For the past year, we have examined the seven assumptions that drive excessive medical care, as described by Dr. H. Gilbert Welch in Less Medicine, More Health. This month, we review the very last assumption that medical care is all about avoiding death [1]. Welch states that most Americans desire to die peacefully in their own home with their loved ones without any medical equipment or alarms. Yet, hospitals are the most common place of death, according to the CDC [2].

The sixth assumption is that newer is always better [1]. One of the examples is the drug thalidomide. Created by a German pharmaceutical company in the 1950s, the drug was marketed as Contergan. Its function was to reduce anxiety and improve sleep. A few years later, an English company licensed the medication as Distaval, touting the drug’s safety and well-tolerance. Within ten years, babies were born to mothers who had ingested thalidomide. The most prominent finding was the missing limbs of these children, a devastating side effect of the drug.

Previously, we discussed the assumption that always treating is best when faced with a health issue. Often, a treatment provides a tangible solution for both patients and healthcare providers. Yet, treatment may not be in the patient’s best interest at all times. There may be value in simply waiting or doing nothing.  As we will see, another option may be to subtract a root cause rather than add a new intervention.

The author starts with a story about President Garfield. Garfield was shot in the back with a pistol in 1881. The bullet stopped by his pancreas, and miraculously, the president survived.

Returning to the discussion of health assumptions that drive too much medical care, let’s review the fourth assumption in Less Medicine More Health by Dr. H. Gilbert Welch. The fourth assumption is that getting more information is always the right choice.

The third assumption is that sooner is always better. This chapter examines screening, which is defined as searches for abnormalities without any presence of disease symptoms

The second assumption is that fixing the problem is always the best choice.

Knowing the kinds of questions to ask your healthcare provider can put you in the driver’s seat so that you can make informed decisions about your care.

Reference ranges are important tools for clinicians to use to compare a patient’s test results against a certain standard and guide decisions

Being familiar with health options and asking questions about the necessity of treatment is important to avoid overuse of the healthcare system and the risks that medical care can bring.

Facing health decisions can feel incredibly overwhelming and daunting at times. Your healthcare provider may deliver a copious amount of information. The news may not be what you expect. There may be pressure to agree to a certain procedure or medication. You may leave the appointment still having unanswered questions, with an uncertain path forward.

Ethics are a moral code that guides the conduct of healthcare professionals. There is a duty to the patient to avoid or minimize harm, as well as respect patient preferences [1]. The four fundamental principles of ethics include beneficence, nonmaleficence, justice, and autonomy. In addition to these are veracity (truth-telling) and confidentiality. These pillars keep the patient at the forefront of care.