Spending on health care in 2008 in the United States accounted for an estimated 16 percent of gross domestic product - $2.2 trillion, or $7,681 per person - and is continuing to rise. Researchers say that up to 30 percent of the total is due to overuse of drugs, tests, and treatments.
To begin attacking this complex problem, a group of physicians has proposed a simple solution: Talk before you test.
"What are the benefits? What are the harms . . . and once you get the results, are they going to change the management of this condition in any way?" said Amir Qaseem, lead author of an article last month in the Annals of Internal Medicine that challenges doctors and patients to think differently.
The article identified 37 situations in which a test did not reflect "high-value" care, meaning that evidence has shown that it would not help and might even cause harm. Think of it as changing the oil in your car every week: It wouldn't make the engine run better, yet all those changes make an error more likely.
Qaseem, who is clinical policy director for the American College of Physicians in Philadelphia, said he couldn't tell, without more medical information, whether my own example of the prostate screening was unnecessary. The 37 situations identified in the paper were very specific, based on evidence and chosen by consensus of the 11 authors.
Getting an MRI for nonspecific lower-back pain is one of them. First, the scan is unnecessary, Qaseem said - 85 percent of cases are caused by a strain that heals with exercise and medication. Second, the test result will not change the treatment. Third, abnormalities that cause no problems often show up on back scans, leading to more tests and sometimes surgery, which raises not just the cost, but the likelihood of injury.
