I like your idea of the devil's advocate. It might be the only way a patient hears the downsides of treatment, or what the stats are from different choices.
One absolutely crucial book to read about this subject is
How We Do Harm: A Doctor Breaks Ranks About Being Sick in America by Otis Webb Brawley, M.D., with Paul Goldberg. From Amazon:
Quote:
Dr. Otis Brawley is the chief medical and scientific officer of The American Cancer Society, an oncologist with a dazzling clinical, research, and policy career. How We Do Harm pulls back the curtain on how medicine is really practiced in America. Brawley tells of doctors who select treatment based on payment they will receive, rather than on demonstrated scientific results; hospitals and pharmaceutical companies that seek out patients to treat even if they are not actually ill (but as long as their insurance will pay); a public primed to swallow the latest pill, no matter the cost; and rising healthcare costs for unnecessary—and often unproven—treatments that we all pay for. Brawley calls for rational healthcare, healthcare drawn from results-based, scientifically justifiable treatments, and not just the peddling of hot new drugs.
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The part that lingers with me is how he describes those routine PSA testing procedures, part of early detection of prostate cancer, which turn into a "harvesting" process for surgeons, urologists, oncologists, and other medical companies. These readings are ambiguous and not well understood. Yet it's easy to get an insured patient to "take precautions" and wind up with treatment for something that would never have led to a problem in the patient's lifetime.
Dr. Brawley described a man recently retired, in good health, and enjoying himself, until the fateful day his wife got him to take a free screening from a van in the local area. His elevated PSA (which Dr. Brawley characterized as something that would take decades to turn into a problem, and thus pointless to worry about in a man of 65) became his doom.
He was convinced to "not take a chance" and got surgery. That decision led to incontinence, impotence, constant pain in his back, repeated infections, and such an erosion in his quality of life, marriage, and hobbies that he committed suicide three years later.
That is not a life that's been saved.