Unnecessary or potentially ineffective medical treatment is a hard pill to swallow, but patients can take some proactive steps to avoid it.
In fact, many treatments that doctors propose “are often on the basis of really incomplete information and tremendous uncertainty,” Vinay Prasad, a hematologist-oncologist and associate professor of medicine at Oregon Health and Science University, told MarketWatch. “Just because we live in 2019 doesn’t mean everything the doctor offers you is something that’s supported by evidence,” he said.
This wasteful medical spending can add up. A review of 1.3 million Washington state patients’ insurance claims last year, for example, found that an estimated $282 million out of a total $785 million (36%) was spent on “wasteful” or “likely wasteful” services. Some 46% of 1.52 million services examined were also deemed wasteful or likely wasteful, according to the report by the nonprofit Washington Health Alliance.
Breast-cancer overdiagnosis and false-positive mammograms alone rack up an annual national tab of $4 billion, according to a 2015 analysis of 2011 to 2013 data published in the journal Health Affairs.
Patients must be their own advocate while navigating the health-care system, said Erica Mobley, the director of operations at the Leapfrog Group, a health-care watchdog. “It is hard and it can sometimes be intimidating, especially if they’re in a case where they’re in a lot of pain or if they’ve been given a terrifying diagnosis,” she added.
A 2017 survey of more than 2,100 doctors estimated that a median of close to 21% of medical care — including 25% of tests, 22% of prescription drugs and 11% of procedures — was unnecessary, according to results published in the journal PLOS One. Doctors most often cited as reasons fear of malpractice, trouble accessing medical records, and pressure or request by the patient, and seven in 10 respondents “believed that physicians are more likely to perform unnecessary procedures when they profit from them.”
What’s more, around half of medical treatments are of “unknown effectiveness,” while one in three are either shown to be or likely to be beneficial, according to a 2012 British Medical Journal analysis summarized by an article in the journal Medical Care Research and Review (MCRR). “Another 7% were rated as trade-offs between benefits and harms, with 6% rated unlikely to be beneficial and another 3% rated likely to be ineffective or harmful,” the MCRR article’s authors added.
Here’s how to minimize your risk of being offered treatments you don’t need:
Get a second opinion, Mobley said, particularly when you’ve been given a serious, potentially life-altering diagnosis (like cancer) or treatment recommendation (like surgery). If your provider is upset, angry or insulted that you want another doctor to weigh in, that’s a sign you should find another doctor, she said.
Even if that second opinion validates the first, at least you’ll have greater peace of mind. If you’re concerned about the time or cost involved in making appointments with multiple doctors, look into telemedicine options, Mobley said.
Ask the right questions. Eric Patashnik, a Brown University professor of public policy who has written about evidence-based medicine, recommended asking your doctor the following questions:
• Will the recommended treatment extend my life or cure my illness?
• Will it relieve my symptoms or give me a higher quality of life?
• How do you know the treatment works?
• What research studies support the use of the treatment in patients like me, and how strong is the scientific evidence indicating that the treatment is likely to be beneficial?
• What are the physical, psychological and other harms associated with the treatment?
• What other treatment options (including allowing my condition to progress naturally) are available for my condition, and what are their comparative benefits and harms?
Ask if altering your lifestyle is an option prior to starting a pill regimen off the bat, added Marc Siegel, a clinical professor of medicine at NYU Langone Health and Fox News medical correspondent. Can you first consult a dietitian, work out at the gym or start walking more?
And steer clear of questions like “How is this supposed to help me?” Prasad said this can launch the doctor into an explanation of the mechanism behind a drug, how a particular surgery works, or the nuts and bolts of a procedure rather than the evidence that it works. You can also ask the doctor to suggest a starting point for reading more about the treatment, he said.
Seek out reliable resources. Mobley recommends the Mayo Clinic’s website for accurate and heavily vetted medical information. She also points to Choosing Wisely, an American Board of Internal Medicine Foundation initiative that seeks to shed light on unnecessary medical treatments and provides bilingual patient guides on specific conditions and specialties.
Prasad, meanwhile, recommends checking out the Cochrane Collaboration, an organization that reviews and summarizes health-care research. Your doctor may also be able to provide informational materials not accessible to patients, he said.
If possible, find out whether your doctor has any conflicts of interest. If your physician is advising you get surgery at a specific clinic, make sure it’s not solely because he or she also has ownership of that clinic, Mobley said. “There can sometimes be a perverse incentive for a provider who’s telling their patients to get a surgery at a place that they own,” she said. Do some digging online or try asking your doctor point blank, she suggested.
In the same vein, you can search for your physician on databases like the Centers for Medicare & Medicaid Services’ Open Payments to suss out any potential relationships with the pharmaceutical industry, Prasad said.
“If a doctor is heavily recommending the products from one particular company and not really able to give you a good reason for doing it, and the doctor is conflicted with a company … you may want to take a pause and maybe consider a second opinion,” he said.
Exercise caution with “unorthodox approaches.” “There are people out there who will make money and get attention by throwing an unorthodox approach at a problem [when] the orthodox approach may be the answer,” Siegel said. For example, don’t assume that an expensive alternative treatment from a clinic in another country is necessarily the best substitute for traditional cancer treatments, he said, especially during “a time of great revolution in cancer care.”
“Don’t overcompensate for a linear approach by looking for an expensive, exotic approach,” he added. “Find somebody who thinks outside the box, but don’t assume that glittery compounded herbs are necessarily the answer.”
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