Are Patients Over Tested and Over Treated?

You, or a loved one, feel sick. You go to your doctor, or maybe even to the Emergency Room. During your appointment, you describe your symptoms and the doctor examines you. Frequently the doctor orders tests. Perhaps even a procedure or surgery is scheduled. Is all this needed? An important question for us all: are patients over tested and over treated? Sadly, the answer is a resounding yes.

photo of test tubes and pipettes in lab: Patients Over Tested and Over Treated?In your quest to feel better, you likely agree to whatever medications, tests and/or procedures are recommended. Or perhaps, you insist on having medications, tests and procedures even though the doctor may not think it’s necessary.  Either way, patients are being over tested and over treated.

This is not to be taken lightly. Unnecessary medications, tests and procedures are not only a waste of time and resources, but every medication, test and procedure carry some degree of risk (of course, some more than others).

Why and where, is this happening?

A few examples:

Emergency Rooms

A study in JAMA Internal Medicine analyzed the data of 240 million adult visits to an Emergency Room and found that many patients who had non-urgent health issues were given diagnostic tests, procedures (like IVs), and were admitted to the hospital, including some to a critical care units, even though these services may not have been necessary.

The study’s authors point out that these potentially unnecessary steps could indicate an overuse of services, a lack of access to primary care physicians, and/or a degree of uncertainty regarding a diagnosis among both patients and health care professionals.

Physician-Owned Surgical Centers

Your doctor might encourage you to have a procedure because he/she has a financial incentive to recommend it or perform it. An analysis by The National Bureau of Economic Research evaluated 12 years of data in Florida.  They looked at the frequency of a common knee procedure to treat osteoarthritis which had recently been found to not improve outcome during a major clinical trial. The research found that doctors who worked in physician-owned surgical centers, who have financial incentive to perform the procedure, did not have as much of a decline in the number of these surgeries performed as compared to doctors who were not part of physician-owned centers.

This suggests that when doctors have a financial incentive, they may perform procedures that are not in the best interest of the patient.

Doctors’ Offices

In the quest for a diagnosis, doctors may order tests “just to be sure” and to “rule things out”. At the same time, patients ask for tests to give them the peace of mind that nothing serious is wrong, and/or ask for medications or procedures in the hopes of feeling better. Combine these factors with the brief time allotted for appointments, and it’s easy to see why patients are getting medications, tests and procedures they do not need.

The findings from a 2014 report from the Choosing Wisely campaign illustrate doctors’ opinions on this topic:

  • Almost 75% of doctors think unnecessary tests and procedures are a serious health care issue
  • 93% feel they have a responsibility to help their patients avoid unneeded tests
  • 47% say patients are asking them for unnecessary tests and procedures at least once a week
  • 53% state they will perform unneeded tests and/or treatments when patients are insistent
  • Doctors frequently order unnecessary tests and treatments to reassure themselves that they are on track with a diagnosis

What can you do about this?

I suggest you consider the following:

  • The patient’s story is a critical part of a correct diagnosis. Some say the patients story comprises 90% of the factors doctors consider. So make sure your doctor hears your whole story. Do not leave any details out, even if you have told the same story to other doctors.  If the doctor interrupts you, don’t hesitate to continue.  It can be helpful to write your story down at home before you see the doctor.
  • Ask your doctor as many questions as you need to be sure you understand your diagnosis (or list of possible diagnoses), tests, procedures and treatments. If you do not understand a response, do not be shy about asking the question again.
  • Take notes at your doctor appointments and bring these notes, and all records, with you every time you will see a doctor, including the Emergency Room. Doctors can make informed decisions when they have a complete picture of patients’ health, including other diagnoses, medications and treatments.
  • Ask your doctor what he/she expects to learn from a suggested test, and what steps will be next.
  • If you have time, get a second, or even third, opinion from another doctor; preferably from a doctor who works at a different hospital. This is particularly helpful if your doctor suggests a test or treatment that doesn’t seem right to you; or conversely, if you think you need a test or treatment and your doctor disagrees.
  • If you speak with other patients, or read internet sites, discuss your findings with your doctor. However, realize that every patient’s circumstances are different, and some things you read on the internet are not accurate.
  • If something doesn’t seem right, speak up!

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