From what I've heard, Leslie Simmons is a caring nurse and is now CEO of Carroll Hospital. I read her "Other Voices" column on May 14 and agree heartily about her need to speak up. This is a bit unusual for a person in her position, and I applaud it. Since I retired from my "day job" as a Department of Energy health risk expert, I have established my own medical "practice" just to gain access to the large (and often conflicting) database available on the web. There is a flood of very useful information available in Consumer Reports, WebMD and other sources that are top notch.

Every point Ms. Simmons makes is what I would have said. We must be vigilant. However, putting these steps into practice is often quite challenging. I also have to say I have been treated at Carroll Hospital several times in the past, and have nothing but good to say about the staff.


Many physicians I've spoken to acknowledge that they have to follow a script when making diagnoses, based on legal advice. If their diagnosis conforms to what is the "norm" or what other practitioners do, that is what they do in order to minimize malpractice claims. Most group practices today are affiliated with hospitals, and they share a legal team. Unfortunately, this often leads to misdiagnosis or over-diagnosis. It's trying to fit square pegs into holes that are not quite square but not exactly round either.

Risk assessment as an offshoot of Obamacare has been used successfully to flag cardiovascular disease (and attendant encroachment of diabetes in some cases) and cancer as the two most likely causes of death and refocused many family practices. Unfortunately, the third-leading cause of death is a generalized area called "medical mistakes," based on a Johns Hopkins Medicine report issued a year ago. This is the national epidemic nobody wants to talk about.

At one time, physicians used to weigh all of this evidence and freely discuss individual situations with the patient's interests at heart. The Affordable Care Act streamlined health care by cracking down on Medicare claims. One paper I reviewed from a family practice indicated a typical physician has an almost incomprehensible 2,300 patients on the average, saw them for 15 minutes and spent 5 to 10 minutes filling out the forms. Further, because of rising costs, physicians' assistants are starting to do the bulk of the examinations.

Most Americans are significantly over-medicated, and it causes a lot of annoying and unnecessary conditions. It can, in some cases, be more damaging than the problem it is attempting to fix. For example, statin use can push one to be prediabetic. The current medical protocol, rather than provide a sharper definition on whether statin use is appropriate for that situation, would be to continue almost universal prescribing of statins, perform extensive sugar level exams for the masses rather than being medically selective, and often have the patient take another medication — usually with multiple side effects — on top of the medication causing the problem. Certainly, this widespread practice is extremely lucrative for hospital laboratories.

Saying "no" to a physician or hospital can take months or years of research and incredible stamina and persistence in order to prevail. The medical teaching community and hospitals generally abhor the use of risk assessment models unless it is on their terms and only they can use it. The Food and Drug Administration use a risk assessment approach to license pharmaceuticals. As mentioned, it is the cornerstone of identifying cardiovascular disease to focus on.

Risk methods are often complex, subjective, require lots of testing and time to mature, can be against prevailing views, and require extensive training and hands-on experience to interpret data, which is generally not in the purview of physicians' course material because it might require a practicing physician to take years of additional training. A select few physicians I have worked with are outstanding in this area. Most aren't. Most physicians have been trained to downplay risk assessment.

My current physician (and it is a practice focusing on Frederick County) was trained in Canada where they use considerable risk assessment — and grudgingly agrees. He is a brilliant man, and I know he cares about people. I'd even go out with him for a beer, if he had the time. But, because of malpractice concerns, the need to produce billable clients and maintain the medical code of practice, his hands are tied.

I eliminated three prescriptions from my package of meds in the past year, but it took an unnecessarily extensive effort on my part. In each case, I had a well-documented and defensible paper trail. My family physician and primary care/hospital staff management (not Carroll Hospital) fought me tooth and nail. It points out that pharmaceuticals have a pervasive hold over our lives. Blue Cross Federal pays more (causing large premium hikes) for pharmaceuticals than for physicians or hospitals, and one could make a case that our "legal" drug problem, eventually leading to unnecessary over-use of medical facilities — remember, medical mistakes are the third-leading cause of death — cause more harm than "street drugs" as well as forcing health care premiums to explode. Physicians and health care executives I've spoken with said people demand to have these drugs.

My own experience is that simplest is best. Cut down treatment to the absolute (or close to it) minimum. Ms. Simmons' lessons are to the point. Providing effective solutions will be extremely difficult, but hopefully patient advocates and physicians can work together. Consider this an olive branch.

Dave Pyatt writes from Mount Airy.