According to the CDC, 83.2% of adults had contact with a health professional within the last year. There were 125.7 million outpatient hospital visits and 928.6 million physician office visits, with 300.8 visits per 100 persons, about 3 visits per person. Studies from the AMA show that 70% of these visits are unnecessary and could be mitigated by a phone call, email, or text.
Some of these unnecessary visits are due to patients seeking out extra medical care. They might be confused by consumer pharmaceutical marketing telling them to get checked out. Other patients may be trying to work the system in order to get prescriptions or disability payments. Patients may also be looking for reassurance about something they’re worried about.
A systemwide problem
However, patients are not the only reason there are so many unnecessary medical visits. Often times, insurance companies require patients to make medical visits in order to obtain a referral or receive test results, things that could be done easily over the phone. Additionally, insurance companies may call patients reminding them to receive their annual checkup, even though there is little evidence annual checkups are necessary, and many of them don’t involve preventative care. When preventative care testing is necessary (usually every few years), such as mammograms or cholesterol testing, patients can go straight to a testing center instead of visiting their general practitioner first.
Doctors are also part of the unnecessary medical visit problem. Many patients may present with something that resides in a grey area of medical care. For instance, thyroid nodules. Thyroid nodules can range from benign to cancerous, although many are often benign and small enough to let alone. However, numerous medical professionals will recommend surgery for their patients “just in case”.
Given the nature of medical liability, doctors like to practice “safe”, defensive medicine. In addition, doctors are usually only paid for face to face interaction, and unscrupulous doctors might pad their schedule or suggest unnecessary medical procedures in order to receive kickbacks from specialists, hospitals, etc.
Why is overutilization bad for healthcare?
The issue with unnecessary medical care is not only monetary. Sometimes unnecessary procedures can make patients worse off than if they were left alone.
Take for example, Michael Taylor.
One morning, Michael threw out his back while working in the lawn. Michael had a history of back issues, having undergone multiple surgeries. His general practitioner ordered an MRI (common procedure), and the test showed he had degenerative disk disease. He was referred to a neurosurgeon who suggested fusing some of Michael’s disks together. The surgeon informed him the chances of this procedure taking his pain away would be fifty-fifty. It might even make the pain worse. Luckily, his employer offered a program for employees undergoing spinal surgery. He was flown off to Virginia Mason Medical Center in Seattle, and they found his disk disease was an abnormality that generally caused no harm. Michael’s spinal cord was not compressed, and he wasn’t having any symptoms of pain in his legs or arms, common indicators that spinal fusion is necessary. Given his lack of symptoms, a spinal fusion would not be more effective than a non-surgery option, according to staff at Virginia Mason. They gave him injections for his pain, referred him to a rehabilitation-medicine specialist, and shortly thereafter, Michael was pain free.
So what is the best way to curb all of these unnecessary medical visits?
Using technology is one answer. There are plenty of phone based apps that connect you to a medical doctor for a free consultation. One of these apps is First Opinion. With First Opinion, you can text a doctor 24 hours a day, 7 days a week. The app connects you with a local doctor (currently only available in certain areas) or could also connect you with any doctor, if local doctors aren’t available in your area. Once signed up on the app, you are always routed to the same doctor in order to build patient/provider trust. They also offer upgrades to your consultation, such as sending prescriptions to your pharmacy or ordering lab tests, for as little as $39.
The Choosing Wisely campaign, an initiative of the American Board of Internal Medicine (ABIM), is also concerned about unnecessary health care. The goal of this campaign is to advance the conversation about wasteful and unnecessary medical tests, treatments, and procedures. One service offered by Choosing Wisely is providing evidence based lists for both patients and providers in order to aid them in making decisions about whether or not medical treatment is necessary. This campaign is backed by numerous other medical specialty societies.
Furthermore, better communication between physicians and insurance companies would help as well. Currently, if a doctor doesn’t use a specific code that indicates a “routine medical general examination”, the insurance will call the patient to remind them they need to have a routine checkup. However, routine checkups are performed almost every time a patient sees the doctor, regardless of the reason. Therefore, going in for only a routine checkup becomes redundant, especially if you are already seeing your doctor for other conditions.
If unnecessary visits could be cut in half, it would save the healthcare system $5.2 billion annually. Decreasing the amount of unneeded medical visits benefits all parties involved.
Aptly named, Enclothed Cognition is the official Medelita blog for medical professionals interested in topics relevant to a discerning and inquisitive audience. Medelita was founded by a licensed clinician who felt strongly about the connection between focus, poise and appearance.