LETTER | As the new Pakatan government increasingly finds itself cash-strapped, cuts to government expenses including its healthcare expenditure may follow.

After over 30 years in the medical profession, we have seen numerous patients and their families burdened with medical expenses which have become a leading cause of personal bankruptcy in America.

What can a person do to keep down medical expenses?

Acquire information

An informed patient tends to be not only healthier but also spend less on medical expenses. In this day of the internet and Google, every person able to read should be able to learn how to keep healthy and what treatment option is available for each disease condition.

Sites like Wikipedia and WebMd give clear and reliable medical information. After seeing, every doctor ask for i) the diagnosis or possible diagnoses ii) commended tests and procedures, and finally iii) suggested treatment.

Every condition, test and treatment has a name and knowing the name allows the patient to look it up and weigh the benefits and risks before making any decision about what to do.

Live healthily

Staying healthy is the best way to keep medical fees low. The smoker not only spends money on cigarettes but is also guaranteeing multiple medical visits to treat heart and lung disease that will inevitably come up in the future.

In 1990 in the Lancet, a healthy lifestyle of adequate exercise, stress management and dietary restrain was shown by the Lifestyle Heart Trial to reverse blockage of the coronary vessels of the heart better than if patients were only on medication without lifestyle change.

In 2004 in the Circulation, exercise was shown to be better than the invasive stenting procedure in reducing the need for hospitalisation and subsequent repeat procedure among 101 patients with coronary heart disease.

For treatment to succeed, faith is essential but seek a second opinion

In this day of increasingly profit motivated medical services, getting a second opinion about any serious condition is important.

However, there is a right and there is a wrong way to do so. Understand clearly what the first doctor has said by getting a written report with the name for diagnosis, tests and treatment recommendation.

Keep a set of all tests done. Then when seeing the second doctor, present all these for him to see, but allow him to repeat them or do any other test he wishes. After that again get him to clearly name his diagnosis, test and treatment recommendation.

Ask any question you like, but please do not add in words like “this doctor says so”. It is irrelevant who says anything, but it is always your right to clarify any doubt.

It is also the right of the doctor to expect full attention and to hope you can be convinced when shown the reasons a particular opinion is offered.

Too often patients clearly show their distrust for an opinion and are preoccupied with something they have heard, sometimes even from non-medical sources. And when being treated by any doctor, a patient must have full faith in him for treatment only works if the patient believes it too. This is not to say you have to forever be under one doctor.

If treatment is unsuccessful, or service poor, change doctor. Then forget about the previous one and give full faith to the next.

Do not postpone death if it extends suffering

All human beings inevitably die. The acceptance that death will come allows a patient, family and doctor to correctly make the remaining time pain-free and as comfortable as possible.

Too often excessive amounts of money are spent on medical procedures that merely prolong suffering and do not give the patient a meaningful life.

A large proportion of health care expenses come in the last year of life. According to a 2016 report in Health Affairs, among Medicare supported patients medical expenses in last year of life vary greatly and four groups have been identified; 48.7 percent of patients were in the top group that spends a median of US$59,394, while only 12.1 percent were in the bottom group that spends a median of US$11,166.

The authors conclude that the focus of treatment should not be on those with the poorest prognosis, for whom great expenses are likely to be spent for the least beneficial result. Emotional as this may be for patients, families and doctors, we must all try to remember that the aim of healthcare is to give a good quality of life as long as possible, and not merely to prolong suffering.

While we cannot prevent the commercialisation of medicine nor hold back its many expensive and lifesaving advances, we each have to take responsibility for our own healthcare and its expenses.

We want to live a comfortable and fruitful life, for which good health is essential. To have good health, start with a healthy lifestyle, then be informed about medical diagnoses and treatment options, and finally accept that a peaceful, pain-free passing is part of good healthcare.

DR ONG HEAN TEIK is a consultant cardiologist and CHOONG YOKE LENG runs a retail pharmacy

The views expressed here are those of the author/contributor and do not necessarily represent the views of Malaysiakini.