Anywhere from one-fifth to nearly one-third of the tests and treatments we get are estimated to be unnecessary, and avoidable care is costly in more ways than the bill: It may lead to dangerous side effects.
It can start during birth, as some of the nation’s increasing C-sections are triggered by controversial fetal monitors that signal a baby is in trouble when really everything’s fine. It extends to often futile intensive care at the end of the life.
Overtreatment means someone could have fared as well or better with a lesser test or therapy, or maybe even none at all. Avoiding it is less about knowing when to say no, than knowing when to say, “Wait, doc, I need more information!”
The Associated Press combed hundreds of pages of studies and quizzed dozens of specialists to examine the nation’s most overused practices. Medical groups are under way to help doctors ratchet back avoidable care and help patients take an unbiased look at the pros and cons of different options before choosing one.
“This is not, I repeat not, rationing,” said Dr Steven Weinberger of the American College of Physicians, which this summer begins publishing recommendations on overused tests. It’s trying to strike a balance, to provide appropriate care rather than the most care. Rare are patients who recognise they’ve crossed that line.
“Yet let me tell you, with additional tests and procedures comes significant harm,” said Dr Bernard Rosof, who heads projects by the nonprofit National Quality Forum and an American Medical Association panel to identify and decrease overuse.
“It’s patient education that’s going to be extremely important if we’re going to make this happen, so people begin to understand less is often better,” he said.Put a stop to more
Not even doctors’ families are immune. A hospital appropriately did six CT scans to check Dr Steven Birnbaum’s 22-year-old daughter for injury after she was hit by a car. But the next day, Molly had an abdominal scan repeated as a precaution despite having no symptoms. When a doctor ordered still another, “I blew a gasket,” said the New Hampshire radiologist, who put a stop to more.
There are numerous reasons that one of three US births now is by caesarean, but Dr Alex Friedman blames some on an imprecise monitor strapped to labouring women. Too often, he has sliced open a mother’s abdomen fearing the worst, only to pull out a pink, screaming bundle.
Electronic fetal monitors record changes in the baby’s heart rate, a possible sign of too little oxygen. They became a tradition – now used in 85 per cent of births – years before research could prove how well they work. Guidelines issued last summer, aiming to help doctors better interpret which tests are worrisome, acknowledge the monitors haven’t reduced deaths or cerebral palsy. But they do increase the chances of a C-section.
Texas author Liza Ely had lined up hospice care for her 93-year-old mother, Verna Burnett, as she lived her last days with Alzheimer’s and heart failure. Yet when Burnett developed an irregular heartbeat, the care provider recommended seeing a cardiologist, to have a tube threaded through blood vessels to her heart to check it out. Ely said: “We asked what could be done if something showed up on the test.” The response: “Nothing, really.”
Ely said the family refused the “painful, expensive and unnecessary test.”Push back overtreatment
In Minnesota, the influential health cooperative HealthPartners saw use of MRIs and radiation-heavy CTs growing between 15 per cent and 18 per cent a year.
So the insurer began a new program: National radiology guidelines pop up on each patient’s electronic medical record whenever a doctor orders a scan. It’s not a requirement, but a gentle reminder of when such tests are recommended. In two years and counting, they estimate it avoided 20,000 unnecessary tests, preventing dangerous radiation exposure and saving $14 million.
Medical director Pat Courneya recently examined a young man who wanted a brain CT because of dizziness. Courneya’s physical exam turned up no neurologic red flags like weakness or eye problems, but seeing the guidelines issued helped reassure the man.
An American Medical Association journal just began a “Less is More” series to educate doctors about the risks of overused treatments.
To increase patients’ savvy, around the country are testing “shared decision-making”. That process uses plain-English guides, often DVDs, to explain the advantages and disadvantages of test and treatment options. Given full information, patients choose a less aggressive approach than doctors initially recommend about 20 per cent of the time, says Dr Michael Barry of Foundation for Informed Medical Decision-Making.
“No one would say, ‘I’m going to let the dealer figure out what car I want or need.’ Now we are taking a little of that spirit to the doctor’s office,” he said.