5 questions you should ask to guard against medical overtreatment
By Kristen Gerencher, MarketWatch
Last Update: 12:01 AM ET May 1, 2012
SAN FRANCISCO (MarketWatch) Worried that questioning your doctor will damage your relationship or make for an awkward office visit? Time to untie your tongue.
Asking a few key questions at your next appointment could save you both money and exposure to medical risks. Meanwhile, more doctors are volunteering to help the conversation along and prescribe evidence-based conservative measures first.
To curb wasteful medical spending and to protect people from potentially dangerous overtreatment, nine medical-specialty societies representing 374,000 physicians recently recommended that doctors go slow in some cases instead of reaching for the tools theyve become accustomed to grabbing right away.
That means forgoing things like routine EKGs when low-risk patients have no symptoms of heart trouble and waiting six weeks before sending patients with uncomplicated lower back pain for imaging tests. Also on the list of unnecessary items: routine chest X-rays before surgery and automatic antibiotics to treat sinusitis.
There are times when every single one of these things is appropriate, but not all the time, not for everyone and certainly not on a routine basis, said Dr. Christine Cassel, president of the American Board of Internal Medicine (ABIM) Foundation in Philadelphia, which initiated the campaign called Choosing Wisely.
The doctor groups, which represent family physicians, kidney specialists, oncologists and cardiologists, among others, released lists of the top five tests and procedures they say are frequently overused in their respective subspecialties. Read about them at the ABIM project website, ChoosingWisely.org.
The ABIM Foundation then partnered with consumer groups such as Consumer Reports and AARP to explain the findings to the public.
It was the right idea at the right moment that didnt involve the government or insurance companies, Cassel said of the campaign.
In the fall, eight more medical-specialty societies are expected to release their lists of tests and procedures that patients and doctors should question.
Overuse of medical resources happens for several reasons, including doctors longstanding habits, fear of malpractice lawsuits and financial incentives that reward them for doing more, not less. And patients sometimes demand more tests and treatments than are necessary.
Worries that insurers will stop covering the listed items or that doctors wont ever offer aggressive care is wrongheaded, said Shannon Brownlee, author of the book Overtreated and the acting director of the New America Foundations health policy program in Washington.
Physicians want to help their patients, she said. The key is to improve the conversation between them and get a stronger dose of reality in many conversations.
For example, the American College of Radiology recommends against using CT scans to confirm suspected appendicitis in children without first considering ultrasound, which reduces radiation exposure. Excess radiation is a big concern for kids, who have more future years than adult patients to develop potential harm from it.
Concern about overuse extends to end-of-life care as well.
Patients are increasingly aware that there is a real downside to our hyperaggressive form of medicine, and it really shows itself when our parents are old and frail, Brownlee said.
Dr. John Santa, director of Consumer Reports Health Ratings Center in Yonkers, N.Y., said the idea is to identify areas where the system has clearly gone overboard, not to make doctors practice cookbook medicine or stir up fears about health-care rationing.
Rationing occurs when people who need something have to do without, Santa said. Thats not whats going on here.
Here are five questions to ask your doctor about a recommended test or treatment:
- What are my options?
- What are the risks and benefits of each option? Make sure you understand the risks. For tests, one risk is often the potential for misleading results that lead to more risk and anxiety from invasive follow-up procedures.
- What happens if we wait or do nothing? Sometimes theres no harm in waiting.
- What does this test measure? How will the results change the course of my treatment? Any test should result in something to do, Santa said. Question the accuracy of the test as well. How good a test is depends on the probability prior to the test that you have the disease in the first place, he said.
- Who will contact me about the results and what happens if they are abnormal?
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