Reducing Healthcare Waste: Don’t Expect Patients To Take The Lead

Lena Wright’s best friend was hunched over like a character from a French novel, with spinal bones so thin they would fracture with a fit of sneezing. Determined to avoid that fate, Wright (a pseudonym) asked her primary care doctor to test her for osteoporosis with a DEXA scan, also known as Dual Energy X-ray Absorption. The scan would send two X-ray beams through her bones, one high energy and the other low. The difference in how much energy passes through her bones would somehow (the wonders of physics!) allow her doctors to calculate the thickness of her skeleton.
If you need to figure out whether you have osteoporosis, a DEXA scan is a good idea. But if you don’t need such a scan, you end up exposing yourself to harmful radiation and, of course, to an unnecessary healthcare expense. According to the American Academy of Family Physicians, most people do not need the test, because they do not have risk factors for osteoporosis. Lena Wright, for example, harbored no family history of osteoporosis, had exercised regularly her whole life, didn’t smoke or drink and, very importantly, had received the test five years earlier at age 65, which showed her to have normal bone density at the time. In the best judgement of medical experts, a DEXA scan would bring Wright more harm than benefit.
But she was worried. So her doctor, to ease her anxieties, ordered another scan.
What, if anything, can we do to reduce unnecessary and potentially harmful medical testing?
We can start by trying to reduce patient demand for such services. That is an approach taken by the Choosing Wisely campaign, a voluntary effort by medical professionals to reduce wasteful medical care. As part of this effort, professional societies like the American Academy of Family Physicians put together “top 5” lists of wasteful services. Then, in partnership with organizations like Consumer Reports, they’ve tried to educate the general public about why they should be happy to avoid such services.
I am a huge fan of educating the general public and think that Consumer Reports does as fine a job at this as anyone in the business. But I also recognize that their reach – their ability to get the word out to the masses – is limited. (To read the rest of this article, please visit Forbes.)

Leave a Reply