Do you ever find yourself doing things just because you’ve always done them that way? You’re not really sure why – you just do it. Well, American health care is, in many cases, the same way. Health care providers go to school, learn to do things a certain way, and many keep doing them that way throughout their careers. Unfortunately, it turns out that some of these things, like having a chest x-ray before even a minor surgery when you have no signs or symptoms of lung disease, are not necessarily useful, are costly, and can even be harmful. Luckily, several health care professional associations have come together over the past few years and created the “Choosing Wisely” campaign to help stop some of this “automatic” thinking and behaviors.
The goal of the campaign is to encourage health care providers and patients to question what’s being prescribed and why. For example, let’s say you need surgery on your knee or shoulder. Your surgeon tells you the procedure will take about an hour and you will be in and out of the hospital the same day. You have never smoked, don’t have chest pain or breathing problems, and you don’t have diabetes or kidney disease. Yet, for some reason, your surgeon (or his/her staff) sends you half way around the world to get blood work, a chest x-ray and an electrocardiogram (EKG or ECG) – and they are insistent that you have these things done a certain amount of time before your surgery is scheduled or you won’t be able to have the procedure. You dutifully go and submit to this torture. If you are paying for this out of pocket, it will cost a pretty penny. If your insurance company is paying for it, these wasteful tests are costing the health care system tons of money. We all end up getting to pay more in premiums and taxes. And, for what? For something we may get very little useful information from.
Often what happens with these excess tests is that some small variation of normal is found and then that has to be investigated – that means more blood work, maybe another type of x-ray or other image, or maybe a biopsy (when a little piece of tissue is taken from the body and looked at under a microscope to see if it is cancerous). At the end of it all, and several hundreds or thousands of dollars later, it turns out you really are fine and you have had to postpone your surgery needlessly. It is rare that any condition is found that would keep you from having your knee or shoulder operated on.
So, how can these tests or procedures actually cause you harm? Often, people feel that they are not being cared for if their health care provider doesn’t do a lot of tests. We have come to expect that lots of tests equal good care. But, many times, that is not the case. Every time you make a hole in your body, like when you have blood taken, there is a risk of infection. X-Ray radiation builds up in the body over time and can contribute to a person developing cancer. Sometimes, biopsies lead to more invasive procedures and treatments that are not needed. If your health care provider tells you to have imaging done that includes putting dye into your blood, there is always the risk of having a reaction to the dye that is potentially very dangerous.
For decades it has been the standard operating procedure (pun intended!) to remove a woman’s ovaries while she is having a hysterectomy to prevent developing cancer of the ovaries. The problem, sadly, is that the ovaries produce estrogen which helps to keep bones healthy. So, the woman who has had that surgery won’t get ovarian cancer but she may very well develop osteoporosis, or thinning of the bones. Also, the spine can become bent over making breathing difficult and even a seemingly minor injury can result in breaking a bone. All of these risks might be worth it if your health care provider got some useful information that would change the course of your treatment or you weren’t creating a problem by trying to fix another, however, many times, these tests or procedures are just not worth the risks.
Some people might think, “Won’t my health care provider get upset with me if I question his/her judgment?” Yes, that’s possible, but the question to ask yourself is, “What’s the bigger risk – my health care provider being upset with me or some potential harm coming to me?” The interesting part about the “Choosing Wisely” campaign is that it was started by a physician, Dr. Howard Brody, who recognized that the standard ways of doing things are not necessarily the best ways. Dr. Brody and colleagues encouraged different specialist groups to actually challenge the way they thought about accepted procedures they had been doing because… well, just because.
Since 2012, there has been a website for clinicians, patients and consumers of health care where you can find out more information about whether the tests or procedures being recommended to you are still the best idea (www.choosingwisely.org). “Choosing Wisely” has also teamed up with Consumer Reports (www.consumerhealthchoices.org) so that you can get the information you need in language that you can understand, instead of medical mumbo-jumbo. And, if your health care provider does get upset, my advice would be to find a new one. Health care should be patient-centered, not health care provider-centered, and shared decision making is the name of the game these days.
Wouldn’t it be nice if we never had to even think about having surgery or being diagnosed with some dreaded disease? Yes, it sure would be. Alas, that’s not the way it goes in this life. But, we can protect ourselves by asking the right questions – so, CHOOSE WISELY! Your health, and maybe even your life, could depend on it!