About The Book

About

the slippery slope of healthcare

Dr. Steven Kussin, physician and a pioneer in the Shared Decision movement, takes readers through the steps of how to avoid the many pitfalls of unnecessary and dangerous medical care.

A slippery slope describes how events progress from an initially innocent step to a cascade of subsequent misfortunes that are increasingly inevitable, difficult to stop, and more harmful than the last. In the attempt to improve what is already just fine, patients can unknowingly find themselves on this Slope. The downward slide from healthy to unhealthy occurs when consumers agree to or ask for unnecessary tests, or for which there are safer options. This book helps consumers learn why less can be best and to know where the dangers lie in wait.

The American healthcare system is subsidized by its services to healthy people. The goal as it is for any business is to encourage people to become consumers by creating an emotionally-fueled demand for things that are suddenly and urgently needed. It’s hard to make healthy people well; it’s easy to make them sick.

Under the goal to make you even healthier, the medical industry identifies and encourages investigations and preventive technologies for ‘problems’ unlikely to occur, unlikely to harm, unlikely to benefit from testing, and, once diagnosed, unlikely to benefit from treatment.
Profitable services go on indefinitely for those who are young and well. For the health care industry being in good health is not just the best way to live; good health is also the slowest way to die.

When an unnecessary test begets more tests, the cascade of escalating misfortunes with higher risk, expense, and fewer benefits can become unstoppable. Many people pay an immediate and visible price for what are distant, invisible, and uncertain benefits. The central starting point for initiating a Slippery Slope adventure can be the first blood test, the first screening test, the first x-ray, the first pill, or the first diagnosis that’s accepted by unwitting and trusting consumers.

The bottom of the Slippery Slope is occupied by those previously well but who now are damaged, and by others who suffered needless unscheduled deaths. America’s famed consumer skepticism when judging retail products is curiously and dangerously absent in their interactions within the healthcare system. Here, Dr. Steven Kussin offers strategies that give readers knowledge and power by providing unique perspectives, information, and hundreds of resources that collectively cannot be found elsewhere.

He confronts the mighty forces arrayed against health care consumers and helps readers learn to identify them. A powerless medical consumer is pitted against the power of money, the authority of science, the stature of physicians, the lure of elective health improvements, the promise of technology, and the pitch-perfect, perfect pitches of televised ads. And against these forces, many will fall prey to needless medical adventures and their consequences.
This book is dedicated to one lesson: The view from atop the Slope, before making a health care decision, is better than the view from the bottom, after having made a bad one.

previous work

Doctor, your patient will see you now

Gaining the Upper Hand in Your Medical Care

Writing my first book was a breeze - no agents, publicists, or publisher. I was on my own and loved it. Only when it was completed did I bring on the crew.

Writing my second book was a fright. The publisher of my first book wanted a second. So, with their check and deadline in hand, I was now working for them. Now that the book is finally completed, I can enjoy and value the contribution of all who helped me.

Washing up on the shores of medical care is risky. There are strangers and dangers at every crossroad. Who are those strangers…where are those dangers? Welcome to my book!

That first step down The Slope is the dangerous one. Tests beget tests, so make sure you need the first one. If you are healthy, think twice. Learn before you leap. The first chapter introduces The Slope and offers an example and warnings.

Chapter 2 - Your Money or Your Life -the role of profit in medical care. It’s the healthy who subsidize the industry. It’s a three-ring-circus of overdiagnosis, overtreatment, and overdoses. And after that first step, your ticket is nonrefundable.

In Chapter 2, you’ll learn what 3 trillion dollars buy. Yes, money does rule medicine. The profits are unimaginable to all except those who are making it.

Chapter 3 - Crocodiles vs. Alligators. Crows vs. Ravens. They look alike, but they aren’t at all the same. MDs look like PhDs, but we also are different species. Medical care is not science. And most doctors are not scientists. Thinking we are scientists is a mistake and leads to misadventures on The Slope.

Doctors and scientists use different databases, languages, protocols, and role models. Our advice is NOT scientific. We are as deficient in science, math, and statistics as you are.

Chapter three is all about Doctors. Being busy is no excuse for doctors. From Benjamin Franklin, “If you want something done, ask a busy person.” The busier the doctor, the more responsive to your needs they should be.

This chapter will help you identify doctors with white coats but black hearts. There are bad players out there.

One of my favorite quotes. “Even the drunk driver will usually get you home safely, but why take the chance.” The Doctor chapter gives readers the tools to judge the best doctors in the best offices. The fact that most people do pretty well most of the time should not be reassuring.

We outline Patient-Centered Medical Homes, Direct Patient Care, and the One Patient One Doctor Models.

Karl Marx said it best. The ‘least bad provider’ model is introduced. Modest needs to not need to be extravagantly met. Matching providers’ abilities to your requirements result in better, safer care.

Why Stephen Curry doesn’t mow his lawn. A gardener does a good enough job allowing Curry to do what HE does best (and that pays more – a lot more!). It’s true too in medical offices. Make room for nurse practitioners and physician assistants. Learn why.

It’s your turn. Why do patients expect so much while at the same time, they accept so much? YOU…the best commercial consumers -the worst medical consumers. Why?

The express isle is convenient but beware. This chapter shows you when convenience is king and when it can kill. The section also discusses elective care…why some patients happily and unknowingly line up for The Slope.

TV. Direct to Consumer ads. Learn the tricks of the trade. These ads are pitch-perfect, perfect pitches. How and why they mispresent the facts.

Screening technologies. Let’s learn a bit about statistics. Early diagnosis always prolongs life by setting back the clock. It means nothing. What are the essential objectives of screening and prevention? In this slide, the train on each panel hits the victim at the same moment. What does early detection of a disease really accomplish?

For every thousand people who line up for preventive and screening, there’s only one winner. It’s The Number Needed to Treat. - it’s a terrific tool to use if any therapy or diagnostic test is recommended. What health risks will you take today for problems you will probably never get, or that are decades in the future?

How many people are harmed while trying to get healthier? Is it worth the risk to be the winner? Advice and resources offered for every screening and prevention technology.

Our last chapter…Shared Decisions. Your way to avoid The Slope or maneuver down it successfully.

There is no single solution to most medical problems. Learn about the alternatives and why your personal choices are rarely taken into account.

Understanding the issues about the medical care you didn’t ask for, agree to, understand, need, or want.

Shared Decisions. Why the healthy are hurt the first, suffer the most, at the times in their lives that they can afford it the least.

Alice in Wonderland asks, “Would you tell me, please, which way I ought to go from here?” The Cheshire cat answers, “That depends a good deal on where you want to go.” Shared Decisions…helps you know which road is the best for you, and to help you know when you have gotten to your destination. Doctor-only resources that show you the way.

Contact Author Steven Z. Kussin, MD

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