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When it comes to older Americans, it's doctors — not patients — that may be driving the overuse of tests and treatments

REUTERS/Jim Young
The poll makes clear that patients and doctors are not doing a good job of communicating with each other.

Doctors often say that one of the key reasons they order medical tests or treatments they know are unnecessary or ineffective is because patients insist that they do so. 

Well, those doctors may be misreading their patients, at least when it comes to many older patients. According to a new national poll, one in four Americans aged 50 and older (the age group that uses the most healthcare services) say their doctors frequently order tests or prescribe drugs that the patients don’t think they really need.

One in six of those patients said it happened within the past year. 

“Conventional wisdom suggests that patients drive overuse of low-value health care services because of their health care preferences,” the report says. “Results of this poll suggest this may not be the case.”

The findings also underscore the need for “patients and providers … to work together more to prevent overuse of health care services that provide the least value to patients,” said the study’s lead author, Dr. Jeffrey Kullgren, a research scientist at the University of Michigan’s Institute for Healthcare Policy and Innovation, in a released statement.

Indeed, the poll makes clear that patients and doctors are not doing a good job of communicating with each other. 

Unnecessary medical care is one of the most serious issues facing the U.S. healthcare system. Not only can it cause harm to individual patients, it’s also a major financial burden. As Dr. Atul Gawande reported in a 2015 article for the New Yorker, unnecessary medical care accounts for about a third of healthcare spending in the U.S. — or $750 billion each year.

That’s “more than our nation’s entire budget for K-12 education,” Gawande pointed out.

Some surprising findings

For their report, Kullgren and his colleagues surveyed a nationally representative sample of 2,007 Americans aged 50 to 80. The researchers focused on patients because most past surveys on the topic of unnecessary medical care have tended to seek the opinions only of doctors and other healthcare providers.

The current survey revealed some unexpected responses, said Kullgren.

“We were surprised to find that only 14 percent agreed that more medical care is usually better,” he explained in a video that accompanied the release of the report.

The survey also revealed that many older adults (54 percent of those polled) believe that doctors too often recommend “low-value” health services — ones that, in Kullgren’s words, “aren’t going to improve most patients’ health outcomes and could lead to unnecessary harms and costs.”

A quarter of the surveyed patients — 25 percent — acknowledged that their own doctor made such recommendations. And 17 percent said their doctor had done so within the past year. The most common types of services that the patients thought had been unnecessarily recommended to them were tests (such as an x-ray or a blood test) and medications.

“Yet about half of those patients ended up getting the service anyways, which suggested to us that patients have a lot of trust in their healthcare provider if they’re often willing to go ahead and get a service even if they feel like they don’t really need it,” said Kullgren.

On the other hand

The survey also found that sometimes it was the patient, not the provider, who insisted on receiving a low-value medical service. This situation, however, was not as common. Only about 1 in 10 of the surveyed patients (9 percent) said they had disagreed with a doctor who had told them within the past year that they didn’t need a particular medication, test or procedure.

When this happened, most of the patients (79 percent) received an explanation from their doctor about why the service wasn’t necessary, but only 60 percent said they had completely understood the explanation.

“Patients don’t always expect more health care,” said Kullgren. “What they do expect is a conversation with their provider about what kind of health care is going to help them most to improve their health and that is unlikely to lead to unnecessary harms and costs.”

“There certainly are things on the provider side of the equation or on the patient side of the equation that can lead us down the path of patients getting too many low-value services,” he added. “So it’s important to identify what some of those drivers might be and then develop solutions to those problems.”

Five important questions

The Choosing Wisely campaign, now in its sixth year, recommends that patients ask their doctors five basic questions before undergoing any test or treatment:

1.  Do I really need this test or procedure?

2.  What are the risks and side effects?

3.  Are there simpler, safer options?

4.  What happens if I don’t do anything?

5.  How much does it cost, and will my insurance pay for it?

On the Choosing Wisely campaign’s website, you’ll also find lists of unnecessary tests and treatments. The lists are continually being updated. It’s a great resource. I recommend bookmarking it.

FMI: You can read the report on the new poll on the website for the University of Michigan’s Institute for Healthcare Policy & Innovation.

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Comments (1)

Not an expert, but it seems to me

It's kind of obvious what some of those "drivers" might be:

1) It is not your physician's job to know the price of any particular diagnostic service, except that some things are expensive and others are really expensive;

2) It is not his or her job to know what your particular insurance policy covers. What if he or she guesses wrong and coverage for your test were to be denied?

3) The family practice physician is usually an employee of an HMO or other provider system, with a set of policies, procedures and protocols to follow during the six minute (on average) conversation with the patient.

4) A physician can't get sued for recommending a pertinent test; he or she can be sued for not recommending it, if the patient turns out to have a problem, no matter how rare, that might have been detected by the test.

5) The physician's employer may exert pressure on its physicians to drum up business for, say, it's brand new sleep clinic, or its new diagnostic imaging center.

I'm sure you can find someone with some expertise to explain the actual causes of overtesting.