Ask the Question and Choose Wisely
December 06, 2016

Ask the Question and Choose Wisely

In early September, I picked up my sixteen-year-old daughter from rehearsals for Mary Poppins. She greeted me with, “Mom, I can’t straighten out my arm.” It seems there was a tap-dancing incident and she fell, catching herself with her left arm. By the time she got in the car she couldn’t straighten it. All evidence of her elbow was camouflaged by swollen, doughy flesh.

At the neighborhood urgent care center we learned she had a “fracture of the radial head.” She emerged with a splint and a referral to an orthopedic surgeon.

Two days later, the ortho wasn’t impressed with the x-ray. He offered to get another film to definitively diagnose it, but emphasized that it wouldn’t change her treatment. She wouldn’t need a cast…just a sling for comfort. So we opted out of the x-ray.

Just last week my youngest injured her big toe, which turned blue and swollen in a matter of minutes. In the urgent care, we were offered two options: buddy tape the big toe to its neighbor and go about our business, or get an x-ray to confirm the broken toe.

When I asked what the x-ray would change, the answer was nothing. Again, we opted out. The doctor was astonished. She told us that in ten years she had never had a parent who opted out of the x-ray.

To be sure, you aren’t taken as seriously if you can’t say a bone is definitely broken. Some of my older daughter’s tap-dancing friends doubted her story. But who needs to pay for extra tests that won’t change anything? And what if those tests lead to more tests and expense?

The American Board of Internal Medicine addresses these possibilities – potential harm and unnecessary cost - in their Choosing Wisely initiative. It aims to help patients choose care that is evidence-based, free from harm, and truly necessary.

It’s also designed to prevent repetitive testing. That’s a bigger problem than you might think. In fact, up to 30 percent of healthcare is either unnecessary or “duplicative,” meaning the test has already been done. The results are just inaccessible for some reason.

This initiative has resulted in the creation of multiple lists of “Things Providers and Patients Should Question.” They are the result of the collaboration of Consumer Reports and over 70 specialty medical associations such as the American Academy of Pediatrics and the American Urological Association.

These lists offer information to help patients ask educated questions designed to rule out unnecessary testing. In the list, “Imaging Tests for Low Back Pain,” for example, symptoms that represent a dangerous situation and warrant imaging without delay are listed. But you are also counseled that most low back pain resolves on its own. So if you don’t have those dangerous symptoms, it is advisable to give it a month or so before opening the Pandora’s box of back imaging.

I would venture a guess that almost no one questions blood tests when they are hospitalized. But the list “Blood Tests When You are in the Hospital,” suggests there are times you should question them.

At 17 to 18 percent of GDP, healthcare costs are one of the most pressing economic threats to our economy as a whole. Unnecessary costs and the risks associated with unnecessary care pose a serious threat to individuals as well.

The good news is that we don’t have to wait for politicians to loosen the stranglehold of healthcare costs. We can chip away at it as individuals by weighing the need for each treatment as it is proposed. Choosing Wisely offers a good starting point. From there it’s as simple as asking the questions.

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