Stuff You Don’t Need

With $210 billion spent on unnecessary care, it should be easier to cut down than it is.  But unnecessary care is not like a bad Christmas gift – it isn’t obvious.  Besides, your own care is never unnecessary – it’s all those other thousands of people, right?

This brings us to the age old problem of seeing yourself as a person, but everyone else as numbers.

Take the case of heart burn.

Nearly 40 percent of American adults have symptoms of heart burn, technically called “gastro-esophageal reflux disease” or GERD.  Most take over-the-counter or prescription drugs for it.

Lots of patients – too many, according to the American College of Physicians — were getting cameras put down their throats to look for cancer.  An upper endoscopy also investigates symptoms, and can be used to choose treatment.  All that sounds good, except that patients under age 50 have a slim chance of having cancer.  The test won’t help them, but will put them in (small) danger of bleeding, infection, or tears in the throat.

Yet who can turn down the test without second thoughts?  Yes, it’s a small chance that cancer is there breeding but you have only one throat.  You don’t think of yourself as having a 0.01 percent chance (less, if you are female) of having throat cancer; you think of yourself as having it or not.

We can be rational and logical about thousands of people, but not about one person at a time and definitely not about ourselves.  Those studying the problem or paying for medical care are looking from the vantage point of thousands.

Experts estimate that one dollar out of every five spent by Medicare goes for unnecessary care or tests.  The $210 billion translates to one dollar out of every eleven, for all of us together.  Can we actually start to chip away at some of this?

Maybe.  Programs like Choosing Wisely, which advises doctors and patients about selecting tests, can help.  Perhaps having people pay part of the fee will also help, though health reform is going to lower co-pays in many plans.  Tamping down the enthusiasm for screening tests will make a difference, but a cultural shift will take time.

In the meantime, listen carefully when your doctor suggests a test – it may be the medical equivalent of nose hair clippers from Aunt Suzie.

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