4 questions you should always ask your doctor | Christer Mjåset

I am a neurosurgeon, and I’m here to tell you today
that people like me need your help. And in a few moments, I will tell you how. But first, let me start off by telling you
about a patient of mine. This was a woman in her 50s, she was in generally good shape, but she had been in and out
of hospital a few times due to curative breast cancer treatment. Now she had gotten a prolapse
from a cervical disc, giving her radiating pain of a tense kind, out into the right arm. Looking at her MRI
before the consultation, I decided to suggest an operation. Now, neck operations like these
are standardized, and they’re quick. But they carry a certain risk. You make an incision right here, and you dissect carefully
past the trachea, the esophagus, and you try not to cut
into the internal carotid artery. (Laughter) Then you bring in the microscope, and you carefully remove
the disc and the prolapse in the nerve root canal, without damaging the cord
and the nerve root lying only millimeters underneath. The worst case scenario
is the damage to the cord, which can result in paralysis
from the neck down. Explaining this to the patient,
she fell silent. And after a few moments, she uttered a few very decisive words
for me and for her. “Doctor, is this really necessary?” (Laughter) And you know what I realized,
right there and then? It was not. In fact, when I get patients
like this woman, I tend to advise not to operate. So what made me do it this time? Well, you see, this prolapse was so delicate, I could practically see myself
pulling it out of the nerve root canal before she entered the consultation room. I have to admit it,
I wanted to operate on her. I’d love to operate on her. Operating, after all,
is the most fun part of my job. (Laughter) I think you can relate to this feeling. My architect neighbor says
he loves to just sit and draw and design houses. He’d rather do that all day than talk to the client
paying for the house that might even give him
restrictions on what to do. But like every architect, every surgeon needs
to look their patient in the eye and together with the patient, they need to decide on what is best
for the person having the operation. And that might sound easy. But let’s look at some statistics. The tonsils are the two lumps
in the back of your throat. They can be removed surgically, and that’s called a tonsillectomy. This chart shows the operation rate
of tonsillectomies in Norway in different regions. What might strike you
is that there is twice the chance that your kid —
because this is for children — will get a tonsillectomy in Finnmark
than in Trondheim. The indications
in both regions are the same. There should be
no difference, but there is. Here’s another chart. The meniscus helps stabilize the knee and can be torn or fragmented acutely, topically during sports like soccer. What you see here is the operation rate
for this condition. And you see that the operation
rate in Møre og Romsdal is five times the operation
rate in Stavanger. Five times. How can this be? Did the soccer players in Møre og Romsdal play more dirty
than elsewhere in the country? (Laughter) Probably not. I added some information now. What you see now
is the procedures performed in public hospitals, in light blue, the ones in private clinics
are light green. There is a lot of activity
in the private clinics in Møre og Romsdal, isn’t there? What does this indicate? A possible economic motivation
to treat the patients. And there’s more. Recent research has shown
that the difference of treatment effect between regular physical therapy
and operations for the knee — there is no difference. Meaning that most
of the procedures performed on the chart I’ve just shown could have been avoided,
even in Stavanger. So what am I trying to tell you here? Even though most indications
for treatments in the world are standardized, there is a lot of unnecessary variation
of treatment decisions, especially in the Western world. Some people are not getting
the treatment that they need, but an even greater portion of you are being overtreated. “Doctor, is this really necessary?” I’ve only heard that question
once in my career. My colleagues say they never heard
these words from a patient. And to turn it the other way around, how often do you think
you’ll get a “no” from a doctor if you ask such a question? Researchers have investigated this, and they come up
with about the same “no” rate wherever they go. And that is 30 percent. Meaning, three out of 10 times, your doctor prescribes
or suggests something that is completely unnecessary. And you know what they claim
the reason for this is? Patient pressure. In other words, you. You want something to be done. A friend of mine came to me
for medical advice. This is a sporty guy, he does a lot of cross-country skiing
in the winter time, he runs in the summer time. And this time, he’d gotten a bad back ache
whenever he went jogging. So much that he had to stop doing it. I did an examination,
I questioned him thoroughly, and what I found out is
that he probably had a degenerated disc in the lower part of his spine. Whenever it got strained, it hurt. He’d already taken up
swimming instead of jogging, there was really nothing to do, so I told him, “You need
to be more selective when it comes to training. Some activities are good for you, some are not.” His reply was, “I want an MRI of my back.” “Why do you want an MRI?” “I can get it for free
through my insurance at work.” “Come on,” I said —
he was also, after all, my friend. “That’s not the real reason.” “Well, I think it’s going to be good
to see how bad it looks back there.” “When did you start interpreting
MRI scans?” I said. (Laughter) “Trust me on this. You’re not going to need the scan.” “Well,” he said, and after a while, he continued,
“It could be cancer.” (Laughter) He got the scan, obviously. And through his insurance at work, he got to see one
of my colleagues at work, telling him about the degenerated disc, that there was nothing to do, and that he should keep on swimming
and quit the jogging. After a while,
I met him again and he said, “At least now I know what this is.” But let me ask you a question. What if all of you in this room
with the same symptoms had an MRI? And what if all the people in Norway had an MRI due to occasional back pain? The waiting list for an MRI
would quadruple, maybe even more. And you would all take
the spot on that list from someone who really had cancer. So a good doctor sometimes says no, but the sensible patient
also turns down, sometimes, an opportunity
to get diagnosed or treated. “Doctor, is this really necessary?” I know this can be
a difficult question to ask. In fact, if you go back 50 years, this was even considered rude. (Laughter) If the doctor had decided
what to do with you, that’s what you did. A colleague of mine,
now a general practitioner, was sent away to a tuberculosis
sanatorium as a little girl, for six months. It was a terrible trauma for her. She later found out, as a grown-up, that her tests on tuberculosis
had been negative all along. The doctor had sent her away
on nothing but wrong suspicion. No one had dared or even considered
confronting him about it. Not even her parents. Today, the Norwegian health minister talks about the patient
health care service. The patient is supposed to get advice
from the doctor about what to do. This is great progress. But it also puts more
responsibility on you. You need to get in the front seat
with your doctor and start sharing
decisions on where to go. So, the next time
you’re in a doctor’s office, I want you to ask, “Doctor, is this really necessary?” And in my female patient’s case, the answer would be no, but an operation could also be justified. “So doctors, what are the risks
attached to this operation?” Well, five to ten percent of patients
will have worsening of pain symptoms. One to two percent of patients will have an infection in the wound
or even a rehemorrhage that might end up in a re-operation. 0.5 percent of patients
also experience permanent hoarseness and a few, but still a few, will experience reduced function
in the arms or even legs. “Doctor, are there other options?” Yes, rest and physical therapy
over some time might get you perfectly well. “And what happens if I don’t do anything?” It’s not recommended, but even then, there’s a slight chance
that you will get well. Four questions. Simple questions. Consider them your new toolbox to help us. Is this really necessary? What are the risks? Are there other options? And what happens if I don’t do anything? Ask them when your doctor
wants to send you to an MRI, when he prescribes antibiotics or suggests an operation. What we know from research is that one out of five
of you, 20 percent, will change your opinion on what to do. And by doing that, you will
not only have made your life a whole lot easier,
and probably even better, but the whole health care sector will have benefited from your decision. Thank you. (Applause)

89 thoughts on “4 questions you should always ask your doctor | Christer Mjåset

  1. Who Is Better?

    Like = Ted

    Comment = Kwebblekop

    (Good Luck In School This Year🙌)
                     Road To 3K

  2. 1. Did you cut and paste your way through med school? Do you have a conscience? Are you refunded or paid by any drug manufacturer? 4. Why did you go to med school?

  3. The questions:

    Doctor, is this really necessary?

    What are the risks?

    Are there other options?

    What happens if I don’t do anything?


  4. Ask. Sure. But I’ve seen MANY Drs over my 48 yrs. and of the Dr.s I’ve seen, I would say almost 100% either lie because they want your money, or they were not taught in school how to Really Care about people’s health.

  5. The most important question to ask any non-white male doctor is "Are you ashamed that the only way you could get accepted by the school was by playing the diversity card, and are you ashamed that the only reason you passed your exams was by the school lowering the standards" ?
    When I interact with any white male, I know with certainty he earned his qualification based on merit.

    >Am I going to live
    >why are you giving me drugs
    >are you a real DOCTOR
    >Who's Joe

  7. We cant dare ask 4 questions from The Doctor,surely not ours but he for himself,may be he asks in brief it for check up Fee and commission in X.Rays,.Tests and medicines fees !

  8. 10:35 are the 4 questions……BTW better question is to ask any doctor if they know a damn thing about nutrition. Do they have an opinion on what caused one to be there? aka the cause of their pain. If they cannot answer both of these questions they are car mechanics and hardly warrant the fees they charge.

  9. in uk there is no personal doctor… always wen I go to '' health centre'' there is different doctor and ha sno idea about my past as he can't be arsed to check on PC

  10. Cure a Patient > Lose a $$ Customer.
    Mantra of Today's Medicine = Control & Manage Symptoms.

    The SAD Part is that after our Medical Professionals go thru all the Personal & Professional Challenges to "Become" a Physician / Nurse / PA etc .. their Scope of Medicine is Dictated to them by the CPA's / Insurance / Lawyers … That Practicing Medicine is really just Following a Protocol / Script.

    Which is Why .. the Days of Kissing the Medical Ring are Over and Patients ( for good and for bad ) are taking a more Pro-Active Position regarding their Health ..

    BottomLine > Prevention Trumps Treatment AnyDay .. and when a Dr is "Necessary" go in with a Plan / Q's or an Advocate

  11. I cured my thyroid problems simply with right diet. No doctors told me that I can do it – they just want me to be sick for keeping their work…If doctors cure us…they think that they loose work

  12. by the time I get to a doctor or hospital …I WANT something done…I'm sick…
    there those who run to a doctor when not necessary … I'm not one of them…
    the last time I was there…2 and a half months ICU…
    I could have very easily not made it.
    waited too long…and that cost me…I've not walked in 6 years now…

    questioning your doctor…should be a no brainer…
    did not have to ask those questions…
    He told me what he did and why…when I woked up in ICU

  13. 5:41 Wait a minute! Logic alert! Just because the patient doesn't ask if it's necessary doesn't mean it's necessarily unnecessary.

  14. A Doctor should always use “the Grand Mother’s Test” when offering Surgery or another form of treatment to a Patient.. i.e would I offer this to my Grandma, my Son, or my Father, had they presented themselves like this patient….🤔🤔🤔

  15. My mother was diagnosed with cancer and given 2 months to live. We asked the doctor, how long will she live if she does chemo and he said "2 months" and if she doesn't ? "2 months." So there was no point in doing chemo, but chemo was all the doctor could offer. She did an alternative natural treatment w another doctor and lasted a total of 9 months. She went literally in one day and didn't have to suffer unnecessarily, yet she would've been miserable if she listened to her oncologist.

  16. A while ago, there was this ugly slogan at the local hospital, that could be translated to "head open, head rotten". So I would say what this video warns is true, especially for neurosurgery.

  17. these questions are completely useless in canada. they will not give you surgery unless it's absolutely necessary. they already answered the questions themselves.

  18. How can you afford a doctor?

    Why has medical care gone through the roof since the supposed "affordable" care act?

    Why is medical care one of the only costs to increase dramatically with innovation?

    What is the correlation between government red tape and medical costs?

    How are government regulations preventing the availability of new treatments?

  19. What happens if I do nothing. I challenged myself for 15 years, well actually I had a mental illness and was afraid of doctors. But it's amazing what the body can do all on its own. Sure, things might take longer to heal, but no medical intervention was needed. Eat healthy, exercise and get enough rest. (which is where most people fail anyway). Stop clogging up the healthcare system for people who really need it.

  20. This is an enlightening presentation! I wrote down the question for future use. In the U.S., we see a barrage of TV commercials promoting drugs for all sorts of ailments. The economic motivations may apply to prescribed drugs too.

  21. How can it be that WE as patients are now responsible for wrong decisions made by doctors who are also stuck in the corrupt health care system? In Germany there are more cesareans since the legal specifications have been changed: the hospitals now only get paid for "cases" and not for time spent on a patient – giving birth the natural way can last some time so it is cheaper to have a highly predictible cesarean operation.

    Another example is back pain – you could either treat it with injections or with physiotherapy. But the doctor only has a certain contingent of prescriptions of physiotherapy (if the limit is exceeded, they have to explain it to the ensurance)

    In both cases, the conservative therapy is (most of the time) better AND cheaper for the whole system, but hospitals are going bankrupt, so they push you to the operation.

  22. Another good question(s) to ask would be, "What will this do for me?"/"Will this make my life better?"
    If possible, I would also advise getting a second opinion from other doctors, preferably if they are already familiar with or aware of your situation.

    I have a long and complicated medical history and thus I've had many doctors over the years. Once, when going to see a doctor that was familiar with operating on me, I brought up an operation another doctor wanted to do on me. He proceeded to tell me it was a bad idea, why it was a bad idea, and gave me a long talk about asking questions like these. He also warned me that some doctors will operate simply to say that they did it, rather than for it being for the betterment of the patient.

    I was fortunate enough to have a doctor that knew my situation and cared enough for my wellbeing to tell me I was making a mistake, and that opened my eyes. Not all doctors will go through the trouble to do that though, which is why it's important that patients remember they have a say in what happens to them and whether or not it's the best decision for them.

  23. How about Doctors simply go through these questions themselves when they give you a diagnosis :s… 2:00 doctors salivating at the chance to operate regardless of the best course of action is NOT a great reason to give bad advice to a patient when they already have the answers they need…infact this should be considered malpractice smh.

  24. You're talking about responsible doctors …
    I had an MRI that turned negative… later the doctor told me it was his first MRI ever, and that he wanted to actually see one.
    P.S. It was the only money I had … It was my rent money 😂😂😂 and believe me I asked … and his answer was … your life depends on it 😂😂😂

  25. 5th would be: doctor can just do gymnastics like exercises, eat predominantly fruits and skip 98% of your corporate modern medicine…?

  26. This is such an important topic, both in countries with an extensive public healthcare system as well as ones with a privatized insurance-based systems. Reducing unnecessary procedures saves everyone's time and resources. Just have to be careful not to dismiss patients who do need the procedures. I've already seen cases where the doctors are quick to prescribe supplements and exercise for everything. The micro nutrient hysteria is getting ridiculous. Also, if you're a woman, they will usually start by making you take a pregnancy test, no matter what your symptoms are and whether you're sexually active or even heterosexual. What a waste!

  27. Really enjoyed the talk, well done!! Many insightful points, so true about patient demands and requests for unnecessary tests and imaging especially in the NHS with the already scarce resources

  28. THANK YOU Dr Mjaset this really needed to be said. Not only unnecessary operations but too many unnecessary pills and medications. We are being drastically overprescribed. They are finally realising the damage that has been done by far to much antibiotics too.

  29. One problem. My family and I have a history of being undertreated .

    These questions will only favor the doctor's pre-existing bias.

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