It’s natural to assume that more health care is better than less—that checkups, tests and treatments make people healthier. But that isn’t always the case.
Obviously, people who are sick need to see doctors and get the necessary tests. Those who are healthy may benefit from preventive medicine. But many of the assumed benefits of medicine don’t always pan out.
Here are four common but false assumptions about medical care…
False: It never hurts to get more information.
It would seem that getting as much medical information as possible would be a good thing. Not necessarily.
Example: A colleague’s father was 85 years old and in good health when his doctor noticed an abdominal bulge during a checkup. He ordered an ultrasound, which showed that the bulge wasn’t a problem—but the test did reveal a possible problem with the pancreas. To check it out, the doctor ordered a CT scan. The pancreas was normal, but the test showed a possible nodule on the liver. A biopsy showed that the liver was healthy, but the biopsy caused serious bleeding and other complications, necessitating a week in the hospital.
More data can produce more problems, which require more tests, which can create problems of their own. And all this can cost you real money—yet not improve your health.
More data also can distract your doctor. Minor laboratory abnormalities identified during a routine visit—such as slightly elevated cholesterol or slightly depressed thyroid function—often draw physicians away from the problems you want to talk about.
My advice: Expect more and more opportunities to get tested for a variety of conditions. Know that while all these tests may serve the financial interests of their manufacturers, they may not serve your interests. Before agreeing to any test, ask your doctor what he/she is looking for. Is there a specific problem you are likely to have? Or is it a fishing expedition? Avoid the latter—it’s too easy to catch trash fish (meaningless abnormalities). Also, ask your doctor whether more information will change what you should do. If not, don’t seek more information.
False: It’s always better to fix the problem.
All medical treatments are a bit of a gamble. You might improve when a problem is “fixed.” Or things could go wrong and you could get worse. It’s often better to manage a problem than to bring out the big guns.
Consider coronary artery disease. It’s potentially life-threatening, so it needs to be treated. Many doctors recommend balloon angioplasty, a procedure to expand the arterial opening and restore normal blood flow. It can eliminate symptoms almost immediately, but it also carries significant risks to the patient.
With medical management, on the other hand, your doctor will treat the problem with medications and advice for a healthier lifestyle. You’ll still have the underlying problem, but you’ll learn to live with it.
How do the approaches compare? One large study found that patients with stable angina who had balloon angioplasty were no less likely to die or have a heart attack than those who depended on lower-risk medical management.
My advice: When you’re faced with a medical decision—scheduling a test, having surgery, starting medications—tell your doctor that you want to take a stepwise approach. Start with the easiest, safest treatments first. You can always add more aggressive treatments later.
Think about upper-respiratory infections. Sure, you could get pneumonia, and you might eventually need antibiotics. But most people can just wait it out. Don’t get tests or treatments unless your doctor convinces you, with good evidence, that you need them.
False: It’s always better to find it sooner.
The argument for cancer screening seems obvious. If you had cancer, wouldn’t you want to know as soon as possible? Screening (looking for disease in large populations) does turn up a lot of cancers. Does this save lives? Less often than you might think.
Take mammography. It’s been used for widespread screening for 30 years, yet the number of women who are diagnosed with metastatic breast cancer is about the same now as it was before. For every 1,000 women who get the screenings, at most three (likely closer to less than one) will avoid dying from breast cancer as a result. The numbers are roughly the same for men who are screened for prostate cancer.
The benefits are huge if you happen to be in one of these small groups, but what about the rest? They’re faced with the cost and inconvenience of the initial test. Many will be advised to get biopsies or other follow-up tests. Some will have surgery or radiation for cancers that probably would have done nothing.
I’m not saying that screening tests are all bad—just that they aren’t all good.
My advice: Ask your doctor if he/she is confident that you, as an individual, will benefit from screening tests.
False: Newer treatments are always better.
There’s a saying in medicine, “When you have a new hammer, everything looks like a nail.” When doctors discover a new treatment, such as a drug or a particular surgery, they tend to want to use it again and again.
Some new drugs really are superior to old ones—but not that often. Vioxx is a good example. It’s an aspirin-like arthritis drug that got a lot of attention because it was somewhat less likely than similar drugs to cause stomach bleeding. But a few years after it was approved by the FDA, it was removed from the market because it was found to increase the risk for heart attack and stroke.
New drugs are tested in relatively small numbers of people. It can take many years before their benefits and risks become fully apparent.
My advice: Unless you have to take a new, breakthrough drug, tell your doctor that you would prefer something tried and true—preferably a drug that’s been on the market for seven years or more.
