What won’t doctors do?

What do doctors say no to when it comes to looking after their own health?

Have you ever wondered what treatment a doctor would refuse to have?

As medical professionals, doctors have specialised knowledge and training that the rest of us don’t. It’s not unusual to find that they have strong ideas about what they would or wouldn’t choose to do when it comes to their own health. CHOICE asks the experts what treatments, medicines or surgery they would refuse. The answers might be surprise you, and possibly even change your mind next time you’re faced with an important decision about your own well-being.

Medicine and surgery

Dr Amanda Bray - psychiatrist

I would not keep taking a medicine that doesn’t seem to help.

It always worries me when patients I see for the first time are taking medications that they know have not helped their symptoms, yet they’ve continued to take them, often for years. If a medication was working for me, I think it would be very much worth putting up with the expense and possible side effects involved, to feel well again. But if a medication hadn’t helped after two or three months of taking it, I would be going back to my doctor to have it adjusted or ceased in the right way.

Dr Geraldine Moses - consultant pharmacist

I would never take a complementary medicine without weighing up the benefits versus the risks.

Firstly, the benefit needs to be clearly identified. This goes way beyond taking herbs or supplements for reasons such as ''good for…'' fill in the dotted line. I want to know exactly what it’s going to do, how long it will take, the chance it will actually do that, what dose to take, and how much it’s going to cost. Don’t worry – I do this with conventional medicines too!

Then I would calculate the potential risks: side effects, drug interactions, cost, delay of more effective therapy, and disappointment. Researching this information is quite easy now that Google does all the legwork. Finally, I’d weigh the potential risks against the potential benefit. If the benefit clearly outweighs any potential risk then it would be quite sensible to give the remedy a go, in a structured fashion. But if the potential risks become too weighty for a goal I may never achieve, then I wouldn’t bother.

Dr John McLennan - paediatrician

I would never reject government-provided health services for children.

Services for children are provided to identify problems early (screening) or to implement preventative strategies (like immunisation) for some of the most serious illnesses that children may experience. These have been so effective that most young parents don’t realise how a return of diseases such as measles and polio, and such screened conditions as hypothyroidism, could affect their children and their own lives, and are vulnerable to complacency and philosophical scaremongering.

Governments are reluctant to spend money without being convinced of clear benefits based on the best available scientific evidence. The high standard of free obstetric care, neonatal care, hearing screening in newborns, the immunisation program, and the maternal and child-health nurses who monitor growth and development are all part of this evidence-based preventative network paid for by your taxes. Don’t ignore it.

Dr Angus Gray - orthopaedic surgeon

I would not undergo spinal fusion for back pain.

Reviews of the medical literature indicate that surgery is no more effective than intensive rehabilitation therapies for what is termed "non-radicular" back pain. This means that the pain is not caused by compression of the nerves in the spinal canal. Less than half of people having back surgery for this type of pain get an optimal outcome – defined as experiencing only sporadic pain, slight restriction of function and occasional pain killers.

I would concentrate on programs aimed at improving fitness and core strength. For pain relief, paracetamol and anti-inflammatory medications are effective, without the side effects of those containing opiates (codeine and morphine). Physiotherapy can help for short periods, but the evidence is weak to support its use for more than a few months. I would not recommend chiropractic.

In cases of sciatica – a spinal disc bulge or spinal instability (one bone moving abnormally on another due to disc degeneration) – surgery has been shown to give better results than non-surgical treatment.

Kimberley Bardsley - heart failure clinical nurse consultant 

I would not go to bed and “sleep off” chest pain.

I would proceed immediately to the nearest large metropolitan hospital for help. Nor would I be complacent about my heart health as I age. I would keep an eye on my blood pressure, and if required I would take medications to manage and control my blood pressure, which will lessen the chances that I could develop heart failure.

Professor Alastair MacLennan - professor of obstetrics and gynaecology 

If I were a pregnant woman, I would never self-medicate without medical or obstetric advice. And I would never plan to have a home delivery – unless it was pizza.

Dr Mary Stewart - acting medical director, Family Planning NSW

I would not use “natural” hormones to treat my menopause symptoms.

So-called bioidentical hormones are mixtures of various un-trialled “natural” hormones synthesised from yam, soy and other products. These come in the form of lozenges sucked and absorbed through the mouth, or creams rubbed into the skin. They usually contain oestrogens and may contain a variety of other hormones in various doses.

Because these therapies have not been subjected to the same vigorous testing as approved hormone replacement therapies, the concern is that there is no certainty that these therapies are effective or safe. Of particular concern is that if oestrogen is used without adequate progestogen, there is a risk of uterine cancer developing. If I developed menopausal symptoms requiring treatment, I would want to choose from the most scientifically proven, effective, safest treatments available.

Professor John Dwyer - immunologist 

I would not avoid the Medicare-funded child vaccination regimen.

Boosting the immune response to infectious agents is the single most important strategy ever developed by scientific medicine, and helps to protect other children and even adults. I would urge parents to read the evidence supplied by a medical doctor or government health authority. I assure them that all the scaremongering that is so common is based on concepts that have been proven to be wrong by scientific studies. For example, we know from major research that vaccination has nothing to do with a child developing autism.

At least 80,000 Australian children are at risk of serious infections as they haven’t been vaccinated. Anyone who has seen a baby with whooping cough would do anything to try to protect their baby from such suffering – and in fact, it can also be fatal. I always warn parents not to fall for the “alternative” line from homeopaths who say they have preparations that can immunise children against all the infections tackled with orthodox vaccines and then some like TB, malaria, HIV etc.

Health and lifestyle choices

Dr Sue Ieraci - emergency medicine specialist

I won’t climb ladders and use power tools when I get older.

Having worked in hospital emergency departments for more than 30 years, sometimes what people do just makes me cringe. Yes, there’s the issue of young men and risk – fast cars, alcohol, aggression – but most grow out of it. But what happens when they retire and have too much time on their hands? What happens is a disastrous combination of declining reflexes, poor balance, odd jobs and power tools.

I’ve lost count of how many times I’ve seen elderly men fall from places where they should never have been – ladders, trees, even roofs. Don’t have a tall enough ladder? Please, whatever you do, don’t use the extension. Better still, get someone else to do it – it just takes a misstep, or a dizzy spell, to have you landing on the ground.

My advice is this: donate the ladder and power tools to a good cause, give a tradesperson some work, and take up a hobby – on level ground.

Dr Gabrielle Caswell - cosmetic physician

I would never get an anti-wrinkle injection from someone who is not a qualified doctor or supervised by one.

The person doing the injecting will not be covered by professional indemnity and patients are unlikely therefore to be compensated if something goes awry. These cosmetic procedures require an understanding of complex facial anatomy, intimate knowledge of the medicine used, and their placement.

Chris Burns - hepatitis clinical nurse consultant

I would never do a liver-cleansing diet.

Although this is a low-fat diet, which may be of benefit to some individuals, there’s an overwhelming lack of scientific evidence both for its use and the claims that the liver is to blame for many possible ailments which an individual may be experiencing. These may be related to lifestyle, diet or other health conditions and are better addressed with the help of your own doctor. Also, people may be unaware of other health conditions and may become unwell or malnourished, or experience a worsening of their ailments if they were to undertake such a diet.

Professor Richard Dowell - audiologist

I would not listen to excessively loud music.

Knowing what I know about the damage that can be done to the sensitive hearing mechanism by loud noise, I cringe at the thought of what my ears went through when I was younger. I played in a rock band for 10 years and would have had more than 10 hours per week of exposure to levels exceeding 110 decibels during that time.

I do have high-frequency hearing loss now and that’s frustrating, particularly at social events, when you’re trying to listen to someone while there are other conversations going on around you. It makes sense to protect your ears from the loudest music at concerts and clubs, as you will pay for it later. There are now earplugs available that are designed to provide a flat frequency response so that the quality of music is not changed – just the damaging level.

Dr Louise Stone - GP

I would not ignore suicidal feelings in myself or someone else.

There are a number of reasons why people consider taking their own life, but for most people, suicidal thinking occurs when suffering and pain becomes unbearable. Unfortunately, many people find talking to someone about these thoughts and feelings just too difficult. They may feel ashamed or guilty about feeling this way, or they may fear being judged, criticised, or even belittled. Whatever the reason may be, it is very important that suicidal feelings are shared. Whether it is with a health professional, helpline, friend, or family member, talking about suicidal thoughts helps enormously.

For those of us who hear these stories, it is important to be a good listener, and provide non-judgemental support. There is good evidence to suggest that this makes all the difference. Suicidal thoughts are usually like waves on a beach: they come and go. Surviving a wave of suicidal thinking with the help of another caring person makes the next wave much easier to bear. Further information and support can be found 24 hours a day through the suicide call-back service, phone 1300 659 467 or Lifeline, phone 13 11 14.

Dr Linda Taoube - GP 

I would never visit a developing country without the appropriate vaccinations.

It always surprises me how many patients intending to travel to common holiday destinations such as Bali and Fiji are not aware of the need to have travel vaccinations prior to embarking on their trip! I have the same concerns for travellers visiting family and friends who live in developing countries – even though this might be their country of origin.

They often believe that because they have lived in that country, they are less likely to acquire food- and water-related illnesses. In fact, they may be placing themselves - and more importantly, their young children - at higher risk. Such travellers tend to take more frequent and longer trips, spend more time in close contact with people and they are more likely to visit more remote areas. The same microbes that their bodies were once used to, could now make them sick.

Planning ahead is essential. Of course, in addition to the routine childhood vaccinations, children over two years of age should also be offered travel vaccines. These, along with plenty of hand-sanitising solution, would help to make their stay less tarnished by diarrhoea and other travel-related illnesses.

Dr Amanda Bray - psychiatrist 

I would not use alcohol to reduce social anxiety.

Many alcoholics begin abusing alcohol because they feel very anxious and uncomfortable in social situations, and find that alcohol relaxes them. Unfortunately, while one or two drinks can do the job in the beginning, it may escalate over time to a much larger amount, leaving the person with two problems – social anxiety and alcohol dependence.

So if I had a problem with social anxiety, I’d avoid “Dutch courage” and see a psychologist for techniques on how to combat it. If this fails, then certain antidepressants can be quite effective in treating it too, and are not addictive.

Chris Burns - hepatitis clinical nurse consultant

I would never have a tattoo.

Not only does it fade and look silly when you are old and wrinkly, but it can be the only risk factor that some individuals had who have acquired hepatitis C. This blood-borne virus can lead to liver cirrhosis and liver cancer in some people and may be caused purely by having had a tattoo.

Dr Vanessa Moran - GP 

I would not "turkey baste" a friend's semen to get pregnant before talking to a doctor and a lawyer first!

With the new laws around sperm donation there is an increasing shortage of sperm available to single women and women in same-sex relationships who are keen to start a family. I have seen an increasing number of women thinking about and getting pregnant using a friend or sometimes relative's sperm (think brother of the partner for example). There are plenty of blogs about how to do this with sometimes quite graphic and often incorrect information.

There is a lot to consider, however, that women just don't think about - for example, the possibility of contracting a sexually transmitted infection, inherited (genetic) disorders or antenatal, peri- and postnatal complications - in particular for single women with no support network. It is a medical, ethical and legal minefield and I'd suggest getting as much advice as possible before heading to the kitchen utensil section of your local supermarket.

Dr James Best - GP

I would not trust advice from a source not recognised by the mainstream medical and scientific communities.

So who is “the expert”? A great way to find the answer to this most important question is to follow the principle that a true expert (or bunch of experts) is going to be:
  1. Recognised as such by those in the know – those people who work in the field, and
  2. Have their recommendations given that all-too-hard-earned sign of authenticity – public funding.
As a GP, the people I trust and respect as experts are those who develop the guidelines that the “coalface” health workers like myself use, to deliver health messages to the public. Because there are so many of them, and all scrutinise what the others say so closely, if any of them made a seriously mistaken recommendation, the medical and scientific communities would come down on them like a tonne of bricks.