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 Self-Care: Toward Full Disclosure 
 
For centuries, doctors have followed the lead of Hippocrates, who advised physicians "not to discuss with patients the nature of the illness and the treatment. " Even worse, health professionals have not always provided their patients with realistic estimates of possible outcomes. This reticence on the part of our doctors—combined with our unrealistic expectations that high-cost, high-tech medicine should be able to "fix" virtually any health problem — has produced a common medical scenario in which layfolk experience health care as a realm controlled by magic. Within this world, the physician is the all-powerful shaman, medical knowledge is composed of a treasury of secrets reserved "for doctors only," and patients are expected to adopt an attitude of blind obedience to doctors' orders.

Back to Reality. This arrangement has produced serious problems. Consumers who have little or no information about their problems and the range of possible solutions can't make good decisions about their care. Uninformed patients can't check for professional mistakes. And laypeople who are led to believe that doctors have a magical cure for every possible illness are set up for inevitable disappointment.

"Public expectations of health care in this country are substantially removed from reality, " says Dr. Dennis O'Leary, president of the Joint Commission on Accreditation of Hospitals. "Blind trust in medical treatment is not in anyone's best interests. Consumers can make better decisions if they have better information about all their available choices. "1

It was only about ten years ago that popular attitudes toward these matters began to change. Just over a decade ago, when I was still in medical school, I accompanied one of my patients to the medical library to help him find information on the various treatments available for his condition. The librarian refused to admit him. She had been instructed to keep laypeople out of the medical library. Her superiors assumed that the only consumers who would seek such information were hot-headed "problem patients" gathering ammunition for malpractice suits.

Fortunately for all of us, there has been a massive change in such attitudes. Today that person would doubtless receive a good deal more encouragement and support. During this same period, we have seen an unparalleled explosion in the quality and amount of medical information available to the public—everything from coverage of the latest high-tech breakthroughs to practical tips on common personal health problems.

From Orthodoxy to Outcome. The prestigious Joint Commission on Accreditation of Hospitals recently announced plans to evaluate hospitals based on clinical outcome measures. Each hospital will be graded for its effectiveness in dealing with every possible type of health problem. When this data is made available to the public, consumers will for the first time be able to determine which local hospitals really do offer the highest-quality medical care.

In a few cases, hospital administrators currently have these figures but refuse to disclose them to the public. But in most cases, even the administrators themselves don't have this information. This has made it extremely difficult for them to root out pockets of poor quality care.

If, for instance, a certain hospital experiences an unusual number of deaths in the intensive care unit, an in-house quality control committee can investigate the problem immediately. If it persists, the accrediting body would send in an investigating team.

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 About The Author
Tom Ferguson MDTom Ferguson, M.D. (1943-2006), was a pioneering physician, author, and researcher who virtually led the movement to advocate informed self-care as the starting point for good health. Dr. Ferguson studied and wrote......more
 
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