Skip to main content

Doctors and patients should talk more, test less

By Kevin Pho, Special to CNN
updated 8:32 AM EDT, Wed April 11, 2012
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
updated 6:03 PM EDT, Tue August 19, 2014
It used to be billy clubs, fire hoses and snarling German shepherds. Now it's armored personnel carriers and flash-bang grenades, writes Kara Dansky.
updated 1:27 PM EDT, Wed August 20, 2014
Maria Haberfeld: People who are unfamiliar with police work can reasonably ask, why was an unarmed man shot so many times, and why was deadly force used at all?
updated 5:52 PM EDT, Mon August 18, 2014
Ruben Navarrette notes that this fall, minority students will outnumber white students at America's public schools.
updated 5:21 PM EDT, Tue August 19, 2014
Humans have driven to extinction four marine mammal species in modern times. As you read this, we are on the brink of losing the fifth, write three experts.
updated 7:58 AM EDT, Tue August 19, 2014
It's been ten days since Michael Brown was killed, and his family is still waiting for information from investigators about what happened to their young man, writes Mel Robbins
updated 10:11 AM EDT, Thu August 21, 2014
Sally Kohn says the Ferguson protests reflect broader patterns of racial injustice across the country, from chronic police violence and abuse against black men to the persistent economic and social exclusion of communities of color.
updated 8:42 AM EDT, Mon August 18, 2014
The former U.K. prime minister and current U.N. envoy says there are 500 days left to fulfill the Millennium Goals' promise to children.
updated 9:10 AM EDT, Mon August 18, 2014
Julian Zelizer says the left mistrusts Clinton but there are ways she can win support from liberals in 2016
updated 1:38 PM EDT, Wed August 20, 2014
Peter Bergen says the terror group is a huge threat in Iraq but only a potential one in the U.S.
updated 1:34 PM EDT, Sat August 16, 2014
Mark O'Mara says the way cops, media, politicians and protesters have behaved since Michael Brown's shooting shows not all the right people have learned the right lessons
updated 11:23 AM EDT, Sun August 17, 2014
Retired Lt. Gen. Mark Hertling says the American military advisers in Iraq are sizing up what needs to be done and recommending accordingly
updated 3:41 PM EDT, Fri August 15, 2014
Marc Lamont Hill says the President's comments on the Michael Brown shooting ignored its racial implications
updated 5:46 PM EDT, Fri August 15, 2014
Joe Stork says the catastrophe in northern Iraq continues, even though many religious minorities have fled to safety: ISIS forces -- intent on purging them -- still control the area where they lived
updated 6:26 PM EDT, Thu August 14, 2014
Tim Lynch says Pentagon's policy of doling out military weapons to police forces is misguided and dangerous.
updated 9:15 AM EDT, Fri August 15, 2014
S.E. Cupp says millennials want big ideas and rapid change; she talks to one of their number who serves in Congress
updated 7:57 PM EDT, Thu August 14, 2014
Dorothy Brown says the power structure is dominated by whites in a town that is 68% black. Elected officials who sat by silently as chaos erupted after Michael Brown shooting should be voted out of office
updated 7:49 AM EDT, Thu August 14, 2014
Bill Schmitz says the media and other adults should never explain suicide as a means of escaping pain. Robin Williams' tragic death offers a chance to educate about prevention
updated 11:05 AM EDT, Fri August 15, 2014
Nafees Syed says President Obama should renew the quest to eliminate bias in the criminal justice system
updated 4:24 PM EDT, Thu August 14, 2014
Eric Liu says what's unfolded in the Missouri town is a shocking violation of American constitutional rights and should be a wake-up call to all
updated 3:22 PM EDT, Wed August 13, 2014
Neal Gabler says Lauren Bacall, a talent in her own right, will be defined by her marriage with the great actor Humphrey Bogart
updated 6:56 AM EDT, Fri August 15, 2014
Bob Butler says the arrest of two journalists covering the Ferguson story is alarming
updated 4:35 PM EDT, Wed August 13, 2014
Mark O'Mara says we all need to work together to make sure the tension between police and African-Americans doesn't result in more tragedies
updated 4:06 PM EDT, Mon August 18, 2014
Pepper Schwartz asks why young women are so entranced with Kardashian, who's putting together a 352-page book of selfies
updated 7:08 PM EDT, Wed August 13, 2014
Michael Friedman says depression does not discriminate, cannot be bargained with and shows no mercy.
updated 11:25 AM EDT, Tue August 12, 2014
LZ Granderson says we must not surrender to apathy about the injustice faced by African Americans
ADVERTISEMENT
ADVERTISEMENT
ADVERTISEMENT
ADVERTISEMENT