3 Doctor's Orders You Should Question
Your doc says you need a full workup-scans, blood tests, the whole shebang. But before you agree, know this: Doctors make more money by ordering extra procedures for patients-not by by seeing more patients, says research from the University of California Los Angeles (UCLA). (Do you know How Often Do You Really Need to See the Doc?)
We expect our M.D.s to protect us in every way possible, including financially, right? Unfortunately, that's not always the case: Some very expensive, non-evidence-based interventions and treatments are often ordered, confirms David Fleming, M.D., chair of medicine at the University of Missouri and president of the American College Of Physicians. Other docs agree: Nearly three-quarters of physicians admit the frequency of unnecessary tests and procedures in the health care system is a very serious problem, according to a 2014 survey from the American Board of Internal Medicine Foundation's Choosing Wisely Campaign-a program that seeks to identify overuse or misuse of tests or procedures.
The good news is that most of our docs aren't out to bankrupt us-they order more tests to cover their butts in case of malpractice suits, the same survey found.
So how do you cover yours? "Ask questions," says Fleming. "Patients tend to be more passive in the questions they ask their physician because they don't want to upset them, and they trust that physicians are going to do the right thing." Back when it comes to your health, you have to put yourself first. So push back on anything that seems unnecessary or that hasn't been explained to you in full, but especially these three points, which Fleming says are the most common excessively ordered tests.
"Historically, doctors have overused imaging a lot," Fleming says. X-rays for back pain, MRIs for sore knees, CT scans for any type of headache-but the evidence that scans are going to protect you from a bad outcome is pretty scarce, he says. And most of the scans will cost you a pretty penny.
What to say: "Is this imagining really necessary? I'm concerned about costs." After asking for the deets, connect with him on a human level, and point out that you're worried about lasting medical bills. Doctors who know the costs of the medical tests and procedures typically opt to do fewer of them than those who don't realize it can break your bank, a 2013 Johns Hopkins University School of Medicine study found.
"To come to a doctor because you're sick and leave without a prescription in your hand without having a full understand of what's going on can be very frustrating," Fleming notes. In fact, this pressure causes a lot of physicians to write unnecessary scripts, which actually works against us. "We give out a lot of antibiotics, and as a result there are a lot more resistant organisms that we're now having to treat," Fleming explains. That means new antibiotics are in constant demand, and it's harder because bugs are getting more and more resistant.
The other reason docs overprescribe? Just in case: "Patients come in with what may or may not be a bacterial infection. There's a chance they are quite ill, and we don't want to delay treatment, even if we don't have strong evidence that it's actually a bacterial infection," Fleming explains.
What to say: "What evidence do you see that I do or don't have an infection that requires an antibiotic?" Questioning him will prompt him to stop and think if he's considered all other options, and give you piece of mind that your symptoms have been seriously considered.
Most physicians will order blood work with your annual exam, but you often don't need the full chemistry panel, which includes almost two dozen tests, Fleming says. (Note: In some cases, it's actually cheaper for the lab to run a full workup than a few individual blood tests.)
What to say: "Is a full workup in my best interest, or is there a way to do an individual test?" Confirming if you really need all of the tests or not is important-there can be a disadvantage in unnecessary results: "Often we find mild abnormalities on blood work, which leads to more tests and procedures that may not be necessarily in the patient's best interest," he explains. (Find out The Diseases Doctors Miss Most.) And if a full chemistry panel isn't cheaper for you, definitely push back-individual tests that don't come at a package cost mean you're paying for each excessive analysis.