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 the 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 braces like these are
standardized and they’re quick let they
carry a certain risk you make an
incision right here and you dissect
carefully past the trachea esophagus and
you try not to cut into the internal
carotid artery 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 a worst-case scenario is the
damage to the cord which can result in
paralysis from the neck down explaining
this to the patient she felt silent and
after a few moments she uttered a few
very decisive words for me and for her
doctor it’s this really necessary
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 runner root
canal before she entered the
consultation room I have to admit it I
wanted to operator
I’d love to operator operating like is
this after all the most fun part of my
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 then talk to the
person the client paying for the house
that I might even give in restrictions
on what to do but like every architect
every surgeon needs to look the 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
own children will get the tonsillectomy
in Finnmark and in Trondheim the
indication in both regions are the same
there should be no difference Patras
here’s another chart the meniscus have
stabilised the knee and can be torn or
fragmented acutely typically during
sports like soccer what you see here is
the operation rate for this condition
and you see that the operation rate in
the room stall it’s five times the
operation rate in Stavanger five times
how can this be the soccer players in
the room stop play more dirty and
elsewhere in the country probably not
I’ve added some information now what you
see now is the procedures performed in
public hospitals a light-blue the one in
private clinics is dried green there is
a lot activity on in the private clinics
in the room so isn’t there what does
this indicate 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 are
just wrong
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 over treated doctor it’s this
really necessary I’ve only heard that
question once in my career my colleagues
say they never heard these words from a
patient aunt eternity all the way around
how often do you think you’ll get a no
from a doctor if you ask such the
questions researchers have investigated
this and they come up with about the
same no rate where ever they go and that
is 30 percent meaning 3 out of 10 times
your doctor prescribes or suggest
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 do a lot of
cross-country skiing in the winter time
he runs in the summertime and this time
he had gotten a bad backache 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
degenerated discs in the lower part with
spine whenever he got strained it hurt
it already taken up swimming instead of
jogging
there was really nothing to do so I told
him you did 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 on 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 thrown my friend
that’s not a real reason well
I think it’s gonna be good to see how
bad it looks back there
when did you start interpreting MRI
scans I said trust me on this you not
gonna need the scan well he said and
after a while he continued it could be
cancer 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 discs that
there was nothing to do 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 would
the same sentence 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 turned
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 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
on a tuberculosis sanatorium as a little
girl for six months it was a terrible
trauma for her she later found out as a
grownup that her tests on tuberculosis
had been negative all along
the doctor has sent her away on nothing
but wrong suspicions no one had dared or
even considered confronting him about it
not even her parents today
the Norwegian Health Minister talks
about the patient’s health care service
the patient’s is supposed to get advice
from the doctor about what to do this is
great progress but it also put more
responsibility on you you need to get in
the front seat with your doctor and
start sharing decisions on where to go
the next time you’re in the doctor’s
office I want you to ask doctor is this
really necessary
and in my female patients case the
answer will 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 three percent of patients will have
an infection in the wound or even a real
Mirage that might end up in Rio pression
0.5 percent of patients also experience
permanent hoarseness and a few but still
a few will experience reduced function
in the arm 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 work
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% 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 that the whole health care sector
will have benefited from your decision thank you
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 the 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 braces like these are
standardized and they’re quick let they
carry a certain risk you make an
incision right here and you dissect
carefully past the trachea esophagus and
you try not to cut into the internal
carotid artery 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 a worst-case scenario is the
damage to the cord which can result in
paralysis from the neck down explaining
this to the patient she felt silent and
after a few moments she uttered a few
very decisive words for me and for her
doctor it’s this really necessary
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 runner root
canal before she entered the
consultation room I have to admit it I
wanted to operator
I’d love to operator operating like is
this after all the most fun part of my
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 then talk to the
person the client paying for the house
that I might even give in restrictions
on what to do but like every architect
every surgeon needs to look the 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
own children will get the tonsillectomy
in Finnmark and in Trondheim the
indication in both regions are the same
there should be no difference Patras
here’s another chart the meniscus have
stabilised the knee and can be torn or
fragmented acutely typically during
sports like soccer what you see here is
the operation rate for this condition
and you see that the operation rate in
the room stall it’s five times the
operation rate in Stavanger five times
how can this be the soccer players in
the room stop play more dirty and
elsewhere in the country probably not
I’ve added some information now what you
see now is the procedures performed in
public hospitals a light-blue the one in
private clinics is dried green there is
a lot activity on in the private clinics
in the room so isn’t there what does
this indicate 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 are
just wrong
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 over treated doctor it’s this
really necessary I’ve only heard that
question once in my career my colleagues
say they never heard these words from a
patient aunt eternity all the way around
how often do you think you’ll get a no
from a doctor if you ask such the
questions researchers have investigated
this and they come up with about the
same no rate where ever they go and that
is 30 percent meaning 3 out of 10 times
your doctor prescribes or suggest
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 do a lot of
cross-country skiing in the winter time
he runs in the summertime and this time
he had gotten a bad backache 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
degenerated discs in the lower part with
spine whenever he got strained it hurt
it already taken up swimming instead of
jogging
there was really nothing to do so I told
him you did 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 on 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 thrown my friend
that’s not a real reason well
I think it’s gonna be good to see how
bad it looks back there
when did you start interpreting MRI
scans I said trust me on this you not
gonna need the scan well he said and
after a while he continued it could be
cancer 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 discs that
there was nothing to do 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 would
the same sentence 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 turned
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 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
on a tuberculosis sanatorium as a little
girl for six months it was a terrible
trauma for her she later found out as a
grownup that her tests on tuberculosis
had been negative all along
the doctor has sent her away on nothing
but wrong suspicions no one had dared or
even considered confronting him about it
not even her parents today
the Norwegian Health Minister talks
about the patient’s health care service
the patient’s is supposed to get advice
from the doctor about what to do this is
great progress but it also put more
responsibility on you you need to get in
the front seat with your doctor and
start sharing decisions on where to go
the next time you’re in the doctor’s
office I want you to ask doctor is this
really necessary
and in my female patients case the
answer will 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 three percent of patients will have
an infection in the wound or even a real
Mirage that might end up in Rio pression
0.5 percent of patients also experience
permanent hoarseness and a few but still
a few will experience reduced function
in the arm 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 work
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% 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 that the whole health care sector
will have benefited from your decision thank you
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