Dr. Nortin M. Hadler is a professor of Medicine at the University of North Carolina, Chapel Hill. He is also a practicing Rheumatologist. He has written several books, but this review will deal with his recent book for the medical and lay person.

It is entitled The Last Well Person.

The book is divided into two sections. In the first section Dr. Hadler critiques the methods for decision making on the two big causes of major illness, heart disease and cancer. He argues that much of what we do does not affect mortality over all. That we may prevent a person from dying right then of heart disease but they will die at the same rate and at about the same time as an untreated cohort of patients. He makes this same argument for cancer, especially prostate cancer.

The second half of the book he looks at some of the most common causes for visits to a provider like neck pain, knee pain, back pain and shoulder pain. He argues that untreated, most of these pains resolve. His arguments have great merit.

Dr. H. Gilbert Welch M.D. termed this text “…a brutal critique in much of what we do in medicine.” Dr. Welch’s review appeared in the March 17, 2005 issue of the New England Journal of Medicine and can be found on Amazon.com. Dr. Welch’s main criticism was that although Hadler was correct statistically, patients don’t want stats, they want relief. What are more effective coping strategies?

The problem that exists that Dr. Hadler points out so well, is the labeling of patients and the treatment of that label. The patient’s life is then entwined with the label, its treatment (often surgery but also other expensive and extensive therapies) and its cost at no additional benefit over supportive care.

Dr. Welch in his NEJM review pointed out one important point this book does not address: alternative coping strategies. What is a person to do with about their chronic pain? That isn’t only a problem for Dr. Hadler but for everyone in medicine.

The Last Well Patient makes an important point, without the right information, a patient can not make an “informed decision” and will be “medicalized” i.e. labeled sick.

As a P.A. these past 30 years, I can tell you what a daunting task that is for the primary care practitioner. Everyone has their agenda, and they don’t want it interrupted by pain, lack of mobility or worse the inability to earn a living. Another problem is the perception of quick cures by pills and less “invasive” surgery via scopes and catheters created by the media and worse large hospitals that offer these services.

If you want to be in greater control of your health and decision making about your health then this book and its references is a good place to start.

Disclaimer: I receive a 4% rebate if you click on the above link and purchase this or any book while visiting Amazon.com. I also own this book and have read it.

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