I.e. in these cases, people pay more and take more medical risks for treatment that does not improve medical outcomes.
Anything that is published by Consumer Reports should be taken with a large grain of salt. They are not as unbiased as they portray themselves.
Choosing Wisely has a long long list of tests and treatments to avoid:
Whole body scans for cancer (way too much radiation, finds tumors that would never make a difference)
Routine CT scans after concussion
Scheduled C-section before due date
Pap smears after age 65
Feeding tubes for people with dementia (feed by hand instead)
and many others
http://www.choosingwisely.org/
Knee surgery for a torn meniscus has not been shown to have a benefit compared to not having knee surgery. A lot of researchers have looked at this question, and found no benefit. One of the studies even did a randomized trial where some patients had real surgery and some had sham surgery (open up the knee, do nothing). No benefit has been found.
My doc told me 70.
Hmm… it almost seems that demanding something like a blood test after a little weight with no other symptoms is one of the reasons our medical system is so expensive…
The ER is the worst. There have been a few times that I knew I needed to go and knew what was wrong with me but put it off as long as possible because I dreaded having yet more unnecessary tests done. It just gets old.
@BunsenBurner the Consumer Reports article cites and is simply passing on findings reported in Journal of American Medical Association on October 2, 2017. I don’t have subscription, but JAMA abstract link cited below in CR isn’t particularly surprising.
http://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2655246
People with advanced dementia (Alzheimer"s) often lose the ability to swallow. No feeding tube? How about hydratiion$
People with advanced dementia (Alzheimer"s) often lose the ability to swallow. No feeding tube? How about hydratiion$<<<<<<<<
That would be covered in an article about making proper advanced directives. Put me in the cheap pile of no tube for me. I will take the diamorph though, assuming that is cheaper. Win win.
10 months ago a surgeon told me I had a tear in a part of my shoulder that “the radiologist doesn’t see”, but he claimed was there. He wanted to fix it surgically, and also re-anchor a tendon with a screw into the bone of my shoulder. He thought the tendon attachment was frayed (again, something that doesn’t show up in the images).
I got a second opinion at our university hospital. That doc diagnosed it as an issue that could probably be fixed by PT, and looked aghast at the end of the appointment when I told him what surgery the first doc had proposed. PT and some time did the trick, and I avoided a serious and unnecessary surgery.
I wonder if the first surgeon would ever have fessed up that the problems he claimed I had don’t exist after the surgery. I kind of doubt it. I have an appointment with my primary care doc who referred me to the first guy coming up, and I’m going to let her know about this.
It is SO important for us to let our referring doc know when the referral was bad so they can consider/re-consider that in choosing whom to refer to in the future. I had a cardiologist whom my internist AND my pulmo referred me to who was awful–very inconsiderate of my time, running HOURS late for appts with NO apology or good reason, not noting prolonged discussions about allergies and anaphylaxis risk, not keeping copies of tests THEY ran in their office and more. TERRIBLE but “good” reputation.
Feeding tubes aren’t for hydration; they are for nutrition. Research shows that hand feeding works just as well as a feeding tube for people with dementia. A feeding tube is pointless torture for someone with advanced dementia. How glad I am that my family refused permission for a feeding tube for my aunt in her late stages of Alzheimer’s. Not that the doctor recommended it, but they did mention it as a possibility.
I know they differ. I have seen both feeding and hydration withheld.
We can also thank lawyers and lawsuits. Dr’s are rightfully concerned about getting sued so there will be a moderate amount of over testing as well. And mammograms - how many times are you hearing, or experiencing, re-tests and biopsy’s that were benign. But when it’s you or your loved one it’s not easy to say, you’re in pain, you’re at the end of your life, we aren’t going to do x, y or z. I believe the largest outlay in money is the last 6 months of life.
I’d sure have sued that surgeon if he’d done major surgery that turned out to be unnecessary (especially against the radiologist’s reading of the image).
Feeding tubes can also be for hydration (and nutrition of course) in people with history of stroke or dementia who have swallowing difficulties and cannot tolerate even thick liquids because they are at risk for aspiration. Some of these people still have quality of life and aren’t ready to go yet.
As to hand feeding of patients, the concept is very nice, and I don’t question the research findings at all. However, this is a very time consuming interaction. Rarely are places staffed well enough for hand feeding on any significant scale. As a nurse, I’ve been beyond frustrated with the lack of proper staffing in health care. I got out of the hospital over a decade ago over this very issue, and it’s only gotten worse since. The “nursing shortage” is, in many areas, simply a “shortage” of desire on the part of facilities to actually staff properly, since this costs money they (and the American public) aren’t willing to part with. Many families can barely afford the care provided by skeleton crews as it is. Of course it doesn’t require a licensed nurse to hand feed patients, but even nursing assistants are often in very short supply. Family members are often just not willing to do it.
It’s not as simple or practical a solution as it might seem.
“I’d sure have sued that surgeon if he’d done major surgery that turned out to be unnecessary (especially against the radiologist’s reading of the image).”
Unfortunately, @intparent, I bet you never would have known because I bet he wouldn’t admit it once he opened you up. I don’t think all doctors have scruples.
A second opinion is a must. Symptoms and diagnostic procedures do not always pinpoint the cause of the issue or the fix. Docs who specialize in a particular discipline tend to think that they can solve it the way they are used to solve these kinds of problems. The surgeon probably based his proposed solution on what he has used to see and what works in those situations. Usually, it is the folks that have tried all sorts of other stuff that end up in surgeons offices. So glad it worked out for you intparent. It could have turned out that none of the non-invasive stuff worked… like it did for me. Let’s try this and let’s try that. Neither of those worked, and it dragged on and on. In the end, I prevailed, demanding surgery, and the doc reluctantly agreed. Let’s say were we both happy when the problem was clearly there as I expected. Oh, he also told me that it would take 4 weeks for me to recover. I was at work in a week. Medicine is not precise science… if it was, we would have had bionic replacements for every part of the body and have cured cancer by now.
I’m not buying the idea that we should torture people with dementia because we don’t have time to not torture them. This is unacceptable.
In any case, readers, don’t authorize feeding tubes for your elderly relatives with dementia.
Where in my post is there anything about “should”? It simply IS. Nursing homes or other similar facilities do not have the staffing to make this kind of thing a standard of practice. I would love to see proper staffing in all facilities, whether long term or acute facilities. It is a huge issue among nurses and has contributed significantly to burn out and of fantastic nurses and ancillary staff leaving the profession. I don’t think this SHOULD happen either, but so far the people in charge have no desire to change this trend. Yep, it’s unacceptable. However, for the staff who are there, there is very little help to be found. There is only so much a person can do when they don’t have the proper support. When I read about nurse/nursing assistant to patient ratios on my nursing forum, I am appalled and sickened for them. I would flip burgers before I’d ever work in a long term facility or even a hospital nowadays.
I’ve been to Hawaii twice in the past two months to see my brother, who is dying of liver failure. He is in a pretty decent facility-I’ve certainly seen far, far worse. While there, I offered to feed him for the staff, and I could tell they were very very relieved to hear it. It took a LONG time to hand feed my brother; I didn’t mind a bit, but he was my only responsibility and I had all the time in the world to do it. That is most certainly not the case for the hired staff at that facility.
Hell if I know what the answer is.
I’m saying we should change what IS, starting by not authorizing feeding tubes for our relatives with dementia. I’m sure that forcing feeding tubes is only one of the bad practices understaffed nursing homes engage it. We have to start somewhere though.
We can save money by not doing some of the other disrecommended health treatments. Not doing stents for non-emergencies and not doing unnecessary knee and back operations would save millions.