Dr. Kussin: Unnecessary Care: Asking the Right Questions

October 11th 2012   ·   0 Comments

By Dr. Steven Z. Kussin, MD, FACP

We’ve spent the last few weeks talking about unnecessary care. It’s time to make sure you don’t fall victim to it.

Why Ask Tough Questions?
In the face of greed, defensive medicine, money primed doctors, and conflicts of interest in our health care delivery system, you should have the right questions ready and be ready to ask them. Why? Because unnecessary, unproven and unsafe practices can leave healthy people sick, and sick ones dead. As H. Gilbert Welch has said, “It’s hard to make a well person better, but it isn’t hard to make them worse.”

Your input should be proportionate to the consequences you might face for a bad decision or a bad result. Remember when your doctor wants to probe, she’s literally using your body to do the probing. And when there’s a fall, it’s you who hits the ground.

When to Ask the Tough Questions

A LIFE SENTENCE. If a medication or a condition is going to last a lifetime you should be learning more about it than one that will require a few days of therapy or a brief recovery period.

MONEY. If the recommendation requires out of pocket expense (and it will), you better make medical demands regarding its financial demands. You do pay for your care.

Consider this. There is a crisis in health care costs, but I’m not talking about the national mess. It’s your family’s potential predicament when it comes to medical expenses. Health care bills cause more bankruptcy than all credit card debt or real estate foreclosures. And when it comes to foreclosures, half are due, in part, to medical costs. The vast majority occur in the insured, home owning middle class. Uh, that’s you. This IS your problem.

RISK. If a test or procedure has more risk than you are comfortable with, you must ask the hard questions. Hey, go with your gut. Your intuitions should be given the full faith and confidence they deserve. TIME TO STUDY If a test or procedure is elective or preference sensitive you should make inquiries. So much is taken for granted. Why do you trust your doctors so much in the face of all the publicity about bad outcomes?

If you have a cancer or face an elective surgery, there is time.

Time….

• for the research

• to frame the right questions

• to know the range of acceptable answers before you ask the questions

Questions To Ask: An Easy List
Several months ago Christine Laine, MD, editor in chief of the Annals of Internal Medicine, published a list of questions that she thought physicians should ask themselves before ordering tests for you. I figure that if your physician won’t ask them of himself, you better do the job. And who’s better than you to pose these questions?

Questions Patients Should Ask Their Doctors Before Agreeing To Testing.

Did I have this test previously?

If so, what is the indication for repeating it? Is the result of a repeated test likely to be substantively different from the last result?

If it was done recently elsewhere, can you get the result instead of repeating the test?

Will the test result change my care ?

What are the probability and potential downsides to a false alarm?

Am I in potential danger over the short term if I do not perform this test?

Who is the test going to reassure?  Is it for me, or to protect my doctor? I don’t want  tests that help doctors defend themselves if it all goes bad.

Are there other strategies to reassure me that are safer and less risky? How about I trust your opinion without the need for tests?

The Best for Last
Gary Schwitzer publishes an award winning weekly blog. Find below, a helpful list of questions he and his editors use. They are the questions health care journalists are urged to think about when reporting on a story. You too can be like a health care journalist.

Link Listen and Learn. Each question below offers a video link. They just take seconds to hear. You will not find more informative and candid insights anywhere. You will hear and read why you can’t take much for granted when you are sent off on a ‘stretcher adventure’.

• How often do benefits occur?  Hear about Absolute vs. Relative risks. It’s Patienthood 101.

• How often do harms occur? Never “let the doctor do his job , and you do yours ” Too much is at stake. Clemenceau said, “War is too important to be left to the generals.” You should know “Health care is too important to be left to the doctors.”

• How strong is the evidence? Learn that you can evaluate the science. No, you aren’t Einstein. But neither are your doctors.

• Is this condition exaggerated? Just how important is this to you, your health, for someone your age, and with your unique risk factors. We’re not talking population studies that include everyone. When a test happens it doesn’t happen to the population, it happens to YOU.

• Are there alternative options? Short answer…there are ALWAYS alternatives. “How does this compare to other more time tested existing technologies?” Or, the increasingly appealing opportunity of doing nothing. Watchful waiting is becoming an attractive option for an increasing number of conditions including pain, slight elevations of cholesterol, glucose and blood pressure, as well as for osteoporosis and some cancers.

• Do they have a conflict of interest? Who is promoting this? Remember, just like the media who have stories to sell, your doctor has stories to tell. It doesn’t make them true or in your interest. Medicine is a 3 trillion dollar per year industry. As noted patient advocate, Trisha Torrey says, “always follow the money.”

By Richard