Daily Editors' Notes

Testing our patience, er, patients with too many medical procedures

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Elizabeth Newman, McKnight's Senior Editor
Elizabeth Newman, McKnight's Senior Editor
A few years ago, I got sick and didn't get better, and eventually landed in the ER for being dehydrated.

That begat weeks of X-rays, an endoscopy and countless tests, including one that revealed that my liver wasn't working quite right. Hepatitis A was mentioned as a possibility, which was weird considering that I didn't remember traveling far from Maryland, using illicit drugs or becoming a hemophiliac. When I finally found an infectious disease doctor, he ran one last blood test that revealed acute Epstein-Barr virus — in other words, I had the poor woman's version of mono and needed a lot of fluids and rest. Within a month, I was back to feeling like myself.

Of course, I'm lucky in that I know plenty of people who have had experiences where physicians ignored them. And I was relieved what I had was not that serious in the grand scheme of things, and that I had health insurance. But even the infectious disease doctor himself suggested that many of the tests and procedures I was prescribed reflected colleagues looking for zebras, rather than horses.

That's one of the reasons I've been fascinated by recent articles in the New York Times that explore overtreatment.

“An epidemic of over treatment — too many scans, too many blood tests, too many procedures — is costing the nation's healthcare system at least $210 billion a year,” Tara Parker-Pope writes.

It's no surprise that those who work in long-term care have struggled with this issue, either as their own parents age or in their experience in treating residents. One of the people the Times interviewed became frustrated when his 79-year-old father was given a diagnosis of depression following a stroke. A cocktail of medications left his father confused and agitated, until the son convinced doctors to change the medication. His father has recovered.

“All the medical professionals seeing him along the way, the hospital, two nursing homes and nobody thought of this,” said Mr. Donohue, who said his father never should have been given a diagnosis of depression in the first place, the Times reported.

There's no easy answer to how much treatment is needed for sick, elderly nursing home residents. We've spent a lot of time going around in circles about end-of-life care, and what that means for those who are terminally ill compared to those who are old and don't want lifesaving measures.

But even beyond that, certainly the recent antipsychotics debate has given many of us pause to consider what medications or tests are being prescribed, and why. Change can sometime begin by thinking about these issues, or reading books such as Shannon Brownlee's Overtreated: Why Too Much Medicine Is Making Us Sicker and Poorer.

 

As patients, nurses, operators or caregivers, we owe it to ourselves to not only ask “why,” but also to ask: Is this procedure, medication or test really necessary?

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Daily Editors' Notes

McKnight's Daily Editor's Notes features commentary on the latest in long-term care news. Entries are written by Editorial Director John O'Connor on Monday and Friday; Staff Writer Tim Mullaney on Tuesday, Editor James M. Berklan on Wednesday and Senior Editor Elizabeth Newman on Thursday.

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