The NY Times takes on medical over treatment. A consumers guide to evaluating medical necessity.
How many of you have had the experience of visiting their primary doctor, being evaluated in cursory fashion, being sent for tests, constant monitoring of a medical condition with no end in sight and having to endure multiple expensive drugs with little guidance on where this is going or when it will end. While this sounds horrible, many of us have either had this happen to us or have family members who have had test after test, regardless of where those tests lead.
A NY Times article explores this longstanding phenomenon, which seems like a diagnostic black hole. How much testing is appropriate? Is it needed? In an elderly person, where does it lead and does the possible intervention solve a problem or create many others? What is a health care consumer to do?
Some call this the medical merry go round, where nobody who you visit takes ownership of your problem and send you from provider to provider and test after test. In the medical system, the primary care doctor is the referee who makes sure this is most appropriate. Unfortunately, in some cases, it is the primary doctor who is at the center of it all. Belief systems often determine how a doctor proceeds, and it they have a disease mentality, it could be detrimental to your health. The best primary doctor is one who is caring, and one who considers all possible options before sending for test after test. Unfortunately, our current system of starve the primary doctor who can only afford to spend 10 minutes with you has been a huge part of the problem (thank you insurance industry for your stewardship in that one).
The other problem is that of the patient who demands all the medical stuff that is available, since they have deemed it their right since they are insured. What they do not understand is that medical tests are often negative, and that the musculoskeletal system, which comprises 55% of the human body is often the cause of their symptoms. Most medical providers have little understanding of the musculoskeletal system and as such, order tests because they do not have the tools to adequate consider the effect of the musculoskeletal system on their symptoms, which leads to many tests that will be negative and are simply not needed (read about that here). This is why patients need a primary care doctor who is open minded and above all, conservative in their consideration of what tests to order and the direction they are heading when those tests return with their results.
There is of course one more thing that will undoubtedly change this: health care reform. Some call it rationing, others call it starving the system, however, there will be more global fees, discouraging doctors from ordering without a direction as to why. Hopefully, the system will remove the most mundane tasks from most primary doctors, reimburse them more appropriately so they will spend more time with their patients because they can afford to and more specialists will gravitate towards primary care, which will solve many of the anticipated future access problems as more people enter the health care system under Obama care and health care reform that increases access to care.
Check out the NY Times article
But an epidemic of overtreatment — too many scans, too many blood tests, too many procedures — is costing the nation’s health care system at least $210 billion a year, according to the Institute of Medicine, and taking a human toll in pain, emotional suffering, severe complications and even death.
“What people are not realizing is that sometimes the test poses harm,” said Shannon Brownlee, acting director of the health policy program at the New America Foundation and the author of “Overtreated: Why Too Much Medicine Is Making Us Sicker and Poorer.”
“Sometimes the test leads you down a path, a therapeutic cascade, where you start to tumble downstream to more and more testing, and more and more invasive testing, and possibly even treatment for things that should be left well enough alone.”
Have you experienced too much medicine? As part of The New York Times’s online series The Agenda, I asked readers to share their stories. More than 1,000 responded, with examples big and small.
Some complained that when they switch doctors they are required to undergo duplicate blood work, scans or other tests that their previous doctor had only recently ordered. Others told of being caught in a unending maze of testing and specialists who seem to forget the patient’s original complaint. I heard from doctors and nurses, too — health professionals frustrated by a system that encourages these excesses.