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Mon March 4, 2013
Too many tests and treatments? Ask your doctor if they're really necessary
An organization of physicians says more isn't always better when it comes to medical tests.
A national campaign called "Choosing Wisely" looked at a list of common procedures that doctors and patients should question.
Dr. Jim Froehlich is director of Cardiovascular Medicine at the University of Michigan.
He says a stress test before a simple surgery is one example of an overused procedure.
"That's not always useful, especially if the planned procedure is of such low risk that if even if someone has some heart disease, it's unlikely to adversely affect them," Froehlich says.
Lab tests to look for a blood clotting disorder in otherwise healthy people also may not be necessary, he says.
"We made some recommendations around whether it is useful to reimage someone who's had a blood clot," Froehlich says. "Most blood clots occur for a reason, such as being sedentary, having cancer or another illness, or being hospitalized. These are scenarios when a blood clot is more likely to occur. When it does, it's very unlikely that someone has an underlying disorder as the cause."
The Choosing Wisely campaign identifies more than 130 tests and procedures that patients should question.
Froehlich admits many patients are reluctant to ask their doctors about their orders.
"I think the problem of a conversation between patients and physicians is exactly what this campaign was trying to address," Froehlich says. "It's trying to empower people and physicians with information about what is and what isn't supported by evidence in the literature, and trying to promote conversations about whether a test really is necessary."
Froehlich says the current climate in health care doesn't lend itself to patients being educated consumers because the balance of knowledge is tilted toward physicians.
He also says doctors are often poorly prepared to comprehend the financial impact of ordering unnecessary procedures.
"I often don't know -- and most physicians don't -- what tests cost, and what they cost is often highly variable depending on the patient's insurance," Froehlich says. "And neither the patient nor I are generally aware of how much (of that cost) will fall to the patient. So it's an ill-informed conversation."
Froehlich recommends that patient ask their doctor open-ended questions.
"What are the benefits? What would be the downside of not doing this test? And do you think it's worth it in this situation? Those can be discussion-encouraging questions I think people should be prepared to ask."