Runaway costs have long plagued the health-care system, and now even doctors acknowledge that not every pricey medical test and procedure is called for, according to a new poll. In a survey of 600 primary care physicians and specialists, nearly three-quarters said that unnecessary care is a serious problem. The average MD, the poll found, prescribes a treatment that's not needed at least once a week—and often more frequently.
"We live in a consumerist culture where people start out with the assumption that more is better," says Richard Baron, president and CEO of the American Board of Internal Medicine Foundation, which commissioned the report. That attitude, however, is starting to shift. "Physicians pretty widely recognize the problem now," says Baron. "I don't think you would have had these findings a few years ago."
What's Behind Too Much Treatment
Doctors don't take all the blame. Nearly half of the physicians polled said patients regularly request tests they don't need, and only four in 10 said they would refuse to order the test. "One of the hardest things for physicians to do is say to a patient who is insisting on a test that you don't need it," says Leonard Feldman, an associate professor of internal medicine and pediatrics at Johns Hopkins University.
Patients often ask for MRIs or CT scans in response to a headache, for example, even though experts generally think they're a waste for that symptom alone. Those scans can run from $340 to $970.
But the top reason for prescribing unnecessary tests, cited by half of doctors, was concern about malpractice. (Interestingly, 5% of providers gave the fact that they are paid per service as a reason.)
How To Say No to the Test
You certainly don't want your doctor to skip tests and miss a serious condition. On the other hand, as deductibles rise on health plans and co-insurance becomes the norm, the more tests your doctor orders, the bigger your bill.
Your best shot at making sure you get the appropriate care and no more, Feldman says, is simply to ask your doctor why a given test or procedure is necessary, what could happen if you skipped it, and whether the results will change the management of your symptoms. If your treatment will be the same regardless, you may not need the test, he says.
Also ask if cheaper options exist. In the poll, only 20% of physicians said they always or almost always talk with their patients about the costs of tests and procedures.
If you are the one pressing for the test, you can’t rely on your doctor to take the time to explain why your idea is a bad one: Nearly 15% of physicians polled said they order unnecessary tests because they don’t have enough time with patients.
You can check out the recommendations for when certain tests should be skipped at choosingwisely.org, where nearly 60 specialty groups, including the American Academy of Family Physicians and the American Academy of Neurology, offer advice. At the least you'll get a better idea of what to ask your doctor before your 15 minutes are up.