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Dr. Hanna's philosophy on medicine
as expressed in his book, Dying of Health Care
On patient care generally
"I have seen over the years that the physical, emotional, and financial health of a patient are closely tied together. All three aspects of a person’s health are crucially and inseparably intertwined. They go hand-in-hand almost all the time; any one of the three can adversely, or positively, affect the other two."
On the importance of primary care
"The primary care physician is the entity in the medical profession that focuses on the entire body, without specializing in one particular area. Because of this, the PCP is able to see the patient holistically, without having a bias towards a particular region of the body."
On the significance of a doctor's judgment
"The primary care physician must have an ideal combination of knowledge, training, experience, and judgment to be able to make the correct decisions on a daily basis. There is simply too much riding on our decisions to take this lightly."
On unnecessary medical and surgical intervention
"According to experts, at least 225,000 American deaths per year are actually caused by medical care. If it were classified as such, this would make iatrogenic causes -- diseases, injuries, or death caused by excessive or unnecessary medical or surgical intervention -- the third most common cause of death in the United States, after heart disease and cancer."
"It is a very important role for a physician to educate patients and steer them away from the false belief that one can 'gobble up medicines on the way to living eternally.' In reality, polypharmacy (or multiple drug therapy) is too frequently the shortest way to the grave, or at least to a significant loss of well-being."
"While the act of writing prescriptions is one of the first skills studied as a young doctor or physician extender, it takes time in practice to realize that excessive prescribing is not only an unhealthy practice economically, but it also can be a physically harmful or even lethal practice."
"For the doctor, many cases come down to essentially weighing a definite zero percent chance of death from the actual diseases in the three examples with a definite greater-than-zero chance of death from the choice of the modalities of treatment. It comes down to the doctor’s judgment."
"The thought of having unnecessary surgery is disturbing, but the thought of dying during an unnecessary surgery is unspeakable."
"One must consider that surgery and anesthesia carry an inherent risk, at times being fatal. "
On the paradox of paying more to get less in health care
"Americans pay considerably more for health care than our counterparts in other developed nations, and yet we are falling short in nearly all metrics of health, including life expectancy. Put simply, we are paying more for health care and getting less... literally less of life, both in terms of quantity and health-related quality. "
"No consumer, no matter what degree of prudence he or she may have, would accept paying more for goods or services to get less when compared to others. In a way, as consumers of health care, we are quite literally shopping for life."
On why doctors differ in opinion
"Unlike exact sciences like physics, medicine is inexact. This is why doctors many times have diverging opinions, sometimes differing dramatically from one another. It is actually not often that doctors agree about the best diagnostic approach and, more importantly, the treatment once a diagnosis is made."
"During my training in the United Kingdom, I conceived the concept of the “Four Dimensions” of the making of a doctor (namely: knowledge, training, experience, and judgment), and it has guided me throughout my professional career. It has helped me to not only strive to give optimal patient service to the best of my abilities, but also to understand and respect my colleagues’ views no matter how different they are from my own."
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