Choosing Wisely: when you should refuse a medical test

A crazy-looking doctorToday I offer you an exclusive preview of a forthcoming late summer blockbuster. Due for premiere later this year, it will be a medical drama billed to be more engaging than Terminator: Genisys and more disturbing than Paranormal Activity: The Ghost Dimension. Directed and produced by an internationally respected team from America, Canada and the UK, the drama will be called ‘Choosing Wisely’ and the star of the show will be… you. ‘Choosing Wisely’ isn’t a movie but it is a health campaign that promises to reveal all about an ongoing medical scandal – and a scandal in which you may unwittingly be a part of.

Choosing Wisely’ tells the tragic tale of how today doctors routinely dole out medicines and order expensive tests unnecessarily. A recent survey has revealed that eight out of ten GPs admit to having given patients treatments they didn’t need. Perhaps it is to appease demanding patients; perhaps it is because it feels better to do something rather than nothing at all. It is an increasingly costly problem – an estimated £2bn a year is wasted every year sending people for unneeded X-rays, MRI scans and blood tests or for medicines that almost certainly won’t help. And that’s before you consider the stress and anxiety brought on by these unnecessary procedures.

This isn’t a new issue though and our expectations can be partly to blame. Go into any GP practice waiting room and most people will tell you what they want from their appointment – a test, an antibiotic, a sick note, or perhaps just an understanding ear. Sometimes we can think that a modern medical test will offer us the answers and the reassurance we need. Rarely is this true. No test is perfect and a false or indeterminate reading can cause weeks of worry and anxiety. An inappropriate investigation can even lead you down a rabbit hole that goes nowhere good. In the USA, for example, the number of people receiving MRI scans for back pain has been going through the roof in recent years – mostly just because the test exists. As a result, rates of back surgery and pain-killer injections are soaring. Faced with a scan result, orthopaedic surgeons want to help but evidence shows that many of the treatments they offer don’t work well – if at all. Many back pain sufferers would ultimately be better off without ever receiving the test.

Trapped in a tumblerWe who are in the UK may not yet have the problems of over-testing that there is in the United States, where almost a third of all healthcare spending is estimated to be wasted on unnecessary procedures. We are catching up and have already learnt a thing or two about how to sue healthcare professionals when they miss a diagnosis. Right or wrong, doctors often say that fear of missing a one-in-a-million diagnosis – and being taken to court for it – causes them to order unnecessary blood tests and x-rays.

The ‘Choosing Wisely’ campaign started in the USA and hopes to put the brakes on out-of-control testing and prescribing. It will see experts being tasked with dumping treatments that don’t really help – just like how tonsil removal for kids was abandoned about thirty years ago. Your doctor will also be tasked with trying to better explain the potential harm any treatment or test may cause.

Importantly, all healthcare professionals will be on a mission to only recommend what is truly necessary.

Your job is to simply decide whether you really need that test or tablet. So just choose wisely.

Thanks for reading – all opinions expressed are my own. Feel free to add your thoughts in the comments below.

Photo Credit: Erik K Veland via Compfight cc and de² via Compfight cc

4 responses to “Choosing Wisely: when you should refuse a medical test”

  1. Great article Stuart, would make a good series if you now started tackling each of the common over tested areas separately. I’ve got three you can start with hearing problems ending in a brain MRI, back problems ending in an MRI and injection and prostrate issues leading to PSA testing.

  2. Just discovered your blog & always appreciate simple logic & common sense. Something the world lacks in a big way today. I think this blog forgets another big driving factor with the over use of tests, scans & prescription drugs, which is the influence from the inventing, producing & manifacturing companys of these products & those that invest in purchasing them for use or sale within their business model. As all only really care about their bottom line expressed as a profit. Im confident in saying, all the above mentioned encourage doctors to refer &/or prescribe patients towards their products to ensure money invested is returned asap, followed with a healthy & continuous profit for many many years to come. Understandably, no business would survive without profit !! Otherwise… future investment, followed by ground breaking discoveries in treatments & proceedures would barely exist, they’d take decades or centuries to be discoved. Only ethics is left to question, a double edged sword of ya like. Yes, unnecessary treatments can have unwanted side effects, public hospitals exhaust vital resourses on so-called hyperchondriacts, then theres, fraudsters, conartists & welfair cheats (probably a small % but) whilst governments, health insurers & individuals bare the finacial bourdon. Meanwhile, the companies supplying these products & services laugh all the way to the bank making money off ones misery. But, not a bad thing & only drives further investment, innovations & discoveries. Around we go again. Wheres the balance ?? In Australia, the government has a somewhat working medicare system in place funded in most, if not all i should say, via the tax system. But is increasingly consuming money that could easily & equally be used elsewhere, and desperately needed elsewhere !! The Australian government tried to implement laws that would require an individual to pay $AU5 to see a GP. Not excessive or unfair really, with 100% of the money raised going back into the health system. With some people being exempt for obvious reason ill assume. But not only funding the health system, it would have deterred some people from consuming resourses that were not required, ie… a person that chucks a sickie for no good reason other than lazyness or a midweek hangover whom requires a doctors certificate, plus whatever treatment the doctor prescribes in responce to the bullshit story or symptoms to patient provides. Yet, government opposition opposed it for political brownie points. But more importantly, medical centres alike, which are all privately owned & operated, opposed it enormously because they knew it would impact on their profit margins, with a flow on effect to investors & producers of medical equipment, testers, drug manufacturers. Nothing but money hungry, power holding wannabes with only self interests in mind. Who cares about the economy. Ethics, Progress, Affordability & Health ?? The answer & solution lays somewhere in amongst those 4 words, somewhere ??

    • Thanks for your comments Lee – sorry for the delay in replying. From my experience, doctors are people who genuinely want to help people and are limited by the tools that they have available. If a doctor feels they are helping someone by ordering a test or prescribing a drug then they will tend to do so. Sometimes, however, the best course of action is to do nothing – and this is a very tough thing for both a patient and a doctor to accept.

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