It really is no wonder that the American healthcare system is the most expensive in the world. What is surprising is that despite how much we spend we have the worst health outcomes of any developed nation. Part of that is because of all the unnecessary tests and procedures.

Are You Buying What Your Doctor Is Selling?

As a country, we waste money and resources on tests and procedures that are not only medically unnecessary but potentially dangerous (i.e., stem cell clinics). Because people want “everything done”. The media feeds into hopes and fears, but does not always explain the real risks involved.

Not every test is helpful in every situation. Many can have false positives that lead you down the rabbit hole to more and more tests, some of them invasive. Biopsies, surgeries, and other procedures can have complications. Some of them may even be life-threatening. Some expensive surgeries have results no better than placebo!

Unfortunately, there are unscrupulous people out there, hospital systems and medical professionals included, who will take advantage of your naivete. There are others that may not realize that certain tests and procedures are no longer seen as beneficial. When faced with the following diagnostic tests, medications, or surgeries, do your research. You may not need them. It’s okay to say no thank you.

The Top 5 Diagnostic Tests You Don’t Need

1 — Annual cervical cancer screening

Cervical cancer screening saves lives, but you don’t need it every year. The American College of Obstetricians and Gynecologists (ACOG) and the U.S. Preventive Services Task Force (USPSTF) recommends Pap Smear screening every 3 years for women 30 to 65 years old. Those who get the Pap Smear with HPV testing can screen every 5 years. I don’t know any woman who wants to do it more often than that!

2 — Electrocardiograms (ECGs) for low-risk people

Some medical offices check an ECG at every physical. If you are at low risk for heart disease (e.g., no diabetes, high blood pressure, high cholesterol, etc.) and do not have symptoms (e.g., chest pain, irregular heartbeats, shortness of breath with exercise), this may not be useful. In fact, the test is not always accurate and can lead to unnecessary invasive procedures and testing.

3 — Pulmonary function tests and spirometry for smokers

While it may seem that diagnosing chronic obstructive pulmonary disease (COPD) and emphysema early makes sense, it has not been shown to improve health outcomes. There are no treatments that will slow the progression of the disease, only medications that treat ongoing symptoms. If we want to protect against lung disease, it is better to focus on getting people to quit smoking.

4 — Imaging for low back pain

The truth is most people recover from back pain in 4 to 6 weeks. Without red flag symptoms (e.g., loss of bladder or bowel control, numbness or weakness in your legs, unexplained weight loss), it does not make sense to get imaging sooner than that. Not to mention that many people have anatomic abnormalities on imaging even when they don’t have back pain! That means you could be treated for something that is not even causing the problem.

5 — Imaging for uncomplicated headaches 

We do not need to be exposed to unnecessary radiation. If you meet criteria for migraine headaches, have a normal physical exam, and do not have red flag symptoms (e.g., fever/chills, neurologic symptoms, visual disturbance, worsening headache with position changes), then imaging is unlikely to provide much help. Few headaches are explained by anatomic changes in the brain.

The Top 5 Medications You Don’t Need

1 — Antibiotics for upper respiratory tract and ear infections. 

Antibiotics do not treat viruses! Even when they treat bacteria, the duration of symptoms may not be reduced for these more common infections. Still, overprescription of antibiotics is rampant in the U.S. The Centers for Disease Control and Prevention (CDC) estimates that as much as one-half of prescribed antibiotics are unnecessary or inappropriate. We are doing more harm than good by promoting antibiotic resistance.

2 — Cholinesterase inhibitors for severe dementia.

Medications like donepezil (Aricept) and memantine (Namenda) have a marginal benefit for mild to moderate dementia, less so for advanced disease. Unfortunately, these medications often have more side effects (bleeding, nausea, vomiting, dizziness, and headaches) than benefits.

3 — Fish oil supplements to prevent heart disease. 

For people who already have heart disease, fish oil supplements may decrease the risk of a future heart attack or even congestive heart failure. For people who do not have a known heart condition, there is no proven benefit.

4 — Non-steroidal anti-inflammatory drugs (NSAIDs) for people with high blood pressure, heart failure, or chronic kidney disease. 

Although these medications can be effective pain relievers, they can also increase blood pressure, trigger fluid retention, and worsen kidney failure. These side effects need to be avoided when you have these medical conditions.

5 — Oxygen for patients with chronic obstructive pulmonary disease (COPD). 

Giving supplemental oxygen to people with COPD does not necessarily help them to breathe easier. In fact, giving too much oxygen can sometimes cause them to retain carbon dioxide and could actually lead to respiratory failure. The need for oxygen should be considered on a case by case basis.

The Top 5 Surgeries You Don’t Need

1 — Angioplasty and Stents

During a heart attack, these procedures could save your life. They can restore blood supply and decrease damage to the heart. The rest of the time, these procedures are unlikely to have much benefit. Of course, cardiologists will tell you that they will decrease your risk for a future heart attack. What they don’t tell you is that other less invasive (and much less expensive) treatments can yield similar results. In fact, multiple studies show that having a stent placed doesn’t decrease the risk of having a heart attack or dying from a cardiac event when compared to using medications alone.

2 — Elective C-sections

A third of all births in the U.S. are by C-section. The procedure may be medically needed when a baby is breech, cannot fit through the vagina canal, or is in distress, but half of these C-sections are medically unnecessary. Moms are choosing to have them done because they think they will have a better recovery. What they don’t realize is that women who have elective c-sections are twice as likely to be re-hospitalized due to complications from surgery. Their hospital stay will be longer, their baby will be at greater risk for respiratory problems, and they will have an increased risk of complications in future pregnancies.

3 — Hysterectomy

A woman may need to have her uterus surgically removed if she has cancer. Other reasons include uncontrolled pain from endometriosis or heavy vaginal bleeding. Unfortunately, not all women undergo a thorough evaluation or have not been offered less invasive treatments like hormone therapies or endometrial ablation that could be effective in treating their symptoms. Depending on the population studied, research shows that anywhere from 40% to 70% of hysterectomies may be unnecessary.

4 — Knee surgery for arthritis 

Knee arthroscopies are big money makers. Medicare may pay as much as $10,000 for each procedure. The problem is that the surgery is no more effective than physical therapy for relief of arthritis symptoms. When you realize that you will likely need physical therapy after surgery anyway, there is no reason to think that surgery is the “easy way out”. In fact, arthroscopic knee surgery for osteoarthritis has been shown to be no more effective than a placebo surgery! For these reasons, the American Medical Society for Sports Medicine advises against knee arthroscopy for degenerative meniscal tears.

5 — Spine surgery

The success rate for back surgery is 25% but the risk for surgical complications are huge (e.g., anesthesia reaction, bleeding, blood clots, heart attack, infection, nerve damage, stroke). Not only that but it is estimated that 10-20% of the surgeries performed are medically unnecessary. That means other treatments would be equally effective. Again, these procedures are big money makers for surgeons. Back surgery truly needs to be a last resort and reserved only for people with confirmed anatomic abnormalities on imaging studies. Surprisingly, some doctors recommend surgery even when an MRI is normal. Dare I ask, what exactly are they hoping to fix with surgery then?

 

Al-Lamee, R. et al. (2018). Percutaneous coronary intervention in stable angina (ORBITA): a double-blind, randomised controlled trial. The Lancet, 391(10115), 31–40. https://doi.org/10.1016/s0140-6736(17)32714-9

Antibiotic Use. CDC.gov. https://www.cdc.gov/antibiotic-use/index.html

Broder, M. et al. (2000). The appropriateness of recommendations for hysterectomy. Obstetrics & Gynecology, 95(2), 199–205. https://doi.org/10.1016/s0029-7844(99)00519-0

Cervical Cancer Screening. ACOG.org. https://www.acog.org/womens-health/faqs/cervical-cancer-screening

Cesarean Delivery on Maternal Request. ACOG.org. https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2019/01/cesarean-delivery-on-maternal-request

Clinician Lists. Choosing Wisely | Promoting Conversations between Providers and Patients. https://www.choosingwisely.org/clinician-lists/

Epstein, N., & Hood, D. (2011). “Unnecessary” spinal surgery: A prospective 1-year study of one surgeon′s experience. Surgical Neurology International, 2(1), 83. https://doi.org/10.4103/2152-7806.82249

Final Recommendation Statement: Screening for Chronic Obstructive Pulmonary Disease | United States Preventive Services Taskforce. (2016). USPreventiveServicesTaskforce.org. https://www.uspreventiveservicestaskforce.org/uspstf/announcements/final-recommendation-statement-screening-chronic-obstructive-pulmonary-disease

Katz, J. N. et al. (2013). Surgery versus Physical Therapy for a Meniscal Tear and Osteoarthritis. New England Journal of Medicine, 368(18), 1675–1684. https://doi.org/10.1056/nejmoa1301408

Siscovick, D. S., et al. (2017). Omega-3 Polyunsaturated Fatty Acid (Fish Oil) Supplementation and the Prevention of Clinical Cardiovascular Disease. Circulation, 135(15). https://doi.org/10.1161/cir.0000000000000482