Snake oil

Dr. Josh Column: I take a deep breath and with a voice of conviction I tell this 65-year-old male, “Based on the findings, I recommend that you have “Y” treatment for your problem. I realize that you have received “X” treatment for this in the past but I feel that “Y” treatment would be better for you.”
“Doctor Baker, I have always received “X” treatment for this problem. It’s always worked for me in the past. Why would you want to mess up a good thing?”
Let me discuss a little back story…I have made a commitment to never sell snake oil in my practice. I don’t mean actual snake oil, but what is represented by snake oil – a product, procedure, device, medication or surgery that has been clearly shown to have no medical benefit. I have similarly made a commitment to never prescribe arsenic. Yes, I said arsenic. Doctors used this as late as the 1940s. I am speaking metaphorically again here. What I mean by this is that I cannot recommend something that is clearly harmful for my patient.
Let me now jump back into that previous conversation. It is clear from the medical literature that Treatment “X,” that the patient wants, is potentially harmful and is not indicated in this particular clinical situation and that Treatment “Y” is clearly the best available option. I explain this to the patient for several minutes in a calm tone and not using a single word of medical jargon.
The patient replies, “But it worked for me in the past, I really think treatment “X” is what I need.”
To use an extreme example, if my 7-year-old son asked me for a gallon of gasoline to get a fire started, I would never agree to this. Sure, it would get a fire started, but there are many better options available. In this patient encounter, I am the one with the medical training and education. I cannot acquiesce to the request and I will not allow the patient to use my medical license to put himself in the way of medical harm when there are much better and safer options now available for use.
In today’s busy medical world, unfortunately a lot of “snake oil” is still prescribed. We, as medical providers need to commit to use the most up-to-date medical information we have available. If we do not use this information, we might as well start selling snake oil. Joshua Baker, DO
FAAFP