Jun 12, 2015


Interviewer: Thirty percent of healthcare spending is being used on unnecessary medical testing and treatments. What can be done about it? Next on The Scope.

Announcer: Medical news and research from University of Utah physicians and specialists you can use for a happier and healthier life. You're listening to The Scope.

Interviewer: We're talking with Dr. Bradford Jones, a current physician at the University of Utah. A lot of patients come into the doctor and obviously they are worried about their health and what's happening to them. And so they ask for a bunch of treatments and it's almost like they're asking for too much treatment.

Dr. Jones: And it's understandable. Like you say, you're worried when something happens to your body, when you're having changes that you don't understand. Thirty percent of our healthcare spending is on unnecessary tests and treatments. That's $500 billion a year. That averages out to $1,700 per person in this country, which means you're spending that for things that we don't need.

Not only does it cost a lot of money, but it also leads to bad outcomes. Basically, if you, for example, get an MRI, you're going to find something that's wrong. And that's just how it is, but it's not necessarily a problem. But it's going to lead to treatments that are not necessary and that can cause lots of harm and complications that you have to deal with for the rest of your life.

Interviewer: So it's almost kind of like another situation where you go into the car dealership for one test and you come out and they tell you your wheels are broken or you need to turn them or all these sorts of things. Then you end up paying for what isn't really needing to be fixed.

Dr. Jones: Exactly. That's where the relationship with your physician comes in really big so that you can have a better conversation with them, and say, "I'm worried about this. What do you think? What do we need to do to figure this out?" And there are many reasons for why we get these over-testing and overtreatment. One thing is we use imaging too much. We do too many MRIs, too many CT scans and this is driven both physicians and patients. A lot of patients, like you said, they come in and say, "Hey, I have a headache. I want an MRI," when it may not be necessarily needed.

At the same time, physicians, we want to please our patients. A lot of our reimbursements are now moving towards patient satisfaction. And so we want patients to be satisfied with the care that they get, but also we're afraid of lawsuits. And so if you're not pleasing the patient or if you think, "Well, it is a headache. We may as well get an MRI to make sure it's not anything more serious." Those are big drivers of some of this overuse.

Some other things that come into it is third-party payers or insurance companies, Medicaid, Medicare. That means we are a little more immune to the cost. We don't know exactly how much it costs so we're more willing to get some of these tests or treatments done.

Also, in this country, we have this culture that we want to live at all costs. Most of the spending comes in the last six months of our lives. And a lot of that has to do with that we have not made our wishes known, we haven't talked about it with our families, we have not filled out an advance directive. So a lot of this can be curtailed simply by that.

Now in politics, nobody wants to talk about this because as soon as you start talking about overuse, people throw out death panels and rationing and things like that. So you hear a lot about defensive medicine, which is a real thing where, like I said, physicians are scared of lawsuits and so you are more likely to over-test and maybe overtreat in order to avoid that.

Interviewer: So from a patient's point of view, my health is the most important thing. So when I come to a doctor, if there is even the tiniest little thing wrong with me, I want to know so I'm able to fix it or you're able to fix it. I guess from a patient's standpoint, how do I know what needs to be fixed and what isn't necessary?

Dr. Jones: That's an excellent question. And like I said earlier, a lot of that comes down to the relationship you have with your physician. You want to be able to trust them and you want to be able to get along with them so that you know that they have your best interest and that we're going to follow every scientific recommendation that we can in order to get you the proper testing and treatment. But also, to work together with you.

Sometimes, you may say, "Well, I want an MRI of my brain to make sure these headaches aren't a big deal," and then talk about it. Have the physician explain why or why not you think that might be a good idea. One other thing is filling out your advance directive, making sure that you're considering end of life issues before they become an issue while you're still healthy. That makes a big difference in guiding care in the last months of your life.

But also, there's a campaign by internal medicine physicians called Choosing Wisely. This is aimed at raising awareness for both patients and physicians on overuse of medical testing and treatments. There are over 100 recommendations that they make in simple language that's very clear. One example is that the vast majority of people with back pain, it will go away within six weeks. So you don't need to get an X-ray, you don't need to get an MRI during that time period unless they're certain things that are concerning about it.

So it's important to be aware that this is a big issue and to work with your doctor to make sure that you're making the best medical decisions that you can.

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