If you’ve ever been a patient, you know how expensive being a patient can be. If you’re responsible for paying a high deductible or other out-of-pocket expenses, you’re certainly familiar with the financial burden. But what about the other costs of obtaining tests and procedures: procedure-induced worry, pain, discomfort, side effects, possible complications (including infections, disability and even death) and lost productivity, not to mention the time investment and inconvenience factor?
Unnecessary Medical Treatment
Lurking just behind all of these costs is an unnerving fact: Many of the services that patients receive are duplicative, unnecessary and actually have no value or a negative value to our health. In 2012, the Institute of Medicine (IOM) published a report saying that fully one-third of all health care spending in the U.S. ($750 billion out of $2.6 trillion) did nothing to make anyone healthier. The IOM categorized $210 billion of that amount as “unnecessary services.”
Dr. Atul Gawande, the bestselling author of Being Mortal, in a 2015 New Yorker article entitled “Overkill” wrote, “Virtually every family in the country, the research indicates, has been subject to overtesting and overtreatment in one form or another. The costs appear to take thousands of dollars out of the paychecks of every household each year. Researchers have come to refer to financial as well as physical ‘toxicities’ of inappropriate care — including reduced spending on food, clothing, education and shelter.”
It Pays to Ask Questions
Few things cause us greater anxiety than health concerns — a sudden cardiac symptom, a cough that doesn’t resolve, an unexpected lab result or incidental X-ray finding.
It’s important for patients to consider that clinicians sometimes refer them for services that have no value or can be harmful.
As our doctors recommend procedures or tests to treat or diagnose, we may not have enough information to make an informed decision about the value, benefit or appropriateness of the services recommended. Instead of asking questions, we too often forge ahead with our physician’s recommendations because we feel worried or rushed. Asking questions may make us feel uncomfortable — and we may not even know what questions to ask.
It’s important for patients to consider that health care providers sometimes refer them for services that have no value or can be harmful, and this occurs for many different reasons. Doctors, being human, may be well-intentioned but ill-informed’ they may be practicing defensive medicine and some may have financial incentives for steering patients to a particular facility for services.
Consider three examples of medical services that may be unnecessary, wasteful and harmful:
- A 2015 American Journal of Obstetrics and Gynecology study reported that 20 percent of hysterectomies were performed unnecessarily because women are sometimes not offered alternative treatments or options to hysterectomies to treat benign conditions.
- No medical society recommends whole body scans to screen for cancer because there is no evidence they are good tools. Whole body scans often miss signs of cancer, providing a false sense of security. They also can result in false positives, leading to further, unnecessary, stress-inducing tests and procedures. To boot, large amounts of radiation the patient is subjected to can increase the risk of cancer.
- In 2014, the Journal of the American Medical Association (JAMA) published a Harvard study listing 26 unnecessary or wasteful tests and procedures that researchers estimated Medicare beneficiaries receive, on average, once per year. Such tests include cardiovascular testing and procedures, imaging, pre-operative testing, and diagnostic, preventative and cancer screening.
The E-Patient Movement
In March 2007, “e-Patient Dave” deBronkart received a cancer diagnosis and a prognosis of six months to live. DeBronkart fiercely researched his diagnosis and brought new research and treatment information to his physicians. In the 10 years since he received successful treatment for a dreadful diagnosis, he co-founded the Society for Participatory Medicine and has become an “international evangelist” for patients being informed consumers of their health care. DeBronkart’s written a book on the topic, Let Patients Help, has been a keynote speaker in at least 15 countries, a TED talk presenter and is the first patient to become a visiting professor of Internal Medicine at the Mayo Clinic.
DeBronkart offers the following advice to patients whose clinicians are recommending tests and procedures:
- Start with Consumer Reports’ “Five Questions to Ask Your Practitioner.”
— Do I really need this test or procedure?
— What are the risks and side effects?
— Are there simpler, safer options?
— What happens if I don’t do anything?
— How much does it cost, and will my insurance pay for it? (Or how much will it cost me?)
- If you feel rushed into obtaining a procedure, hold back for a moment and catch your breath. Unless it’s a matter of immediate life or death, get a second opinion from an independent provider who isn’t associated with the first provider.
- Bring a friend or loved one with you to your appointment to ask questions and take notes. If you don’t understand a provider’s response, request clarification and don’t be afraid to ask more questions.
- If the provider becomes defensive or evasive in response to your questions, these are red flags. Consider finding another provider.
Finally, deBronkart advises patients to “know what’s in your medical records. It’s your legal right, and most records contain mistakes — it’s best to find them when you’re not in crisis.” Visit GetMyHealthData.org for a wealth of information on this topic, and ask your providers if you’re among the millions of patients who can access their medical records through OpenNotes.
Fortunately there are more reputable resources available online than ever. Below are two trustworthy resources for researching medical conditions and services:
- Choosing Wisely is an initiative of the American Board of Internal Medicine (ABIM) Foundation in partnership with Consumer Reports that seeks to advance a national dialogue on avoiding wasteful or unnecessary medical tests, treatments and procedures.
- WebMD publishes content on a wide range of medical topics. Viewers can check symptoms, find a doctor and even compare drug prices.
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