By Shannon Brownlee, MS
Every year, hundreds of thousands of Americans experience avoidable harm in our nation's hospitals, and estimates suggest that tens of thousands of those people die. Medical errors and unintended harm in the US health care system are driven in part by the breakdown in the relationships that ought to be the foundation of good medicine.
|| Shannon Brownlee, MS
Part of the tragedy of harmful medical care is that often treatments that end up causing harm weren't needed in the first place. Unnecessary medical procedures are shockingly common. Unnecessary or ineffective medical treatments, tests, drugs, and days in the hospital account for anywhere from 10 percent to 30 percent
of total medical expenditures in the US. Examples range from PSA tests to CT scans, medication for mild blood pressure, and cardiac stents for patients who don’t have symptoms of heart disease. A recent analysis
found that in a single year, about 40% of Medicare recipients received at least one from a list of just 26 examples of useless or low-value procedures.
Asking questions can help patients better understand their treatment options. Patients and families can reduce their risk of suffering an error or hospital infection by avoiding unnecessary medical treatment in the first place. Here are five questions to bear in mind when discussing your treatment options with your doctor:
- What are all of my options for treatment? For many conditions and illnesses, there can be more than one treatment. Sometimes changing your lifestyle (diet and exercise) can reduce your symptoms or the risk of a bad outcome. Sometimes, not getting treated at all is a reasonable choice. Ask your doctor what all of your options are, and ask for clear explanations you can understand for each.
- How exactly might the recommended treatment help me?
You need to know exactly how you might benefit from a treatment. Even if you think you know, it’s important to ask. A hip replacement, for example, might allow you to walk again with greater ease, but it won’t cure your arthritis. In fact, you may need another replacement in 10 to 20 years. A drug might relieve some of your symptoms and not others. Other treatments have no effect at all on how you feel now and are supposed to help prevent a disease from harming you in the future. Ask how the proposed treatment is supposed to help you.
- How good is the evidence that I’ll benefit from the treatment or test?
Many treatments and tests that doctors prescribe have never been fully tested to see if they work, or have been tested, but not in patients like you. Find out if the treatment or test your doctor is recommending is a proven therapy. If not, your doctor should explain why he or she thinks it’s a good idea for you.
- What side effects can I expect, and what bad outcomes might happen?
Every test, drug, surgery, and medical procedure has side effects, and some can be serious. Simply being in the hospital exposes you to medical errors and hospital-acquired infections. You need to know the risks so you can decide if the danger or discomfort of your condition is more concerning than the risks of the proposed treatment. If it’s a test, ask how often it’s wrong, and what will happen if it shows you’re sick when you’re really not. If it’s a drug or surgery, ask what all the serious side effects can be, and how often they occur.
- If it’s a test, what does your doctor expect to learn from it, and how might it change treatment?
If a test won’t change the way you’ll be treated, or if you’ve already decided you don’t want the possible treatment, ask why you should be tested.
We salute the National Patient Safety Foundation for promoting Patient Safety Awareness Week. We hope this week helps everyone in the health care system—patients, doctors, nurses, and everyone else—to focus on the critical mission of keeping patients as safe and healthy as possible.
To learn more about unnecessary treatment, and what you can do to protect yourself from it, read Overuse 101 or explore the Lown Institute website at lowninstitute.org.
The Lown Institute hosts the Road to RightCare Conference in San Diego from March 8-11, 2015. For more information, visit conference.lowninstitute.org, and follow the conversation on Twitter at #Lown2015.
Shannon Brownlee, MS, is senior vice president of the Lown Institute. Ms. Brownlee has been a national leader in highlighting the scope and consequences of overuse in health care. An internationally known writer and essayist, her book, Overtreated: Why Too Much Medicine Is Making Us Sicker and Poorer, was named the best economics book of 2007 by New York Times economics correspondent, David Leonhardt. Her articles and essays have appeared in such outlets as The Atlantic, New York Times Magazine, The New Republic, Time Magazine, and The Sunday Times of London, among other publications.