Making wise healthcare choices is not as simple as it sounds. We are hearing more and more about our rising costs, the squandering of our healthcare dollars and the potential harms of tests and treatments. Once upon a time, we could turn a blind eye toward these issues but things have gotten out of hand. Healthcare in America is truly in crisis. And even though the issues are system-wide, some of the solutions are within our own control.
Whoa, hold on a second! My doctor chooses my medical tests and treatments, not me! This stuff isn't under my control! To address this, we have to look at the nitty-gritty of what goes into your doctor's recommendations. In addition to education and experience, there are several other factors that come into play.
The first of these factors is medico-legal, so-called defensive medicine. If your provider doesn't order that extra test or treatment, a charge of negligence could follow suit. I know that you've never threatened to sue, never even hinted at it. But for many reasons too complex for this post, it's the most common reason for overuse of medical care. Well, isn't it ok if insurance pays for it? No, because after all is said and done, we ALL pay for it. If you think your doctor may be over-ordering for this reason, have a frank discussion about it. If you're not satisfied with the result, find another doctor.
A second factor involves the way treatments and tests are marketed to providers and consumers. Aren't expensive tests and treatments better that cheaper ones? Once in a while they are, but more often than not the answer is no. For example, most of the drugs you see advertised are nearly identical to previous versions. The manufacturer has made a tiny change so that it can be patented as a new drug and given a new exorbitant price. (See Marcia Angell's The Truth About the Drug Companies: How They Deceive Us and What to Do About It.) There are countless other examples. The myth that more expensive is better is alive and well in American medicine. Let your doctor know that you are concerned about how much things cost, whether you or your insurance is paying for it.
A third factor that informs your doctor's recommendations is what was learned in training. Jerome Groopman's book, How Doctors Think, enlightens us about common (but accepted) medical fallacies. Say you have low back pain. Most surgeons will opt for spinal fusion, which is what they were trained to do. But disc surgery is more effective and costs far less, $5,000 compared to $20,000. Finding a surgeon to perform disc surgery rather than spinal fusion is nearly impossible, even in the Bay Area. A hassle? yes. Worth the effort? Most definitely. If you need a second opinion, get one from someone in a different specialty, like pain management. This is where it really pays to do your homework on the internet. Be smart, think critically, and ask questions!
I'm a patient advocate and I'm here to help.
(Dale Alexander holds a Certificate in Patient Advocacy from UCLA, a Master's in Medical Humanities from the University of Texas and has thirty years of experience in clinical healthcare, education and management. She may be reached at dale5657@gmail.com or 707.319.5856.)
