An Epidemic of Over Testing, Diagnosing and Treatment
During my years as a nurse, I recall a number of instances where unnecessary tests and treatments were given.
Just this week I was exercising at my local YMCA when a woman got light headed and fainted. The Paramedics were called and transported her to the local Hospital where doctors did blood work. But they did not stop there. They administered an ultrasound of her carotid arteries and a cardiac catheterization, neither of which is typical diagnostic workup for someone who’s simply fainted after a work out. And in the end, neither revealed anything significant.
Only after hours of testing did someone sit down with her and take a proper history. It was revealed that she simply was a little dehydrated and didn’t eat prior to her rigorous workout, which caused her to pass out.
I recently began asking individuals if they or their family members had been subject to what they believed to be unnecessary testing or “over” treatment. Almost everyone had a story to tell. Some were appalling.
Research has documented the rising cost of health care in the last 12 months of life. A large number of the procedures administered in this time period reveal a profound overuse of medical technology. Compassionate and reasonable care would often provide greater benefit for the patient.
Our health-care industry is vast and costly. It is devoted to finding and responding to every pain, twitch or concern. Our ever more sensitive technologies turn up more and more abnormalities—cancers, clogged arteries, damaged-looking knees and backs—that are actually not a problem now and some never will be. And then, of course, our doctors try to fix them, even though the result is often more harm than good.
The forces that have led to a global epidemic of over testing, over diagnosing, and overtreatment are easy to grasp. Doctors get paid for doing more, not less. They are more afraid of doing too little than of doing too much. And patients often feel the same way. They’re likely to be grateful for the extra test done in the name of “being thorough”—and then for the procedure to address what’s found.
In the field of Palliative care, we focus on inner coping and meaning with our patients while dealing with a serious illness. When our Palliative Team becomes involved the quest for more testing and treatments diminishes. What emerges as being more important is tying up fragments of their lives and spending time with those they love. The focus of trying to prevent dying starts shifting to living.