Medicine and healthcare are complex. Often, patients discuss their condition with family and friends, or search the Internet regarding their symptoms, and somehow always come up with the worst-case scenario.
Part of the problem is that we are trained to “just be careful.” Thus, we often order tests that are of low value, with very little potential impact on patient QOL or outcomes.
The health literacy of our nation is very low. Patients may not understand that just because we can do a test doesn’t mean we should.
I fully support my patients empowering themselves. However, without context, this can be detrimental.
Often, patients equate “more” with “better,” but increasing evidence demonstrates just the opposite. While additional tests following resolution of a skin rash may not be necessary, a patient may think these steps are part of good care.
Layered on top of this is the fact that current healthcare spending in this nation is literally breaking the bank. We spend more than $4 trillion per year on health; however, we have little to show for it, with some of the worst—if not THE worst—health outcomes in the world.
All Physicians Play a Part
Part of the situation is driven by defensive medicine, when physicians order unnecessary tests or procedures just to avoid malpractice claims, keep patients happy, and/or because of a lack of time and energy. The impact of this is immeasurable.
So, what can physicians do? The Choosing Wisely campaign demonstrated that when physicians talk with a patient about the risks and benefits of a potential procedure or test, the patient will often avoid it. Evidence-based and appropriate medical care that helps patients understand what is or is not indicated can likely avoid potential risks.
We also need to advocate for fair compensation. Unfortunately, in our current system, taking 5 minutes to perform a cursory physical exam and order some meds and tests will result in greater compensation than taking 10 or 15 minutes to explain why these tests may be inappropriate—and we all know time is a physician’s most precious commodity.
There is no easy solution; it is going to take every physician doing their part to educate patients, themselves, and each other regarding what is medically appropriate.
