“We’re used to 'more' being 'better'. More memory in the new cell phone model, more food in a portion size, more shoes at a two-for-one sale, more tests and screenings at the doctor’s office just in case… But more medical tests and more antibiotics aren’t always better and sometimes, they can even cause harm, ” says Dr. Moriah Ellen, who works as a senior lecturer at Machon Lev in Jerusalem (also known as JCT).
“Over the past five years,” Ellen explained “health systems around the world have been addressing the issue of unnecessary tests, treatments and procedures. This is because a significant amount of resources are consumed as a result of the unnecessary use of the health-system.”
Dr. Ellen collaborates with two leading canadian universities, McMaster University and the University of Toronto; she is an Investigator in the former and an Assistant Professor in the latter.
Ellen said that the overuse of medical systems, particularly in countries in which healthcare is subsidized or free, occurs on numerous levels, and this overuse is leading to long term negative effects.
“At the patient level, the overuse of health services can lead to serious harm and lower quality of care for the individual. For example, in the area of prescription medications, there has been substantial overuse of [tranquilizing drugs such as] benzodiazepines documented among older adults, despite large-scale studies demonstrating high risks associated with prolonged use, including higher rates of motor vehicle accidents, and of falls and hip fractures that may lead to hospitalization and death,” Ellen noted.
The problem also occurs at the physician level. Ellen explained that often, as early as residency or even medical school, young doctors are encouraged and taught to use every medical test that they can in order to be thorough and to get exact results regarding a patient’s ailment. Often tests return inconclusive and then more tests are ordered. “Unnecessary tests such as X-rays can be dangerous as well, and a person should not subject themselves to that kind of radiation blindly,” she said.
“There are many causes as to the unnecessary use of health services at all levels. Most times when the health care system faces a challenge, we expect the Kupot (HMO’s) or the providers to address the challenge and lead the change. However, patients can also take a lead role in addressing the issue. In this case, patients can take steps to minimize the unnecessary use of health services thereby improving the quality of care and reducing the risk of harm.”
But patients have the ability to make a change in the system and take more control of their own health.
An international campaign known as “The Choosing Wisely Campaign” addresses the issue of unnecessary care within health systems. The campaign has developed a list of five questions that any patient can ask their doctor before a test, treatment or procedure. “The point of asking these questions is to start having open-dialogues with our health care providers to determine if the test, treatment, or procedure is really necessary,” said Ellen.
These questions listed on the Choosing Wisely website are as follows:
1: “Do I really need this test or procedure? Medical tests help you and your doctor or other health care provider decide how to treat a problem. And medical procedures help to actually treat it.
2: What are the risks? Will there be side effects? What are the chances of getting results that aren’t accurate? Could that lead to more testing or another procedure?
3: Are there simpler, safer options? Sometimes all you need to do is make lifestyle changes, such as eating healthier foods or exercising more.
4: What happens if I don’t do anything? Ask if your condition might get worse — or better — if you don’t have the test or procedure right away.
5: How much does it cost? Ask if there are less-expensive tests, treatments or procedures, what your insurance may cover, and about generic drugs instead of brand-name drugs”
“Addressing the overuse of health services that provide no added benefit, may cause harm, or are low-value, can result in improvements in patient safety, appropriateness and quality of care, as well as and reduced waste in the health system,” Ellen emphasized.
“We need to think more in line with ‘less is more’.”