April 25, 2018
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The growing patient power to know what tests or treatments they don’t need

Erik Steele
By Dr. Erik Steele

It turns out many American women have been taking half their clothes off, climbing up on exam tables and getting Pap smears they don’t need. That should happen less and less often as they and millions of other patients are progressively more able to compare the tests and treatments their health care providers recommend with other expert second opinions.

That’s a good thing, because a patient who challenges a physician about alternatives to recommended tests or treatments can feel awfully alone. Such patients may have few other credible sources of information, or may have to ask the provider of the first opinion for a recommendation to someone else for a second opinion — potentially a tad awkward.

That’s all changing. First, powerful and credible allies are now standing up with the patient who wants to ask such questions. Some leading physician organizations are finally stepping up on this issue, going public with recommendations that essentially say, “You should think about not getting certain tests and treatments even if your own physician tells you to.” Those of us who have always welcomed such questions from patients appreciate the support.

Second, patients who want to know how some tests or treatments recommended to them by their physicians stack up against the opinions of national expert physician groups can find that out with a few clicks on the Internet.

Both of these big changes are embodied in the new Choosing Wisely Initiative, online at http://choosingwisely.org. On its website are 45 tests and treatments that nine professional physician organizations have said are unnecessary for many patients. Heart specialists, for example, have listed five heart tests that are often ordered unnecessarily, including regular stress tests before surgery or as part of annual physicals for patients without heart problems.

The American Society of Clinical Oncology, representing cancer specialists, has suggested when to stop treating some solid tumor cancer patients, and to focus instead on palliative care, among its five recommendations.

Before any of us gets an elective test or procedure, we ought to be checking out the Choosing Wisely website and seeing whether the test or procedure recommended for us is on these lists. Another good online resource is one comparing treatment options for different problems at ahrq.gov/consumer/compare.html, and recommendations for preventive health tests at uspreventiveservicestaskforce.org/uspstopics.htm.

Physicians represented in the Choosing Wisely campaign are now being joined by powerful nonphysician organizations, including Consumer Reports and the American Association of Retired Persons, in efforts to inform patients about unnecessary medical care. These organizations are less and less deferential to a health care industry (including physicians) that has heretofore failed to do much to rein in wasteful overtreatment and testing. In June of 2011 the AARP published an article in its magazine entitled “Four Surgeries to Avoid,” ( aarp.org/health/conditions-treatments/info-05-2011/4-surgeries-to-avoid.html), identifying cardiac stents for stable angina, spinal fusions, hysterectomies and knee scoping for osteoarthritis as often unnecessary.

Mass media is doing some of its part, too. In August of 2011, Newsweek magazine published the article: “No! The One Word That Can Save Your Life.” In addition to those procedures mentioned in the AARP article, the Newsweek piece also pointed out that most women under age 21 and over 65 don’t need Pap smears. My recommendation: no American woman should be getting an annual pap smear anymore without asking their primary care provider whether published national preventive health guidelines say they need one. (See these recommendations at uspreventiveservicestaskforce.org/uspstf/uspscerv.htm)

American patients who want to question whether a test or treatment is necessary and right for them now have more help than ever, through powerful allies and good information. That’s a big step, but it’s not enough; what the patient needs is a partnering health care professional with whom to have a good conversation about “What’s right for me,” and then to ask the question.

Sometimes the best test or treatment is no test or treatment. With a little work, it’s never been easier for patients and their healthcare providers to know when that’s the case.

Erik Steele, a physician in Bangor, is chief medical officer of Eastern Maine Healthcare Systems.

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