Have you ever insisted on a test or treatment when your doctor is suggesting otherwise? I know I have done it – and sometimes it’s been well justified upon finding an issue that needed treatment – and sometimes it’s turned out to be a waste of time and resources.
On the other side of the equation, doctors may insist on tests or treatments that might not be in the best interest of the patient. I have been on the receiving side of that equation and it was , time-consuming, expensive and unpleasant (to say the least!).
How common is overtesting and overtreatment?
A recent survey of US primary care doctors found that 42% believe their own patients are receiving too much care; in contrast, only 6% said their patients were receiving too little. That’s a lot of doctors who think their patients are being overtested and overtreated!
Of course, it’s not only primary care doctors who are prescribing too much medical care. There has been a lot of discussion about patients close to death receiving aggressive, expensive treatment, which perhaps prolongs life a bit but also likely prolongs the suffering. But what about overtesting and overtreatment of healthy people? Unfortunately, that is happening as well.
Why are primary care doctors prescribing too much medical care?
The survey of primary care doctors uncovered the most important factors doctors identified as leading them to practice more aggressively:
- 76% – malpractice concerns
- 52% – clinical performance measures
- 40% – inadequate time to spend with patients
This survey also identified some other interesting factors:
- The doctors stated they felt financial incentives to encourage aggressive practice – 62% said diagnostic testing would be reduced if it did not generate income for medical subspecialists
- 95% think doctors vary in how they approach care for identical patients
Cancer is being overdiagnosed.
Cancer is scary. Being told you have cancer is some of the worst news you will ever hear in your lifetime. But what if you were told you had cancer, received treatments, and later found out those difficult treatments weren’t needed?
In a recent STAT article, a doctor describes his experiences screening seemingly healthy patients for cancer. He and his colleagues have discovered that for some cancers (cancers of the breast, prostate and thyroid, as well as melanoma), the number of patients who are diagnosed with these conditions is a function of how thoroughly they are examined. Meaning, the harder the doctors look for cancer, the more cancer they find. They found that affluent Americans were at a particularly high risk of being diagnosed with these cancers – because they are examined so thoroughly – yet the death rates among the affluent from these cancers are similar to everyone else.
An analysis of breast cancer diagnoses in northern California drew similar conclusions. The women with the highest socioeconomic status were roughly 2x more likely to have been diagnosed with breast cancer, even after controlling for a range of other risk factors.
Why is this happening?
As science advances, the ability to detect cancers has improved. Sophisticated testing can find cancers when they are very small; in many cases these may never grow over time. These tests are sometimes identifying cancers that would never have impacted a patient’s health!
What about other specialists?
It is safe to say that across the board doctors of all types are sometimes guilty of overtesting and overtreating. Whether it’s abnormal arteries, bulging discs, or in my case anemia of unknown origin, technology is allowing doctors to thoroughly test patients, and fear of missing something is encouraging this behavior – for patients and doctors.
Additionally, there is a lot of money at stake here. Even though more and more doctors recognize the issue of prescribing too much medical care, they feel trapped in a system that rewards them financially for doing more. And some doctors struggle to fight the traditional thinking that more medical care is better.
Why is too much medical care so bad?
Everyone of us has some abnormalities that would turn up with enough probing. The problem is, increased testing leads to increased treatments. And that’s not good for patients or our collective wallets. All tests, procedures, treatments and medications carries some degree of risk and a price tag.
What can you do?
In order to reduce your risk of being overtested and overtreated, consider these suggestions by Roberta Carson of Zaggo:
- Prepare for medical appointments by writing out a detailed version of your “story”. When did the issue begin? What does it feel like? How is it impacting your life? Have there been any changes in behavior, location, food?
- At medical appointments, share your whole story with your doctor – even if you are interrupted.
- Before agreeing to any test, ask your doctor:
- What does he/she expect to learn from the test?
- What will happen as the result of the test – how will it impact diagnosis and treatment?
- What are the risk factors of the test?
- If the risks seem high, are there any alternative ways to get a diagnosis?
- What would happen if you did NOT do the test?
- When evaluating treatment options, ask:
- What is being recommended and why?
- What is offered at other hospitals or facilities?
- Are there other options?
- How will the recommended treatment impact my prognosis?
- What are the short and long-term possible side effects?
- What if I take a “wait and see” approach?
- Any alternative medicine treatments to augment traditional treatments?
- Realize you have the right to refuse any test or treatment.
- If the diagnosis doesn’t make sense to you, discuss this with the doctor. Ask if your story “fits” with the diagnosis, and if not, ask for an explanation of the symptoms that don’t “fit” the diagnosis.
- Don’t be afraid to contact the doctor’s office after you have left if you later feel that the diagnosis doesn’t seem right.
- Get a 2nd opinion, or even a 3rd opinion, preferably from a doctor at a different practice/hospital. When speaking with a new doctor, be sure to tell the doctor your story. Don’t let him/her rely on notes from other doctors.
- Think carefully before insisting on a test or treatment. Of course, there will be times where you need to be persistent, but there will also be times where you might be pushing for unnecessary care. Getting a 2nd opinion can help you make these decisions.