Choosing Wisely: Health Care

Are you concerned about how much you’re spending on health care? Are you wondering if the blood test, X-ray, or MRI your doctor recommends is absolutely necessary? Maybe you don’t make it a habit to discuss the pros and cons of testing with your doctor because, after all, he or she is your doctor and always chooses wisely what is best for you, right? I do trust my own primary doctor’s recommendations, because she listens to me, closely. And she carefully considers whether or not a test is needed, then explains to me the reasons for her recommendation. Here’s the rub: We have a conversation about evidence-based practices before making any final decisions. In other words, she engages with me, as a human being – someone with worries, fears, doubts, and needs. So why am I sharing this with you? Last fall my husband went to his primary doctor for a physical exam. A month later we received a bill from the hospital she is affiliated with; the charges for routine blood work were far greater than I had expected. Though we have health insurance, like most people, we must first fulfill a yearly deductible, which doesn’t include copays and coinsurance. When I asked a representative from the health insurance company how they arrived at the number my husband and I were responsible to pay, and who decides on the formula, he answered with what amounted to the following: hospital charge – some random number chosen by a faceless person = contracted rate – deductible – ten percent co-insurance. I had no choice but to reach for the Advil in the kitchen cabinet nearby.

There’s more. Health insurance company administrators treat people not as human beings but as fixed codes that should fit snuggly into pre-printed, micro-millimeter boxes. So, since my husband’s doctor advised him to take Vitamin D supplements, because his lab work showed it to be low, we received another bill charging us a nominal fee for what our health insurance called a “consult.” (That single blood test alone cost us a chunk of $125.29.) It didn’t matter that the “consult” took place during his physical – it didn’t fit into the insurance company’s pre-fab, coded square for “preventative care.” But isn’t that why we have physicals, not only to be examined, but also to discuss what measures we can take to improve our overall health? That sounds a lot like the dictionary definition of “preventative”: the branch of medicine concerned with prolonging life and preventing disease.” If my husband’s doctor didn’t speak with him about his Vitamin D level, how else would he have known that he needed supplements? Health care has become much like an a la carte menu.

Here’s the good news: A friend and author at Strategy Health Care, Dr. Gene Lindsey, led me to a handy resource when I reached out to him with my concern about health care costs. That resource is Choosing Wisely. Launched, in 2012 by Advancing Medical Professionalism to Improve Health Care (ABIM), the goal of Choosing Wisely is to encourage dialogue between providers and patients in an effort to prevent unnecessary medical tests, treatments, and procedures. A practitioner of cardiology for nearly four decades, and President and CEO Emeritus of Atrius Health and Harvard Vanguard Medical Associates, I trusted Dr. Lindsey’s recommendation, as much as I trust my own primary doctor.

Choosing Wisely offers lists of health-related topics created by medical specialty societies, and represents evidence-based recommendations providers and patients should discuss. Topics range from plantar fasciitis to cancer drugs. Each topic includes information about when tests and procedures are deemed appropriate. The recommendations should not be relied upon to decide health care coverage, but to provoke conversation about whether or not particular treatments are necessary.

While reading through the list on Vitamin D testing and supplementation, this is what I learned: Testing doesn’t improve treatment. Most of us have low Vitamin D levels, but not “seriously low levels.” It’s recommended that we get a little more sun, eat foods rich in Vitamin D, and if we don’t get a lot of sun or eat enough D-rich foods, we should talk to our doctor about supplements. According to Choosing Wisely, “Getting tests that you don’t need often leads to treatments you don’t need, or treatments that can even be harmful. For example, if you take too much vitamin D, it can damage your kidneys and other organs.” And “doctors are ordering tests six times as often as in 2008.” Of course, there are conditions that warrant Vitamin D supplementation, like osteoporosis, and any disease that damages the body’s ability to absorb the vitamin.

Take a look at Choosing Wisely, and look out for yourself, your body, your health, because it’s you that matters.