The fact that you may be young and healthy is no guarantee against unsolicited medical services. Actually, for the health-care industry, it’s an opportunity.
In 40 years of clinical practice, I’ve cared for thousands of people who have been sent off to fight battles against wars that don’t exist, or who have been encouraged to regain health that was never lost.
Welcome to what I call The Slope. It all starts innocently enough as a “simple” or “routine” blood test, screening technology or X-ray. The ensuing series of tests and their unintended consequences are difficult to stop and become sequentially more invasive, expensive and dangerous. Indeed, the cancellation of elective operations in the wake of the coronavirus reveals that many were not necessary in the first place.
According to Consumer Reports, 44 percent of healthy adults with no risk factors for heart disease reported that they’d had a screening test for heart-attack prevention in the last five years. Few had a conversation about the accuracy of the test or the potential complications that could arise. Only 1 percent knew whether the test could save lives.
But screening tests often lead to a cascade of unnecessary, costly, and in some cases, risky follow-up tests and treatments. The “routine” EKG turns into a recommendation for a stress test, which, for many people, turns into a coronary artery calcium test and, finally, a cardiac catheterization.
Do you want to save your life? Sure, you do! Avoiding or quitting smoking could prevent 50,000-100,000 deaths annually. This alone adds 10 healthy years to your life. But most other preventive technologies, such as cervical and colon-cancer screening, provide a fraction of that benefit with greater risk. For 90 percent of women, a positive mammogram turns out to be a false alarm. But 100 percent of those end up with more tests, often increasingly invasive, dangerous and expensive until they can breathe a sigh of relief.
Americans routinely fall down The Slope in the attempt to prevent diseases that are decades into the future and unlikely to occur, unlikely to benefit from early diagnosis and, once diagnosed, unlikely to benefit from treatment. The PSA blood test, for example, leads to most of the 190,000 men diagnosed with prostate cancers yearly in the US, but 60 percent will never be harmed by the disease, and many of those diagnosed could be carefully watched without the need for radical surgery. Meanwhile, treatment for prostate cancer can lead to decades of impotence, incontinence and a life of needless struggles.
In the words of the physician Gilbert Welch, “It’s hard to make a well person better, but it’s easy to make them worse.”
The goal is to learn before you leap. Gently apply the brakes and use what I call industrial-strength resources available to the public. MedPage Today, for example, is your medical provider’s daily newspaper, and it’s an open portal to unbiased daily headlines with a search engine and a resource rich in links to original data.
Knowing the best medical path takes work. But the view from atop The Slope, before making a decision, is better than the view from the bottom after having made a bad one.
Steven Kussin, MD FACP, is a physician, television commentator, and pioneer in the Shared Decision movement. His book, “The Slippery Slope of Health Care: Why Bad Things Happen to Healthy Patients” (Rowman & Littlefield) is available online now.