Have you had unnecessary medical procedures?
If you see a physician on a regular basis and always follow his or her advice regarding routine screening tests or common diagnostic tests for minor illnesses, the answer is probably YES.
I just finished reading a new report published in my state (Washington) about the extent and cost of these unnecessary medical procedures.
This is a problem I’ve posted about before. Many times (see links below). Most estimates put the cost of useless medical care at roughly $200 billion every year. But unnecessary care is difficult to measure, so that figure could be significantly higher.
The Washington Health Alliance, a non-profit group dedicated to improving quality of care while lowering costs, joined forces with Choosing Wisely and ProPublica, and used a new waste-calculator tool, to put together this report.
What did they find?
- 47 tests/procedures were flagged as unnecessary or overused (low-value care)
- more than 600,000 patients had tests or treatments they didn’t need
- $282 million was spent on unnecessary medical procedures
- almost half of medical services were considered wasteful
Although this report came out of Washington state, I have no doubt all 50 states would see a similar trend if they looked.
Why is low-value care so harmful?
It’s not just about the money, although overuse is certainly one of the reasons our country spends so much on health care, and why health insurance costs so much.
But aside from financial harm, consider the physical and emotional harms caused by unnecessary care.
I was glad that the report, titled First, Do No Harm, did.
Of paramount importance is physical harm; that is, when a medical intervention
is the cause of one or more negative consequences for the patient — for example, an
infection, overexposure to radiation through unnecessary imaging, a bad reaction to a
medication, or an unneeded or duplicative test or procedure that results in even more
There is also emotional harm, meaning the worry and anxiety caused by a
medical intervention; for example, being prescribed tests and/or procedures that are
known to produce high rates of false positives (thereby driving additional interventions).
Physical and emotional harm often go hand-in-hand, but emotional harm can occur
even without physical harm.
Examples of unnecessary or overused care
Read the report to see all 47 flagged tests and procedures, but here are the top 11:
- annual cervical cancer screening (Pap smears)
- pre-op lab tests
- imaging tests for eye disease
- annual EKGs or cardiac screening
- antibiotics for viral sinus, lung and ear infections
- PSA screening for prostate cancer
- screening for vitamin D deficiency
- imaging (x-ray, CT scans, MRI) for low back pain
- pre-op EKGs, chest x-rays and lung function studies
- cardiac stress testing
- imaging (CT scan) for uncomplicated headache
Are any of these familiar to you?
Why are these tests used or overused if they’re unnecessary? Partly because doctors get paid more to do more. Or they worry about getting sued if they miss a diagnosis (that’s called cover-your-ass medicine). Sometimes doctors are just in a hurry and ordering a bunch of “routine” tests is easier and faster.
We, as patients, have had a role in the problem, too. When we demand a CT scan for that headache, or an MRI for back pain. Or when we see a doctor for a cough or cold and ask for antibiotics.
We are all part of the problem, and we all have to be part of the solution.
I like how the authors concluded the report:
The result of the “more is always better” culture present in today’s health care
delivery seems to be: “first, do something.” It is time to get back to, “first, do no
- Choosing Wisely: 5 questions to ask your doctor
- We’re doing too many screening and diagnostic tests
- Do you need an annual exam?
- Patients need Choosing Wisely
- Don’t be a victim of too much medical care
For links to good evidence-based healthcare groups, like Choosing Wisely, check out my Resources page.
Want even more information on the harms of unnecessary care? Here are some great books on the topic: