug with well known side effects? If the are small rectal polyps present, which are quite common and can morph into cancer but usually don’t, is surgery to remove the polyps really needed, or is it better to just monitor the polyps for changes?
This book addresses the issue of how insecure we have become as a population about our health. Too many of us no longer trust how we feel about our bodies. Even when we are feeling great we will get batteries of tests and take multiple prescription drugs on the advice of a doctor just to prevent possible future problems. The thing with possible future problems is that they will probably never develop.
It is like Winnie the Pooh and Piglet sitting under a tree on a beautiful summer day. Piglet asks Pooh: “What if the tree falls on us?” Pooh thinks for a minute and asks: “But what if it doesn’t?” I wonder sometimes how much sicker we really are just because of all the worry we put into health issues. Every visit to the doctor and every medical test brings to light new multitudes of things that might possibly go wrong. Isn’t it much better to just concentrate on feeling good?
The ideas presented in “Less Medicine More Health”, if taken to heart, could go a long way towards bringing our country’s healthcare costs under control. Operating on the principles presented in this book could greatly lower the national anxiety about health. And just thinking about our personal healthcare in a more reasonable way would probably improve our health more than additional drugs and testing.