It is widely recognized that 1/3rd of the money spent on health care in this country is wasted…and THAT isn’t even the BAD news. The truly BAD news is that all that unnecessary wasted money, $800,000,000,000 and counting, is actually making us sicker in so, so many ways. We’re just beginning to understand those many ways.
Consider the following quotations from medical practitioners:
“Let’s get a test”
“I need to operate”
“Try this pill”
Such proclamations occur myriad times across the land…and, the unpleasant truth is that, for a wide variety of reasons, it is becoming increasingly clear that patients need a degree of skepticism when listening to such proclamations, because they can be harmful to our health.
An October, 2018 article in the “Journal of the American Medical Association, Internal Medicine,” reviewed 140 research articles and 54 individual patient case reports of medical harms caused by unnecessary medical care. The results showed that un-necessary tests, medicines, and procedures (defined as services for which the potential harm exceeds the potential benefit) caused a variety of harms:
- Physical harm. This, of course, is the first thing we all think of when we think of harm done from medical care, and it was well documented in this study. Short-term complications of surgery can always occur such as bleeding, infection, death; but also long term complications, even life-long disability. Less recognized is that short- and long-term physical harm including, of course, death, can also occur from seemingly innocuous pills, even common antibiotics; and medical tests, especially x-ray procedures that use dye contrast injections. This study also identified what they called “down-stream” harms. The original un-necessary medical intervention or test may not have had a complication, but, maybe, as a result of something found on that un-necessary intervention, an ADDITIONAL test or procedure was done and THAT test or procedure led to harm. In some documented cases, there were multiple repeat tests or procedures done as a consequence of that one, single un-necessary initial test or procedure. Yikes!
- Psychological harm: Imagine, for a second what was going through the mind of the above patient who had those multiple un-necessary tests or procedures. Imagine the stress and anxiety of every single one of those tests or procedures occurring over several months. The stark fear that THIS TIME they’ll find cancer, and then the let-down, but “Oh, we’ll have to do another test.” You can see how it would be enough to cause PTSD. Even under the best of circumstances, our healthcare system can be confusing; even think physically painful; impersonal; and scarily expensive. Doctors, the authors of this article point out, tend to discount these issues, but they are always hard on patients psychologically.
- Treatment burden: The frequent doctor visits can lead to being overwhelmed, a loss of control in one’s life. What happens to other responsibilities during all these wasted medical services? One’s life may fall apart…and, as this is un-necessary care, all to no purpose. Simply put, patients get frazzled…and doctors do as well (after all, we now know that our doctors are getting sick from overwork, but that’s a topic for another time).
- Social burden: While getting all the tests and procedures, patients may have to abandon their usual social activities, leading to loss of enjoyment of life. This may overlap with the psychological harm described above and lead to depression.
- Dissatisfaction with health care: Some of the patients started routinely questioning all their doctors. This can be a dangerous situation, when patients become dis-illusioned with medical care, avoid doctors and delay truly necessary diagnosis and treatment.
- Financial burden: One patient, of limited income, described paying $36,000 for dietary supplements ordered by his doctor. Few patients are wealthy, and few insurance plans pay the full cost of care. Un-necessary care is already a financial burden, but when it leads to complications, it can be a cascading financial disaster for someone of limited or even moderate means.
What needs to be done about this problem? The article has no answers. But Choosingingwisely.org can help us here, suggesting patients ask the following questions when confronted with a potential medical intervention:
- Do I really need this test, treatment or procedure?
- What are the risks?
- Are there simpler, safer options?
- What happens if I don’t do anything?
- What are the costs?
It would behoove the wise medical practitioner to familiarize himself or herself with these questions, and offer satisfactory answers to all of them BEFORE ordering ANY medical intervention. After all, it is the responsibility of physicians (the Hippocratic Oath says “First do no harm”) to use medical tests, medicines, and procedures when and only when those medical services are in the best interests of their patients, and “overusing” medical services are inappropriate.
And, realizing that our community will never attain its goal of economic and physical health without solving the problem of undue patient harms, THRIVE is allotting significant resources to addressing this. More later.