Let’s begin with the response, “When the data tells you to!” I often hear patients say, in response to their treatment plan, “Because my doctor told me I needed it.” I would like to see patients self-advocate by saying, “Well, according to the data provided to me by my doctor after his examination of my condition, which is…” or “My doctor reported my condition as ____ and advised this treatment plan as appropriate for my condition because the supporting data indicates….” This type of thinking is a self-advocacy shift in how consumers must collaborate with their providers.
Why do we need collaboration? Because the data tells us we have a problem with treatment plans that are not really data driven. An article in The Boston Globe from May 3, 2012 discusses how hundreds of billions of dollars a year are wasted on unnecessary or duplicate procedures. This is preventable waste that effects Medicare and Medicaid spending, health insurance costs, and, most importantly, patient health. In order to prevent this, nine specialty groups, including the American College of Cardiology and the American Board of Internal Medicine Foundation, compiled a list of 45 tests and procedures that patients usually don’t need. In addition, the Lown Cardiovascular Research Foundation and the New America Foundation hosted the first major medical conference about “Avoiding Avoidable Care” in late April.
One example of unnecessary medical care is radiation for early stage-invasive breast cancer in women over the age of 70. Eight years ago, a major study published in the New England Journal of Medicine revealed that radiation after surgery had no effect on the survival rate of women in this category. The National Comprehensive Cancer Network updated their guidelines a year later to reflect this. However, a study from Yale University’s School of Medicine discovered that these findings did nothing to reduce the number of women within this category who were treated with radiation.
The Boston Globe goes on to name reasons for over treatment discussed at the conference, including “defensive medicine,” where doctors prescribe extra tests to avoid malpractice or negligence suits. David Newman, an emergency physician and director of clinical research at Mt. Sinai School of Medicine, called one reason “scienciness,” or “doctors being very knowledgeable about the array of tests they could order but not the likelihood those tests will actually reveal anything of value.” Similarly, others blamed current trends in medical education for over testing, instead of waiting and observing symptoms. Another idea brought up was padding the bill. For example, cardiologists are paid to interpret any imaging work they may order, especially if their company owns the imaging equipment.
However, beyond the money wasted is the patient’s health. Unnecessary treatments have an effect on the patient’s health, and, especially in cases like that of radiation, the effect isn’t good. In order to protect your health and your wallet from unnecessary procedures for any reason, talk to your doctor about why he or she has chosen the prescribed treatment plan. Discuss how the treatments will affect your health, and also any other options available. If the “data” supporting the treatment option does not make sense, consider getting a second opinion.
Be your own healthcare advocate, which also includes a trusted advisor (family member) to be with you. Advocate for the healthiest data driven treatment plan so that you understand why, in addition to what, how, and by whom, the treatment will be provided. Do not avoid necessary treatment. However, by understanding your treatment plan and the reasons behind it, you will be on the right path to avoid unnecessary treatment and the bills that follow.
Send me your thoughts and thanks for reading!
Rebecca S Busch
Patient Healthcare Advocate