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global health
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health
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Healthcare and health reform
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aged care
allied health care
Australian Medical Association
cancer
cardiovascular disease
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Choosing Wisely
chronic diseases
co-payments
Cochrane Collaboration
complementary medicines
conflicts of interest
death and dying
diabetes
digital technology
disabilities
e-health
emergency departments and care
Equally Well
euthanasia
evidence-based issues
general practice
genetics
health & medical marketing
health and medical education
health and medical research
Health Care Homes
health ethics
health financing and costs
health reform
health regulation
health workforce
HIV/AIDS
hospitals
HRT
infectious diseases
influenza
international medical graduates
journal articles
LGBTIQ
medical marijuana
Medicare Locals
men's health
mental health
MyHospitals website
National Commission of Audit 2014
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naturopathy
NDIS
NHMRC
non communicable diseases
nurses and nursing
oral health
organ transplants
out of pocket costs
pain
palliative care
paramedics
pathology
Pharmaceutical Benefits Scheme
pharmaceutical industry
pharmacy
Pregnancy and childbirth
primary health care
Primary Health Networks
private health insurance
quality and safety of health care
rural and remote health
screening
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social media and healthcare
suicide
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swine flu
telehealth
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TGA
trauma
women's health
youth health
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#NTRC
Acknowledgement
cultural safety
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Lowitja Institute
NT Intervention
social and emotional wellbeing
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#PreventiveHealthStrategy
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COVIDwrap
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food and nutrition
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health communications
health impact assessment
Health in All Policies
health inequalities
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media-related issues
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public health
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The Naked Doctor

Naked Doctor aims to encourage discussion and awareness of the opportunities to do more for health by doing less. It is a compilation of articles, books and other works that highlight overdiagnosis and overtreatment.

It is a project of Dr Justin Coleman, a GP who works in Aboriginal and Torres Strait Islander health in Brisbane. He holds a Masters in Public Health, and is President of the Australasian Medical Writers Association. You can also find him on Twitter.

Launched in January 2012, Naked Doctor is a work in progress. Comments and suggestions are welcomed.

Below are two items: an introduction to the project; and Naked Doctor’s first entries (some articles are from subscriber-only journals; if you are unable to access an article, please leave your details on the bottom of this post or email Croakey asking for a copy).

Note: Naked Doctor was updated on March 11, 2015, with this article: If it smells like research misconduct…

Naked Doctor was updated on June 23, 2015 with this article at Croakey: An indepth look at the pitfalls of “cutting edge” medicine

***

Introducing the Naked Doctor: When is ‘no action’ the best action?

Justin Coleman writes:

The modern doctor seems to have an intervention for every occasion. He or she wears a magician’s coat of surprises, each more incredible than the last. Hidden pockets contain pills, scalpels and lasers, with sophisticated medical tests providing the performance instructions.

At its finest, the medical method is impeccable; type I diabetes was a rapid death sentence prior to insulin and accurate blood sugar tests. Sometimes, though, the heavy clothing creates it own problems. Tests point to the wrong diagnosis, treatments cause harm and the promised magic fails.

Some failures are a consequence of bad luck and random variation. But the closer we study these problem areas—applying the scientific method—the more we find predictable patterns emerging. Many tests and interventions fail because they should never have been used in the first place.

The Naked Doctor probes the places in medicine that would be better stripped bare. Places where the correct option is to do nothing. The ‘doctor’s bag’ accompanying a home visit before the second world war contained no medication which would be considered of any use today, and quite a few dangerous poisons. The physician would have been of more use turning up empty handed—or, given the lack of latex gloves and infection control, perhaps not turning up at all. The modern example of cancer screening via whole-body CT scanning offers as much protection as the emperor’s new clothes, and the guileless emperor would be better off naked.

Naked Doctor’s old anatomy professor Norm Eisenberg used to claim ‘only half of the stuff we teach you in this medical course is true. The problem is, we don’t know which half!’

Luckily, various health professionals and journalists around the globe dedicate themselves to steadily peeling back the covers. Naked Doctor exposes their disrobing of over investigation and overtreatment. We invite you to watch, and to contribute.

***

Naked Doctor: the list

Over-intervention unveiled

Start at home with our very own Melissa Sweet who introduced the over-intervention theme to Crikey readers. A systematic approach is needed to balance the all-powerful “give us more” lobby.

Speaking of which, Melissa does give us more; in her non-Croakey spare time, she sums up our ‘less is more’ theme at Inside Story.

Sharon Beglee at The Daily Beast pens a neat appraisal of situations where saying ‘No’ to a test or procedure can potentially save your life. Some thoughtful doctors are voting ‘No’ when it comes to their own health—and Sharon names names.

Sharon also dispels four health care myths in the Scientific American, although it’s doubtful much dynamite is required to explode myth 4: The US has the best health care system in the world.

In 2010, Archives of Internal Medicine started a column ‘Less is More: How Less Health Care Can Result in Better Health’. Section editor Deborah Grady maintains the impressive article list. Naked Doctor recommends a pleasurable browse through the less-is-more garden, plucking full-texts at whim. Discover that doctors themselves think their patients get too much care, and find out the interventions voted ‘top 5’ for superfluities to avoid in general practice and paediatrics.

Josh Freeman, physician educator, Kansas US, writes a lovely blog mixing medicine with social justice. A number of articles discuss the inequities of spending money on treatments that don’t work. He scrutinises the money spent on MRIs and suggests patient advocacy organisations don’t necessarily have the population’s interests at heart.

Shannon Brownlee discusses a study by cardiologists Grace Lin and Rita Redberg, who designed three theoretical cases where evidence suggests non-intervention was the correct treatment. They found that their cardiologist colleagues would almost always recommend surgical intervention. Surprise! Maybe author Upton Sinclair had it right when he said: It is difficult to get a man to understand something when his salary depends upon his not understanding it.

Blogger Dr Jay Parkinson wonders if Lindsay Lohan and Steve Jobs received the worst health care in America…by which he means the most health care. The more famous you are, the more care you get and therefore the more can go wrong. A certain M. Jackson springs to mind. Jay deplores the relative lack of interest in preventative health.

Former BMJ editor Richard Smith teaches ten lessons about the world delivering the wrong care to the wrong places. When North America has 250 times Africa’s number of health workers per percentage of global disease burden, then modern clinical medicine is as out of control as the banks and is unaffordable globally.

He points out the Victorians eventually couldn’t live with the difference between rich and poor, and we got income tax with substantial transfers of wealth within countries. We now need such transfers between countries. Less over here, more over there; them’s fightin’ words, Dr Smith!

Croakey readers will be familiar with Dr Gary Schwitzer’s HealthNewsReview.org which is often relevant to our theme; could Gary himself be a closet Naked Doctor? One blog here covers disease-mongering, the ancient alchemic art of creating something out of nothing.

Chris Del Mar’s BMJ editorial provides a cogent argument for avoiding antibiotic prescription for colds, sore throats and ear infections. Unfortunately, patients expect doctors to intervene, and even when they don’t, doctors expect that their patients expect intervention. Confused? Paul Little explains the concept here.

Pharmed Out is a Georgetown University project educating healthcare professionals about pharmaceutical marketing practices. Grab a ‘No Drug Reps’ certificate for your waiting room or play Drug Ad Bingo in your spare time.

Departing boss of the US Medicare and Medicaid system, Dr Donald Berwick, lists ‘overtreatment’ as the first of five reasons for the very high 20-30 percent of US health spending he calls waste that yields no benefit to patients.

In a world where dental undertreatment is the norm, dentists are not immune from the temptation to overtreat when the patient can afford it. Many experts think it doesn’t make sense to operate in the early stages of decay…yet a majority of practitioners are inclined to do so. Just say Aaaaargh!

***

Revealing what lies behind the screening

We live in testing times. The National Cancer Institute provides a wordy but interesting overview of the hazards of cancer screening.

Two former ‘track favourites’ for cancer screening—mammograms and PSA tests —seem to be running off the pace in 2012, although both still have plenty of backing. The controversy provides insight into the pros and cons of screening tests.

Med Page Today is a hardworking site which covers medical news for clinicians and is prepared to call bad behaviour when spotted. In Arithmetic stings when well people seek medical care, Dr George Lundberg gives a simple maths lesson, demonstrating the large number of false positives generated by even an accurate test for a rare condition. The increase of well people seeking medical care lowers the prevalence of all diseases and increases the rates of false diagnoses.

Patients referred for MRIs by physicians who owned their own MRI machine were almost twice as likely to have no pathology on review by an independent radiologist. Nothing beats the moolah as an incentive for ordering a test. Do private hospitals also see dollar signs when over treating patients with dementia?

***

Books that bare all

Overtreated: Why too much medicine is making us sicker and poorer
Shannon Brownlee, 2007, US
Find out about Roemer’s Law ‘A built hospital bed is a filled hospital bed.’ Discover the ‘Limits of Seeing’, where high tech scans make us as transparent as jellyfish, but just as often cloud the diagnosis. And read the last chapter ‘Less is More’, which would have made a great title for this Croakey page, if only Naked Doctor had thought of it first.

Testing Treatments: Better research for better healthcare
Imogen Evans, Hazel Thornton, Iain Chalmers, Paul Glasziou
With the addition of Queensland’s Paul Glasziou, this second edition discusses how to ensure research into medical treatments best meets the needs of patients. The chapter Earlier is not necessarily better covers a Naked Doctor pet theme of the benefits and harms of screening tests.

Overdiagnosed: Making people sick in the pursuit of health
H. Gilbert Welch, Lisa Schwartz and Steve Woloshin
As a society consumed by technological advances and scientific breakthroughs, we have narrowed the definition of normal and increasingly are turning more and more people into patients. Well worth a read: but why take Naked Doctor’s word for it, when you can read the BMJ book review by Croakey regular and fellow sceptic Ray Moynihan.

Ten questions you must ask your doctor
Ray Moynihan and Melissa Sweet
Ray and Melissa would make their mothers proud and their GP nervous. Their approach to keeping the bastards honest is patient-driven quality control at its best. I just hope they book longer consultations. There is little doubt that a dose of healthy scepticism is just what the doctor ordered. Indeed, the Naked Doctor orders scepticism twice daily, taken with a glass of water and a grain of salt.

House of God
Samuel Shem
Shem’s classic 1978 novel has the narrator as an intern admitting his hospital’s most important benefactor and secretly ordering no investigations or treatment. The patient’s rapid improvement underlines the thirteenth and final law taught to the intern by his wise mentor, the Fat Man: The delivery of good medical care is to do as much nothing as possible. Another Naked Doctor favourite is his tenth law; If you don’t take a temperature, you can’t find a fever. Indeed!

Disclaimer: Reading House of God as an intern was Naked Doctor’s original inspiration for a career-long interest in avoiding overtreatment. He does still own a thermometer and uses it discretionally.

***

Naked Doctor welcomes suggestions for inclusion on this list, but is responsible for the final decision about which entries are included.

 

 

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HUGE congratulations to all the Croakey team on your coverage of our Summit. To say we have been delighted with the event, your coverage and the wash up is an understatement. You did such a fantastic job.  I know how much there was to synthesise! I was particularly impressed with the flair and variety in how you approached the various pieces of coverage. 

Leanne Wells

Chief Executive Officer, Consumer Health Forum of Australia re: #ShiftingGears (2021)

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We are working very hard to ensure Croakey Health Media becomes sustainable into the future. Every donation helps! No amount is too small to make a difference. You can choose to make a one-off donation or become a regular donor. Please donate here.

Please also consider registering at our Patreon account that supports public interest journalism on the climate crisis and health – it’s an easy way to support us through regular donations. Every dollar helps.

Help support non-profit public interest journalism

Public interest journalism is an important determinant of health, due to its roles in accountability and holding power to account, empowering communities, and contributing to health literacy. A strong public interest journalism sector contributes to planetary health and health equity, as well as healthier people, communities, societies, and systems of governance.

Donate

We are working very hard to ensure Croakey Health Media becomes sustainable into the future. Every donation helps! No amount is too small to make a difference. You can choose to make a one-off donation or become a regular donor.

Donate now

Please also consider registering at our Patreon account that supports public interest journalism on the climate crisis and health – it’s an easy way to support us through regular donations. Every dollar helps.

Subscribe

Although you can always access Croakey’s articles for free, a convenient way to stay up to date is with our weekly emailed summary of Croakey articles. It is only $60 per year (including GST).  We also offer special rates for bulk deals – for example, for organisations or students.

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More options

Join one of our annual Funding Consortia

Croakey is supported by two main funding consortia, whose contributions help to pay the Croakey News team. We would not be able to operate without our editorial team, who commission, edit and publish articles and also support special projects.

Two membership options are available:

  • $2600 + GST consortium membership.
  • $3600 + GST consortium membership with logo and statement included on four of the weekly Croakey News bulletin as follows: “XXX is a supporter of Croakey and public interest journalism”. This advertisement is provided at a significant discount to our usual advertising rate in the bulletin.

Members of the consortium are provided ten complimentary yearly subscriptions to the weekly Croakey News bulletin (total value $600), and a further discount offered on bulk subscriptions.  Members are acknowledged on the Croakey website with organisation logo on the front page and name and link to your website here.

If you would like to be part of one of the Consortia, please contact us at: support@croakey.org.

What people say about Croakey

Croakey has served splendidly as an independent voice in the health policy arena.  It provided a forum for people with ideas and passion about health, especially from a social perspective and policy position, but always with humane concern can find a home.  We wish the re-platformed Croakey every success.

Emeritus Professor Stephen Leeder

The University of Sydney

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