The "orthodox" medical community has a history of arrogance, dogmatism, and hostility to new ideas. That attitude has been changing recently, and patients are benefiting.

For more than a century, those with MD degrees had a monopoly on the legal practice of medicine. Patients went to doctors submissively, and did not dare question their pronouncements. Any potential competition to medical doctors was denounced as quackery. Diet and environment were dismissed as largely irrelevant factors in disease. Vitamin supplementation was declared to be unnecessary for people who eat a "normal diet".

Those attitudes have not vanished, but the easy public availability of alternate information, and the discouraging results of some standard medical treatments (for example, the excruciating and often ineffective treatments of some cancers) have made people less timid about utilizing non-standard treatments and practitioners. Furthermore, public opinion and other factors have forced the orthodox medical community to widen its view. Today, some physicians even refer patients to chiropractors, a move that would previously have jeopardized an MD's license.

Information that casts doubt on some aspects of medicine has begun to appear in newspapers and magazines. Such information was previously available, if at all, only in the scholarly medical literature. Recent examples include:

• A newspaper report (based on a paper in a leading medical journal) that many screening tests result in treatment that reduces the quality of life without providing significant medical benefit;
  
  
• A newspaper report (based on a paper in a leading medical journal) that pharmaceutical companies often recommend dosages far above those that are required for effective treatment;
  
  
• A magazine article pointing out that pharmaceutical companies choose and hire the laboratories that test the companies' products, thus providing a strong incentive for the laboratories to "find" that the products are safe and effective.
  
  

Perhaps most encouraging, most doctors are no longer hostile to patients who want to take a more active role in determining their treatment. Many hospitals now even have resident patients' advocates, and will provide you with a pamphlet informing you of your rights.

What can you do to get the best health care possible? In a new book "Power to the Patient", Dr. Isadore Rosenfeld recommends the following:

• If possible, choose a health plan that gives you a choice of doctors, that pays for preventive care, and that provides an impartial appeal mechanism.
  
  
• When a doctor prescribes medication or other treatment (such as surgery), insist that you be told about all other possible treatments, including choices of alternative medication or of a non-medical approach.
  
  
• When the prescribed treatment is extensive or brings significant risk, ask for a second opinion by someone who is not affiliated with the first doctor or group.
  
  
• Hospitals and surgeons are required to tell you their track records for the procedure you are to undergo (how many are done per year, and the success rate), but only if you ask.
  
  
• Ask your doctor if your health plan pays him/her a bonus for cutting health costs, in other words, for limiting your treatment. You are entitled to know.
  
  
• If your health plan refuses to pay for something and you've done enough homework to believe that the decision is arbitrary or dead wrong, appeal the decision. In most states, health insurance companies hey are required to provide an impartial appeal process.
  
  

W. A. Shapiro