Is this test necessary, doc?
Ever wonder if you needed a test or procedure?
“Should I start another pill for my diabetes?” “Do I need an MRI for my joint pain?”
You’d be right questioning the decision 20% of the time. Here’s why.
In a national survey, doctors estimated 20% of overall medical care was unnecessary, including one in five prescription drugs, one in four tests, one in 10 procedures. The two major reasons they give: fear of malpractice and patient pressure/request.
Yes, I’ve sprouted a few gray hairs denying patients antibiotics for a common cold. But studies strongly support a third reason behind unnecessary testing – money. The number of wasteful tests is double for fee-for-service compared to capitated contracts. That is, if I get paid more for doing more, I will do more.
So what’s the harm if doctors order a few more tests/procedures just to be thorough?
In 2013, experts calculated unnecessary medical services cost the U.S. $210 billion, the biggest cause of health care waste.
To patients, there are direct harms. Drugs, tests, procedures and diagnoses have side effects, provoke anxiety and cost time and money. According to a Kaiser Family Foundation study, a quarter of American households have difficulty paying medical bills. Of those, 70% need to “cut back spending on food, clothing, or basic household items”; 59% drain all or most of their savings.
To address this issue, leading medical experts and organizations drafted the Choosing Wisely campaign in 2012, unveiling “things providers and patients should question.”
Last year, a Washington state health organization picked 47 tests from the Choosing Wisely watch list and found half the time they were done unnecessarily. Yet these tests alone had cost the state $258 million in wasteful spending.
How can you find out if a test is needed or not?
The fastest, safest way is to ask your doctor. “Do I need it?” “Can it wait?” What’s the harm if I wait?” As a doctor, if I think a test is important, I’d let you know – in no uncertain terms – that I need it done yesterday. Otherwise, as long as you understand the risk: keep me informed, we have a plan.
You can also visit the Choosing Wisely website at choosingwisely.org. It has a patient section, where you can search for various conditions and read about the necessity of treatments.
Last weekend, instead of spring cleaning, I started playing around with it, typing random terms into random boxes. The results were hilarious. For example, I typed in “diabetes” and got “colds and flu,” “testosterone for erection problem.” I typed in “car” and got “insomnia and anxiety,” “neck and back pain.” (Trust me, it’s me, not them.)
I think Choosing Wisely tries to be fair and helpful. Medical jargon aside, its recommendations are short and factual. But I also noticed that some controversial (and money-making) topics like spine fusion and knee meniscus tear are missing. Apparently, not every topic “sparks joy” for the experts.
Rest assured that you have options, legitimate concerns. Start a conversation with your doctor. And that "I’m busy researching!" is as good an excuse as any to postpone spring cleaning till next weekend. Marie Kondo can wait.