Patients must learn more, question doctors to prevent unneeded treatment

October 28, 2013

In all of the discussions about the Affordable Care Act and how to rein in the escalating cost of medical care in this country, no one seems to mention the need for patients to become more informed and to take more responsibility for their own health.

stethoscope

Greed, ego, lack of time or even discouragement with human nature can drive physicians to prescribe a pill or recommend surgery when a discussion about losing weight or quitting smoking might make more sense. But doctors have told me they’re not reimbursed for the time it takes to educate patients, and too often, patients want an easy fix.

Add to that the influence of pharmacy sales reps and the fear of malpractice, resulting in prescriptions for drugs that might be questionable and extra tests ordered simply to cover the doctor in case of legal trouble down the road.

Medicine’s not an exact science, either. What works for one patient may not work for another. A former dean of the medical school at the University of Missouri in Columbia where I once worked liked to say, “It’s called the practice of medicine for a reason.”

Back pain is one of those “iffy” areas that can be treated with surgery or with less-invasive methods. The Washington Post analysis of spinal fusions raises questions about how many of the 465,000 procedures done in the United States in 2011 should have been performed.

But there’s an entire Pandora’s box of procedures and pills that may not only be unnecessary but dangerous. A June 13 USA Today article questioned six common procedures. Consumer Reports looked at a dozen procedures in 2005 “you may be better off without.” Hysterectomies, the second-most common surgery in the U.S., and the overuse of some prescription drugs, especially antibiotics, have come under fire for raising medical costs without improving patient health.

In the 1990s, I did ghostwriting for the late Dr. John Renner, then a nationally known expert on patient education and health fraud and quackery. We worked together on a book, “How to Stay Well Without Going Broke.”

My favorite chapter began with the tale of two women who came down with colds. One self-medicated with over-the-counter remedies and chicken soup, along with plenty of rest and fluids. The other saw her doctor and insisted on antibiotics, even though such medicines don’t treat any of the viruses responsible for colds and flu.

Even today, antibiotics are still over-prescribed. A study published Oct. 3 in JAMA Internal Medicine discovered that antibiotics were prescribed for 60 percent of adults with sore throats, yet only 10 percent of them were caused by a strep infection that would actually respond to antibiotic treatment. The rest were viral; time’s the only cure.

You can translate those prescriptions into dollars: $1.1 billion spent on medicines that won’t work. Even worse, though, the continued use of unnecessary antibiotics leads to the development of drug-resistant bacteria.

The elderly are the largest consumers of prescription drugs. People ages 65 to 69 take an average of nearly 14 prescription medications a year, while those ages 80 to 84 take 18, according to the American Society of Consultant Pharmacists. Yet adverse reactions to drugs are one of the top five causes of death for seniors and are responsible for 28 percent of their hospitalizations. The cost of medication-related problems, as estimated by the ASCP? More than $100 billion a year for people 65 and older.

Granted, many chronic health problems, like high blood pressure and type 2 diabetes, become more common with age, but are all these prescriptions truly needed?

Ask your physician what you can do to help your condition. Type 2 diabetes, for example, can sometimes be managed with a combination of exercise (just walking 30 minutes a day), diet and maintaining a normal weight. So can high blood pressure.

Get a second opinion, even if you have to pay for it out of pocket. It could save you money down the road. Don’t be afraid to ask your doctor questions. What happens if you don’t have that surgery or take that pill? Are there other options?

Do research online, but check Web sites carefully. Trust those associated with the National Institutes of Health, the Centers for Disease Control, peer-reviewed medical journals and respected research institutions.

Diana Reese is a journalist in Overland Park, Kan. Follow her on Twitter at @dianareese.
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