Good medicine also includes knowing what shouldn’t be done

October 19, 2012 

Why is health care in the United States so expensive? The reasons are many – defensive medicine, overuse of the emergency department, patient expecta-tions for the latest tests, among others. Another big driver is overuse and waste.

A recent Institute of Medicine report finds that the health care system wastes $750 billion per year in unnecessary, redundant or ineffective care. That’s shameful, and it needs to change. Governments can’t control health care costs without the help of physicians, and physicians need the help of patients. It’s all of us working together that can make a real difference so we can continue to deliver and receive the highest quality and safest care.

So what can we do? Physicians believe the best health care decisions should be made through meaningful conversations with patients. Evidence-based medicine is more than just using clinically proven procedures. Equally important is using the evidence to decide what not to do. Having a dialogue with patients about their care goals and how we can achieve them is more effective than opting for the latest test or procedure highlighted on a billboard or in a TV commercial.

In talking to your doctor, you may find that an MRI is not needed for your lower back pain, antibiotics won’t help your sinusitis, imaging tests will not help diagnose your condition, and in all of these cases may cause more harm than good.

In my own practice as a pediatric orthopedic surgeon, I noticed that young patients were coming to my office with what I thought were unnecessary MRIs for back pain. While parents want a quick fix for their child’s pain, often waiting is the best course of action.

Last year I worked with local pediatricians to talk about the appropriate use of advanced imaging for back problems. These pediatricians, in turn, talked with their patients about their care choices. Today in my practice I see significantly fewer MRIs ordered for lower back pain in children, without a negative outcry from concerned parents.

At $4,000 to $5,000 for each MRI, that’s a significant savings to the system, but more importantly, it’s better care for these kids. Overuse and unnecessary care is not good medicine.

Through a statewide initiative – Know Your Choices-Ask Your Doctor – the Washington State Medical Association is educating physicians and giving patients the tools they need to make informed choices about their care, whether that’s a CT scan for a headache, understanding their choices other than the emergency room when unexpected care is needed or making informed end-of-life choices.

Through this effort, Washington physicians have teamed up with hospitals, the Puget Sound Health Alliance, county medical societies and numerous medical specialty organizations to promote the national Choosing Wisely campaign. Dozens of national medical specialty societies are each developing lists of five tests/procedures that – based on the evidence – may not be necessary, may be harmful, and should be discussed between patient and physician.

We want to continue to make Washington state the best place to practice medicine and the best place to receive care. While we have little control over many causes for the high costs of health care, physicians can and must shoulder some of the responsibility.

Patients, too, should have some understanding of what their options are so they can make informed choices. By doing so we can all be good stewards of our scarce health care resources.

Dr. Nick Rajacich is a pediatric orthopedic surgeon at Mary Bridge Children’s Health Center in Tacoma. He is the newly elected president of the Washington State Medical Association, which represents more than 9,800 physicians throughout Washington state.

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