Skip to main content

Doctors and patients should talk more, test less

By Kevin Pho, Special to CNN
April 11, 2012 -- Updated 1232 GMT (2032 HKT)
It's important for doctors and patients to discuss whether some tests and procedures are truly necessary, says Kevin Pho.
It's important for doctors and patients to discuss whether some tests and procedures are truly necessary, says Kevin Pho.
STORY HIGHLIGHTS
  • About $700 billion of our $2 trillion annual health spending is considered wasteful medicine
  • Kevin Pho: A new guideline lists 45 tests and procedures that are performed too often
  • He says implementing the recommendations will not be easy for doctors and patients
  • Pho: Doctors and their patients need to talk more about what options are truly necessary

Editor's note: Kevin Pho is an internal medicine physician based in Nashua, New Hampshire. He blogs at MedPage Today's KevinMD.com.

(CNN) -- When you visit the doctor, chances are you are given a prescription for a drug or an order for an X-ray or lab test. Before you leave, it's important to ask whether your doctor's recommendations are truly necessary.

Even though much of what physicians do is meant to help patients, sometimes it's not always the case. Drugs may have harmful side effects and tests have the potential for adverse complications.

Unnecessary tests and medications contribute significantly to our country's spiraling health costs. It's estimated that $700 billion of our $2 trillion annual health spending falls under the category of wasteful medicine.

Kevin Pho
Kevin Pho

Consider the common sinus infection, which brings 16 million Americans into the doctor's office each year. Unfortunately, most of these cases have a viral cause, so antibiotics won't help the patient. Despite that, antibiotics are still prescribed in 80% of cases. Sinus infections alone equal $5.8 billion in health care costs each year.

Or, take the example of prostate cancer screening on a certain demographic. The U.S. Preventive Services Task Force, an independent panel of nongovernment clinicians who provide evidence-based practice guidelines, recommends against screening men over age 75 for prostate cancer. Studies have shown that the benefit of prostate cancer screening is uncertain and further tempered by the complications from treatment, which can include impotence and urinary incontinence. However, a December 2011 study from the Archives of Internal Medicine reveals that more than half of men over 75 continue to undergo prostate cancer screenings.

This past week, the American Board of Internal Medicine Foundation along with nine professional physician groups released a list of 45 common tests and procedures that are performed too often. The list includes electrocardiograms for asymptomatic patients, imaging tests for routine back pain, and Pap smears for women younger than 21 years old. Along with the recommendations to cut down on these procedures, an education campaign called Choosing Wisely was launched with the goal to start the important conversation between doctors and patients about the necessity, or lack thereof, of these commonly ordered tests.

But implementing these guidelines into everyday practice may not be easy.

Most doctors don't have the time to go into detailed discussions about all the options on the table. If I try to explain to my elderly male patients why prostate cancer screening doesn't always help, or inform young adults that antibiotics aren't necessary for most sinus infections, it would take much more time than the 15 minutes that I can give for a routine office visit. In many cases, it's quicker to simply order a test or prescribe a drug, which takes seconds, rather than go into the pros and cons of a treatment path.

The medical community needs to come up with strong incentives to encourage doctors to spend more time educating their patients about the harms of over-testing, and soliciting their input when considering various options. When patients play an active role in their medical decisions, studies show they tend to choose less aggressive treatment paths.

There's also the threat of malpractice, which makes it difficult for doctors to rein in tests. A recent survey of 1,214 orthopedic surgeons found that 30% of the tests they ordered didn't help patients, and were mainly aimed at reducing exposure to liability suits. If doctors who restrict unnecessary testing according to the new guidelines can be provided with appropriate legal protection, then it's more likely that they will actually do so.

Finally, whenever the topic of limiting tests is raised in today's partisan environment, the specter of rationing is often brought up. Back in 2009 when a recommendation against routine mammograms for women age 40 to 49 came out, there was a backlash despite the fact that the basis for it was scientifically reasonable. Politicizing medical recommendations that are backed by solid research will only hinder doctors from doing a better job.

Today, discussing whether tests and treatments actually help patients or cause more harm doesn't happen nearly enough. By providing a specific list of procedures to question -- and to cut down -- the medical community hopes to push us in the right direction. More people need to realize that limiting unnecessary tests is not rationing. It's a way to potentially cut the waste out of our health system, and also reminds doctors of a promise they make to each and every patient: a promise to do no harm.

Follow us on Twitter @CNNOpinion

Join us on Facebook/CNNOpinion

The opinions expressed in this commentary are solely those of Kevin Pho.

ADVERTISEMENT
Part of complete coverage on
October 28, 2014 -- Updated 1237 GMT (2037 HKT)
Errol Louis says forced to choose between narrow political advantage and the public good, the governors showed they are willing to take the easy way out over Ebola.
October 27, 2014 -- Updated 1803 GMT (0203 HKT)
Eric Liu says with our family and friends and neighbors, each one of us must decide what kind of civilization we expect in the United States. It's our responsibility to set tone and standards, with our laws and norms
October 27, 2014 -- Updated 1145 GMT (1945 HKT)
Sally Kohn says the UNC report highlights how some colleges exploit student athletes while offering little in return
October 26, 2014 -- Updated 1904 GMT (0304 HKT)
Terrorists don't represent Islam, but Muslims must step up efforts to counter some of the bigotry within the world of Islam, says Fareed Zakaria
October 24, 2014 -- Updated 1302 GMT (2102 HKT)
Scott Yates says extending Daylight Saving Time could save energy, reduce heart attacks and get you more sleep
October 27, 2014 -- Updated 0032 GMT (0832 HKT)
Reza Aslan says the interplay between beliefs and actions is a lot more complicated than critics of Islam portray
October 27, 2014 -- Updated 1119 GMT (1919 HKT)
Julian Zelizer says control of the Senate will be decided by a few close contests
October 24, 2014 -- Updated 1212 GMT (2012 HKT)
The response of some U.S. institutions that should know better to Ebola has been anything but inspiring, writes Idris Ayodeji Bello.
October 22, 2014 -- Updated 2101 GMT (0501 HKT)
Paul Callan says the grand jury is the right process to use to decide if charges should be brought against the police officer
October 23, 2014 -- Updated 1619 GMT (0019 HKT)
Theresa Brown says the Ebola crisis brought nurses into the national conversation on health care. They need to stay there.
October 21, 2014 -- Updated 2235 GMT (0635 HKT)
Patrick Hornbeck says don't buy the hype: The arguments the Vatican used in its interim report would have virtually guaranteed that same-sex couples remained second class citizens
October 24, 2014 -- Updated 1630 GMT (0030 HKT)
The Swedes will find sitting on the fence to be increasingly uncomfortable with Putin as next door neighbor, writes Gary Schmitt
October 24, 2014 -- Updated 1632 GMT (0032 HKT)
The Ottawa shooting pre-empted Malala's appearances in Canada, but her message to young people needs to be spread, writes Frida Ghitis
October 26, 2014 -- Updated 0148 GMT (0948 HKT)
Paul Begala says Iowa's U.S. Senate candidate, Joni Ernst, told NRA she has right to use gun to defend herself--even from the government. But shooting at officials is not what the Founders had in mind
October 23, 2014 -- Updated 2208 GMT (0608 HKT)
John Sutter: Why are we so surprised the head of a major international corporation learned another language?
October 23, 2014 -- Updated 2154 GMT (0554 HKT)
Jason Johnson says Ferguson isn't a downtrodden community rising up against the white oppressor, but it is looking for justice
October 24, 2014 -- Updated 1621 GMT (0021 HKT)
Sally Kohn says a video of little girls dressed as princesses using the F-word very loudly to condemn sexism is provocative. But is it exploitative?
October 21, 2014 -- Updated 2006 GMT (0406 HKT)
Timothy Stanley says Lewinsky is shamelessly playing the victim in her affair with Bill Clinton, humiliating Hillary Clinton again and aiding her critics
October 23, 2014 -- Updated 1414 GMT (2214 HKT)
Imagine being rescued from modern slavery, only to be charged with a crime, writes John Sutter
October 21, 2014 -- Updated 1600 GMT (0000 HKT)
Tidal flooding used to be a relatively rare occurrence along the East Coast. Not anymore, write Melanie Fitzpatrick and Erika Spanger-Siegfried.
October 21, 2014 -- Updated 1135 GMT (1935 HKT)
Carol Costello says activists, writers, politicians have begun discussing their abortions. But will that new approach make a difference on an old battleground?
October 21, 2014 -- Updated 1312 GMT (2112 HKT)
Sigrid Fry-Revere says the National Organ Transplant Act has caused more Americans to die waiting for an organ than died in both World Wars, Korea, Vietnam, Afghanistan and Iraq
ADVERTISEMENT