Author of “The Secrets of Medical Decision Making: How to Avoid Becoming a Victim of the Health Care Machine”

Dr. Reznik, a Board Certified Family Physician, is here talking with us about his recently published book. Welcome to Reader Views.

Irene:  Oleg, you have written a book that has been long coming.  Would you please tell us what “The Secrets of Medical Decision Making” is about.

Oleg: This book is about the commonly encountered medical situations with an uncommon exposure of the issues involved in the physician’s thought process, and the impact they have on the patient. Its span covers outpatient encounters at a physician’s office for both illness-related and preventative issues, common situations faced during a hospitalization, prenatal care and childbirth-related issues, terminal illness and end-of-life issues. Most readers/listeners who’ve had to deal with the medical system will recognize the challenges that they’ve had to face and will gain a perspective that they probably haven’t been aware of. The topics are presented from the points of view of the patient, physician, and society as a whole. Philosophical/spiritual considerations are briefly explored as well. 

Irene:  What inspired you to write the book?

I wrote this book to bring a sense of independence and self-empowerment to the prospective patients. During my training and practice as a physician I became acutely aware of the great deal of suffering that stems not only from the illnesses, but more so from the beliefs that most people have regarding the capabilities of the modern medical system. These beliefs almost invariably lead to disappointment, frustration, and a great deal of physical and emotional pain. Patients with such beliefs submit themselves to tests and invasive procedures that bring them nothing more than additional suffering.

While modern medicine does have an effective arsenal of treatments for the acute medical problems, things are different when it comes to chronic illness. A modest slowing of progression is the most modern medicine can boast, when it comes to most chronic illness. In my book I accurately describe what medicine can and cannot do for some of the common medical problems. It is my hope awareness of these issues would motivate the reader/listener to take charge of their own lives and consider their health in the light of their own lifestyles, instead of believing that someone else (the medical system) will fix it for them.

Irene:   Who did you specifically write the book for?

Oleg: I wrote it for a general reader, anyone who may come in contact with the medical system for any reason, be it for themselves or for their family. My editors and I made our best efforts to write it in simple language, avoiding the use of medical terminology. Whenever medical terminology is used, it is clearly explained. It is appropriate for a young person, who would be prompted by the book to rely more on healthy living than on the future miracles of medicine. It will also help them in assisting their elder family members in their medical decision making and, if the need should arise, in addressing end-of-life care of their loved ones. It is appropriate for middle age and older people because they are the main consumers of healthcare and are impacted directly by most issues discussed in the book. It is appropriate for those who are close to the end of their journey in this world, so that their passing may happen with more peace, less suffering, and more according to their wishes.

Irene:  This is a very helpful book to many people. In what ways do you feel patients would benefit from reading “Secrets of Medical Decision Making”?

Oleg: I think the book may be helpful in several ways. Perhaps the most important may be the overall change of attitude from that of dependence to that of self-reliance. I think that in this book I make a good case for that, both by presenting the data, and, more importantly, by presenting the examples of lives of the actual patients from my practice. In addition to that, the information contained in the book can be used as recourse and as a reference. It can be brought up during a conversation with a physician to help clarify medical situations. I also offer a direct advice on how to speak to the physician and what questions to ask in order to obtain the information that one needs and in order to be treated in accordance to one’s wishes. The last chapter of the book is a summary of the material that can be used as a quick review before a discussion of any important medical issue.

Irene:  In your title you use the word “secrets.”  Are you really revealing secrets that we don’t know about?

Oleg:  I used the word “secrets” in its usual sense—things that the majority of people aren’t aware of. It is the non-medical components that go into the physician’s decision making that qualify to be called “secrets.” I bring to light exactly how your physician’s recommendations can be influenced by several powerful forces that have nothing to do with the patient’s best interest. Fear of litigation is one of these forces with power to change the way medicine is practiced. The influence of the pharmaceutical industry on creating medical guidelines is another force responsible for the direction of today’s medicine. The current medical model, which was created close to one hundred years ago mainly for the treatment of the acute illnesses, and is now applied to our current plague—chronic illness. Financial and time pressure is another challenge that is contributing more and more to what happens to the quality of out interaction with a physician, as our health care dollars are dwindling. While the existence of these challenges has been recognized before, I believe that I’ve made a contribution in clarifying exactly how they translate into the everyday doctor-patient interaction. 

Irene:  Unfortunately these issues occur.  How have you been personally impacted by these issues?

Oleg:  I am impacted by these issues in my everyday practice. Literally everyday that I see patients I encounter the issues that I described in the book and my task is always not to fall victim to misconceptions that I’ve described, and not to let my patient fall with me. Writing this book has helped me to clarify these important topics for myself, and it is helping me to clarify them for my patients. I continue to be influenced by the very same forces that I described in the book, but being aware of them has afforded me a greater degree of freedom, which is what I hope to bring to the reader/listener as well. Not going smoothly with the flow I’ve become somewhat of a renegade, though so far I am remaining within the boundaries of the conventional medicine, for the most part. I hope to continue to be available to the patients who encounter conventional medical system, and to provide a point of view that may further the medicine’s goal of reducing human suffering. The awareness of the problems described in the book is prompting me, as they do many other physicians, to search for models of health and illness that are better suited for today’s medical challenges. 

Irene:  There are many factors that we should be aware of. What do you believe we, as concerned patients, should know about medical decision making?

Oleg: Awareness of the factors that go into medical decision making will always help to find a better solution to any given medical problem. The patient can learn the limiting aspects of the physician’s and of their own thinking that lead to more suffering. Physicians, bound by their own fears and pressures, are one such source of such suffering. Patients’ unreasonable expectations are another. The audience should be aware every time they see a commercial advertising a medication or a medical service on TV, that such advertising does not have purely altruistic motives. For this reason it is biased, prone to inaccuracies and to giving false impressions. Our false impressions about the capabilities of medicine drive us to its unnecessary consumption, to disappointment, frustration, resentment, to emotional and physical pain.

Irene:  What are some things our readers can do to support someone who is in the throes of a difficult decision?

Oleg: I think the most helpful thing for a person involved in helping someone who is facing a difficult medical situation, is first to shed their own fear of that situation (illness or death). After that they can be in position to help relieve the sufferer’s fear as much as possible. The decisions that are based on fear bring the most suffering. Fearful grasping for reassurance is by far the most common source of unnecessary tests, treatments, and procedures that end up bringing more pain. A person who is not afraid is in a much better position to know the appropriate time to intervene and to stop intervening into the situation, be it as trivial as sore throat, or as serious as cancer. Information I provide in the book should be helpful in guiding one toward the solution once peace of mind is attained. I hope that reading/discussing the book would also create a ‘mental environment’ that protects readers from developing unusual dependence on the medical system, helps them remain their own authority, and as such to be in touch with what is best for them.    

Irene:  Thank you Oleg.  I appreciate you taking your time to talk with us.  For more information or to contact Dr. Reznik please go to: http://www.olegreznikmd.com/