Too much testing = too much medicine
I just ran across an old doctor joke: What is a well person? Someone who hasn’t yet been thoroughly examined.
It’s not funny, of course, if you’re the patient and have suffered the harms—and the expense—of too much medical care.
In 2010, my husband was the victim of too much medical care. Because of complications and a string of medical errors he almost died. His care cost our insurance company over $100,000 and we were out of pocket for our $10,000 deductible.
Now he has no thyroid and has to take medication every day. And in hindsight, we know he didn’t need as much treatment as he ended up having.
We certainly wish we had been more informed and asked more questions.
The joke was in a recent article by H. Gilbert Welch, MD, one of the leading physician experts on over-testing, over-diagnosis and over-treatment.
His book, Overdiagnosed: Making People Sick in the Pursuit of Health, was one of the first books I read on the subject after my husband’s near-death at the hands of our healthcare system.
He writes in the article:
In the past, people sought medical care because they were sick. Now we encourage the well to get examined to determine if they are not, in fact, sick.
It turns out that for some cancers — particularly breast cancer, prostate cancer, thyroid cancer, and melanoma — the number of people who have it is a function of how thoroughly we examine them. The harder we look, the more cancer we find. Yet most of these extra “cancers” are less likely to affect health.
My husband had aggressive treatment for a thyroid cancer that we now know did not require it.
Why those with insurance are more at risk
There’s another joke in healthcare circles that is only funny to an insider: the wallet biopsy.
A cynical term used in fee-for-service health care systems for the assessment—biopsy—of a patient’s wallet for insurance coverage information to determine whether he can pay before admitting him to a hospital or performing expensive procedures.
Our healthcare system is full of perverse incentives (it only makes money if someone is sick) that abet too much medical care.
Related post: Deprescribing prescription drugs
And as Dr. Welch points out in his article, clever marketing of healthcare has us wanting to buy more and more.
If we can afford it, or have an insurance plan that requires little out-of-pocket costs, we are at risk of being over-treated. We’re more likely to visit our doctors for minor aches and pains. We’re more likely to sign up for every screening test offered to us. We’re more likely to ask our doctors about the latest prescription drugs and tests and procedures.
The truth is that we all harbor abnormalities. And diagnostic tests are increasingly detecting them. It’s a process that could turn all of us into patients. Too much testing begets too much treatment, which leads to too many people suffering from unnecessary medication side effects, complications from procedures, and sometimes even death.
Be informed, ask questions
Over-treatment is such an important topic that I come back it again and again in my posts. In fact, what happened with my husband really started me down the Frugal Nurse path.
It’s important not only because people are being unnecessarily harmed, but too much medical care is costing us billions of dollars. As a country, we can’t begin to adequately and fairly provide affordable insurance coverage for everyone until we get these bloated costs under control.
I’ve often commented to friends and family that we don’t have a physician shortage in this country, we have a patient glut. Too many people are wasting their valuable resources—money, time, peace of mind—on the illusion that more healthcare means better health. It doesn’t.
The right healthcare at the right time is great. Medical care when you don’t need it leads you down a costly and dangerous path.
No one cares about your health as much as you do. Avoiding unnecessary care is not always easy, but it involves being more informed and asking more questions.
Related post: Choosing Wisely: 5 questions to ask your doctor
More and more doctors understand these problems but feel trapped in a system that rewards them to do more. There’s a lot of money on the table to do just that — money in developing new tests and money in producing new patients to use them on. And some doctors find it hard to buck the conventional wisdom that more medical care is better because we assume it’s what our patients want.
If you do ask your doctor whether she has ever had a patient who suffered from getting too much medical care, it just might give her permission to change the way she treats you.
The first step is to just be aware of the problem, hopefully before you are harmed like my husband!
The next is to gather more information, especially on topics that interest you, such as screening tests, medications, or treatments for specific conditions.
I also recommend reading Dr. Welch’s book, or one of those in the gallery below.