Unnecessary care = unnecessary expense
Every day I see a new article about the high costs of health care.
A new study suggests that in a single year, up to 42 percent of Medicare patients got at least one medical procedure they didn’t need — overtreatment that cost as much as $8 billion.
Use of [Mohs] surgery has skyrocketed in the United States — over 400 percent in a little over a decade — to the point that last summer Medicare put it at the top of its “potentially misvalued” list of overused or overpriced procedures.
As I’ve criticized in past posts, although Obamacare has helped more people obtain some form of health insurance, it does very little to decrease health care costs overall.
Related post: “The Treatment Trap”
That’s why I love the Choosing Wisely® campaign. I believe it’s a really important step to not only encourage physicians to examine how they use—sometimes overuse—health care technology (including drugs), but to empower health care consumers—patients—to make more informed decisions about their care.
About Choosing Wisely
The Choosing Wisely campaign was started in 2011 by the ABIM Foundation, a non-profit established by the American Board of Internal Medicine. Aimed at both patients and physicians, it focuses on
…encouraging physicians, patients and other health care stakeholders to think and talk about medical tests and procedures that may be unnecessary, and in some instances can cause harm.
Twenty-six medical specialty groups contributed lists of five items each. Each list, called Things Physicians and Patients Should Question, provides
…evidence-based recommendations that should be discussed to help make wise decisions about the most appropriate care based on a patients’ individual situation.
When I read through the lists I was chagrined (but not surprised) to see that my husband, son and I have all fallen victim to some of the “Don’t do’s”:
- Don’t use dual-energy x-ray absorptiometry (DEXA) screening for osteoporosis in women younger than 65. (I was way too young!)
- Don’t perform laboratory screening for Vitamin D deficiency in low-risk adults. (My husband had this done, too, and it’s an expensive blood test—over $100.)
- Don’t use antibiotics for apparent viral respiratory illnesses (sinusitis, pharyngitis, bronchitis). (As Frugal Nurse readers know, my son was prescribed unnecessary antibiotics for a viral sinus infection.)
- Don’t screen for carotid artery stenosis in asymptomatic adult patients. (My husband had a carotid artery ultrasound done for no apparent reason!)
- Don’t perform routine general health checks for asymptomatic adults. (That’s right—those “annual exams” that we have all prepaid for with our new insurance plans are a waste of money!)
Some of the other common practices that are now on the “Don’t do” list are:
- Don’t do imaging (CT, MRI) for low back pain within the first six weeks, unless red flags are present.
- Don’t order annual electrocardiograms (EKGs) or any other cardiac screening for low-risk patients without symptoms.
- Don’t do imaging (CT, MRI) for uncomplicated headache.
- Don’t order computed tomography (CT) scan of the head/brain for sudden hearing loss.
- Don’t treat uncomplicated, non-melanoma skin cancer less than one centimeter in size on the trunk and extremities with Mohs surgery.
- Don’t routinely screen for prostate cancer using a PSA test or digital rectal exam.
There are many more! I think you’ll find reading these lists informative and illuminating.
Related post: Choosing Wisely for kids
Consumer Reports is helping the ABIM Foundation publish and spread this information to the public.
Be an informed patient
As I’ve also complained about in past posts, I don’t like corporate medicine’s and Big Pharma’s trend to advertise medical procedures and drugs directly to the consumer through radio, print and TV ads.
I also don’t like medical TV shows that are completely idiotic and improbable (I’m talking to you, Dr. House and Dr. Grey!).
These set up unrealistic expectations that can lead to unnecessary care.
What can you do?
First, don’t demand a specific treatment from your doctor. Antibiotics, expensive prescription drugs, CT scans and MRIs are overused every year simply because patients ask for them.
Second, don’t meekly accept every test ordered or every drug prescribed. Ask questions! Only agree to the recommended treatment if you fully understand the benefits, risks (including cost), and other options available.
I always use the same general questions:
- Why do I need this test, drug, or surgery/procedure? Make sure the doctor explains in terms you understand.
- What will happen if I don’t? If the doctor simply says “You will die,” get a second opinion! Unless you are in a truly life-threatening situation, that is not an acceptable answer.
- How long can I “wait and see”?
- Are there cheaper and/or safer treatment options?
- Bottom line: Does the best evidence show that the benefits outweigh the risks?
As patients, we have more power than you might think. Use it. Besides Choosing Wisely, there are other websites devoted to helping you make informed decisions about your care. I’ve listed many of them in my Links column in the sidebar.
Related post: “When Doctor’s Don’t Listen”
As we navigate through all the changes in health care, the need to be an informed consumer is more vital than ever. Thank you, Choosing Wisely, for helping us! And a special shout out to the American Academy of Pediatrics and the American Academy of Family Physicians. Both groups have contributed more than the minimum of 5 “things” physicians and patients should question. Keep ’em coming!