Sometimes people tell me how impressed they are with a doctor for ordering a battery of obscure diagnostic tests — as though this is a sign of great skill! In fact, it could be all about business. A recent poll commissioned by the Alpharetta, Georgia-based Jackson Healthcare consulting firm reported that 73% of doctors said they practice defensive medicine — which can include ordering unnecessary tests and sometimes even unnecessary treatments to be sure that all bases were covered in the event of a malpractice lawsuit. Whatever the reason, by the doctors’ own estimate, unnecessary tests and treatments account for more than one-quarter of health-care costs.
Not only is this practice expensive — it also can be dangerous. For instance, according to the US Department of Health & Human Services, about 1% of people who have a coronary angiogram (a catheter containing contrast dye is threaded through the arteries and the arteries are then x-rayed to learn whether there’s any blockage) experience a stroke as a result of the test. That’s a significant risk when you’re talking about something as serious as a stroke — and really, there is no point in having a test like this unless it is actually necessary.
I asked Charles Inlander, a consumer advocate/health-care consultant who authored Take This Book to the Hospital with You: A Consumer Guide to Surviving Your Hospital Stay, whether we consumers can do anything to protect ourselves against defensive medicine… and he assured me that, in fact, we can. He told me that patients should always ask three questions when a doctor orders a medical test:
Why do this test? You want to hear: That there’s a specific question to be answered, either to gain information that will lead to a diagnosis or treatment decision or to rule out a dangerous condition. If your doctor is vague and can’t explain why the information is important, just say “no.”
What will we do if the test shows A versus if it shows B? A good answer would include: Information about what your doctor will recommend when results are in or what the next steps will be if something is found. If there are no specific potential steps that can be discussed, it’s likely the test is better for your doctor’s wallet than for your health.
How do the risks of having this test done compare with the potential benefit? All tests have some level of risk — sometimes significant, depending on your health status. Therefore it’s essential for your doctor to rank the significance of the risk relative to what the test results may show because, in some cases, the risks outweigh the benefits of having a test.
Of course, asking your doctor these sorts of questions may elicit some very defensive answers. If your doctor puts you off: Inlander suggests reminding him/her that you’re gathering information you need in order to decide. If you don’t get satisfactory answers to all three questions above, Inlander advises seeking a second — even, if need be, a third — medical opinion, asking the same questions of the other doctors. He told me that he remembers a case where one woman was given just two weeks to live. Despite the prognosis, her doctor ordered nearly a dozen new tests. When her husband questioned the need for them, the doctor (not surprisingly) was not able to justify them — nothing could change the outcome. If a test doesn’t stand a reasonable chance of helping you in some way, it’s probably safest to say you don’t need it.
