The Key Question to Ask Your Doctor to Avoid Unnecessary Medical Care
There's an epidemic of overtreatment in the United States - and it's costing us. Patients can be protected if they are properly prepared.
My friends often contact me when they need help choosing a good doctor. In Jeff’s case, he reached out because he thought he needed spine surgery to help with severe neck pain.
There’s little public data about the quality of surgeons, but I helped Jeff by backgrounding the spine surgeons in his community. I also gave him a warning: Spine surgery may not be the answer for his pain. Studies show that many of the operations are unnecessary and they come with risk of serious complications.
I explained to Jeff that overtreatment is a huge problem in health care. Clinicians and hospitals get paid for performing operations or providing tests and treatment. The industry makes its money by doing stuff—whether you need it, or not.
With those warnings in mind, Jeff consulted two surgeons about his problem. The first told him he risked paralysis if he did not immediately schedule an operation. The second wasn’t as ominous, but also recommended surgery.
Jeff took a step back and decided that he would first opt for something less severe. He changed his diet and the intensity of his workouts, and went to physical therapy, where he learned stretches and exercises. The lifestyle changes worked – his pain went away! Now he shakes his head thinking about the harm he would have suffered if he had followed the advice of the surgeons he consulted.
The American epidemic of unnecessary medical treatment is one reason our health care costs keep going up. Experts estimate it’s wasting hundreds of billions of dollars a year. That’s not some number that’s detached from you and me. We pay higher premiums and deductibles because of all this care the system is providing that people don’t need. I talk in my book, Never Pay the First Bill, and in my health literacy videos, The Never Pay Pathway, about pushing back against unjustified health care costs. Sometimes it’s as simple as avoiding treatment we shouldn’t get in the first place.
Examples of overtreatment are all around us. A Lown Institute study tallied more than 100,000 unnecessary procedures performed in hospitals during the first year of COVID-19. They included stents for stable coronary disease, spinal fusion for back pain, hysterectomy for benign disease, and more. The Washington Health Alliance analyzed the care provided to Medicaid and commercially-insured patients and found an average of 846,973 individuals experienced low-value care in each year of the four years it studied. Of the 9.5 million services it examined, an estimated 51% were found to be low-value, costing more than $700 million.
Many studies highlight factors that contribute to the problem. Doctors who take money from pharmaceutical companies are more likely to prescribe the pricey brand-name drugs manufactured by those same companies. Research has also shown that doctors who purchase magnetic resonance imaging (MRI) machines ordered substantially more MRIs for their patients.
This may sound overwhelming, but each patient can take action to be protected from unnecessary medical care. If you’re undergoing emergency treatment or something urgent there may not be time to check to make sure everything they’re doing is necessary. But emergency room spending accounts for a small portion of overall health care spending. Thus, any strategy to protect your health care dollars needs to address how your money gets thrown away on things you don’t need. Every medical procedure or drug comes with physical risks. And it all comes at a cost — overtreatment wastes money and contributes to higher medical costs for ourselves and others.
Avoiding unnecessary treatment requires being prepared when you talk to your clinician. You need to ask the right questions. If your doctor or other clinician is recommending a test or drug or procedure that’s discretionary – you may need it, or you may not – step back and discuss your options. The Choosing Wisely campaign recommends five key questions you can ask. But if you can only remember one, I would go with this: “What happens if I don’t do anything right now?”
Asking what happens if you wait can help avoid the host of financial and physical problems that can come with unnecessary treatment. The question crystalizes the conversation. It requires a clinician to lay out the risk of not taking action so you can compare it with the risk of taking action.
Often there’s no serious risk in waiting. In those cases, you can take the time to research the best care for your ailment. You can get a second opinion and learn about your options from Google Scholar or MedlinePlus.gov, which contains a wealth of medical information published by the U.S. National Library of Medicine. You can check the recommendations of the U.S. Preventive Services Task Force, which produces independent, evidence-based guidelines.
On the flip side, if the clinician can make a clear case for why you need the proposed treatment now – like maybe you’ll infect someone else, or there’s a strong chance your condition will worsen to the point that it will become an emergency – then you can proceed, knowing you’ve considered the option of waiting.
Asking, “What happens if I wait?” won’t prevent you from getting the treatment you need. But it could protect you from getting medical treatment you don’t need. Give it a try and see if it reframes the conversations in a constructive way.
I checked in with Jeff a few days ago. It’s been a few years, so I wanted to see how his neck has been doing. “Neck is still good,” he texted to me. “Did a Tae kwon do seminar for three hrs yesterday without issue.”
How much is overtreatment costing you and your health plan?
I recently launched The Never Pay Pathway health literacy videos to help working Americans become savvy health care consumers. There’s no magic money tree that’s funding our health care - and we all need to get engaged to protect our money.
I feature a video on avoiding overtreatment in The Never Pay Pathway. Imagine how much money Jeff and his employer sponsored health plan saved when he dodged that unnecessary spine surgery. Not to mention the physical harm he avoided. In many cases, employees can save hundreds or thousands of dollars per health care interaction with the right information. In Jeff’s case the savings was in the tens of thousands.
Sound intriguing? Sign up for the curriculum and learn more at www.allenhealthacademy.com. Scholarships are available, so don’t let money get in the way of getting yourself equipped. If you’re a broker or advisor or employer and are interested in empowering the employees on your health plans, please reach out. Contact us at neverpay@marshallallen.com.
Mark Cuban shares a Victory Story
Mark Cuban spoke recently with Trevor Noah on The Daily Show about his new Cost Plus Drugs venture. Check out the clip starting at the five-minute mark. In one case, Cuban said his company was able to procure for $63 a three-month supply of a drug that had been costing the patient $3,000 a month. I believe it.
Cuban, the famous billionaire owner of the Dallas Mavericks and star of “Shark Tank,” is out to disrupt the pharmaceutical industry. “Five years from now we can look back and say, ‘You f***** ‘em up.’ That’ll be like a dream. That’s my goal!”
Folks, there are a lot of smart people, Cuban included, who are looking at the money-sucking machine of American medicine and seeing an opportunity. It’s possible to provide better health care at a lower price.
Side note: Has anyone out there used Cuban’s Cost Plus Drugs? I’d love to hear about your experience. How did it go?
Commonwealth Fund finds 43% are inadequately insured
Good news: The number of Americans without health insurance is much lower.
Bad news: Almost half the people with health insurance are underinsured, which can be as bad or worse as having no insurance at all.
The Commonwealth Fund surveyed more than 8,000 adults under age 65 and found that 43% of working Americans were inadequately insured. And 29% with employer coverage and 44% with individual plans were underinsured.
Half of respondents said they would be unable to pay an unexpected $1,000 medical bill within 30 days.
Now the really bad news: Just wait until everyone gets hit with next year’s premium increase. I talked to some brokers last week who said their clients were getting slapped with increases of 35%!
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Remember Quizzify's mantra: just because it's healthcare doesn't mean it's good for you.