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Going to the Doctor Like Visiting the Auto Mechanic?

Another doctor's appointment...

Sitting on the examination table, you twiddle your thumbs and wonder if those succulent hospital lollipops might be hidden away in a cupboard. Maybe I'll take a quick glance... Dismissing the thought as childish, you instead check your watch. Boy, the "doc" sure is taking his time. You look up and analyze the white walls, the white cabinet, and the whitish painting undoubtedly chosen for its calming effect. Your eyes wander to the brochure stand. I wonder if there's anything good in those pamphlets? You plant you hands on the table, ready to shove yourself onto your feet when the doctor re-enters. He cuts to the chase and tells you the news. You're going to require an x-ray for your lower back, a CT angiography, and some blood work. Just as a precaution. Gee, I just went in for mild chest pain, I don't know if I want all of that. Uggghhhh. What should I do?

Sharon Begley, science editor for Newsweek, might argue that you should simply tell the doctor, "No."  In her recent article, "One Word Can Save Your Life: No!" Begley calls our attention to the surfeit of unnecessary tests and procedures being performed in hospitals, which are not only bloating our nation's healthcare costs - now $2.7 trillion per year - but may also be doing more harm than good. To call her piece "eye-opening" is an understatement.

As Begley points out, there are a lot of reasons to just say "no" to a wide variety of tests and treatments:

At least five large, randomized controlled studies have analyzed

treatments for stable heart patients who have nothing worse than mild

chest pain. Every study found that the surgical

procedures didn't improve survival rates or quality of life more than

noninvasive treatments including drugs, exercise, and a healthy

diet.

Many of the 500,000 elective angioplasties (at least $50,000 each)

performed every year are done on patients who could benefit more from

drugs, exercise, and healthy eating.

Expert groups advise against colonoscopies for anyone over age 75 or who has had a negative exam in the last ten years. Yet a study of Medicare patients found that 46 percent had a screening colonoscopy fewer than seven years

after a negative one. Making matters worse, many of them were over 80.

Arthroscopic knee surgery for osteoarthritis is performed about 650,000

times a year; studies show that it, too, is no more effective than

placebo treatment, yet taxpayers and private insurers pay for it.

After reading these staggering facts (and the above list is only a sampling), I couldn't help but get the impression that visiting

the doctor is really a lot like going to the auto mechanic. I had never thought of a trip to hospital in this manner before, but the comparison makes a lot of sense.

Think back to the very first situation. With a little adjustment, that same scenario transpires in countless numbers of car shops each and every year. You bring in your car because the breaks are squeaking, and suddenly that squeak calls for thousands of dollars worth of tests and repairs. Now, the beginning of the doctor and mechanic scenarios are very similar, but there's a huge difference in what happens next.

At the mechanic, I would wager that the vast majority of Americans would turn down a bulk of those tests and repairs (probably with a hint of incredulity). Instead, most of us would probably go to a different mechanic for a second opinion, call in to National Public Radio's Car Talk, or simply do nothing at all. However, at the doctor's office, I would place an equally large wager that almost all of us would accede to the suggested tests with little hesitation. Why take the chance? After all, if you're on Medicare or have health insurance with a low deductible, you won't be paying for most of the costs Right?

In her article, Sharon Begley answers that question unequivocally.

Experts estimate that the U.S. spends hundreds of billions of dollars

every year on medical procedures that provide no benefit or a

substantial risk of harm, suggesting that Medicare could save both money

and lives if it stopped paying for some common treatments. "There's a

reason we spend almost twice as much per capita on health care [as other

developed countries] with no gain in health or longevity," argues Dr.

Steven Nissen, the noted cardiologist at the Cleveland Clinic. "We spend

money like a drunken sailor on shore leave."


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