Every year patients become victims of unnecessary medical care; suffering both physical, social and financial consequences. Millions of patients get tests, drugs, interventions, and operations that won’t improve their quality of life, may cause harm, and cost an arm and leg. At times the damage is irreversible; which begs us to ask what can we do about it?
Take for instance the 65-year-old lady who presented to the emergency room with dizziness and an episode where she nearly passed out. The ER physician proceeded with ordering a CT scan of her Brain, an ultrasound scan of the arteries of the neck, an EKG, and obtained a cardiac and neurological work-up. As all of these tests came back negative; a more detailed history revealed that she was simply suffering from dehydration. After receiving a fluid bolus through a peripheral IV line; all of her symptoms were gone. She felt great after the fluids. Sadly, the lady had received a battery of unnecessary tests; unnecessary radiation, and a ballooning medical bill. She missed valuable time with her grand kids. The physician showed no remorse; and expressed to the patient that she had dodged a bullet. I was devastated and perplexed.
The problem with health care nowadays is that patients know very little about the value or benefit of the medical treatment they will receive. Several studies have demonstrated huge disadvantages a buyer faces when they are ill-informed about the product they are about to purchase. Health care is a prime example of this; physicians are well informed and powerful where as patients are inherently impaired. Consequently, doctors can exploit their position; recommending care of little or no value and patients will tend to adhere to recommendations given to them. A physician’s perception of success following a treatment is often very different from a patient’s perception of success.
Many physicians have morphed into businessmen advocating tests and procedures for personal gain. Take another instance of an ill-informed patient from a rural village who comes in with right lower abdominal pain. Having no insight into his condition; the patient agreed to having his appendix removed. The surgeon went ahead to remove the patient’s appendix. The tissue that was removed was sent for pathology and analysis revealed that the appendix was completely normal. This is called a negative appendectomy; where the appendix that was removed was completely normal. Another example of a 45-year-old male who presented to the ER with chest pain and underwent an EKG, which was normal. Serial cardiac enzymes were also checked which were all noted to be normal. Unfortunately, the patient also underwent a heart catheterization, an invasive procedure to examine the arteries of the heart; and this too was normal. For weeks after the procedure the man suffered groin pain; all consequences of unnecessary care.
Over-testing patients has significant consequences on the health and viability of our community. Doctors are frequently afraid to do too little and sadly a global epidemic of over testing, over diagnoses, and unnecessary treatment has emerged. Because of their position and power; physicians are guilty of advocating widespread unnecessary medical care. Increased hospital stays also translate into missed work, and significant economic impairment. While physicians face this global epidemic; they are obligated to relieve anxiety, and ethically motivated to provide better and cheaper care. Patients must become aware and educated in order to combat the ailment they face. Patient failure to become proactive will only lead to unnecessary impairment, unnecessary testing, and over diagnoses.