How to avoid unnecessary medical procedures
Sometimes less is more – this applies to medical tests and procedures, too. Sanacare expert Dr Marc Jungi explains how patients can avoid unnecessary procedures .
Be it iron infusions, X-rays, joint replacements or prescriptions for antibiotics – estimates indicate that over 20% of the medical procedures performed in Switzerland are unnecessary. On the one hand, this leads to unnecessary costs for patients and the insured population generally and, on the other hand, it causes uncertainty among patients. In the worst case, it can lead to undesirable side effects or complications.
The “smarter medicine – Choosing Wisely Switzerland” association seeks to ensure that medical procedures are only applied when they are really needed. With this aim in mind, it encourages discussion, promotes research and published information around the topic of unnecessary treatments. Marc Jungi, deputy managing director of Sanacare and head of medicine, also works as a specialist in general internal medicine in the Sanacare group practice in Bern and he sees this for himself during his work as a family doctor: “Our top priority is to provide our patients with the best possible medical services tailored to their individual needs.” That’s why we discuss the latest medical findings – including information from “smarter medicine” – at our meetings or send out newsletters and regularly pick up on specific action items in medical quality review circles. “All Sanacare practices also address and selectively review potentially unnecessary measures.”
Time pressure and lack of patience
The fact that unnecessary tests and procedures are still performed and prescribed despite the safeguards that are in place is attributed by Jungi to the fast pace of our lives. “Consultation times are short. Doctors often only have a few minutes to make decisions, so they don’t always have time to look up the latest guidelines.” It’s also more difficult and time-consuming to explain to patients why they shouldn’t undergo an expected test or treatment. This sense of pressure is often exacerbated by the patients themselves and their need to be back in action again as soon as possible. This can lead to prescriptions that are not clearly medically indicated. Or hasty referrals to a specialist by the family doctor. “Sometimes patients just aren’t patient enough. If they have a sore knee, for example, they immediately push for additional tests to find out if it’s the meniscus – even though these tests could be performed a few days later – rather than holding off a few days, cooling the area affected, applying cream, resting and waiting to see whether it gets better.” This leads to unnecessary costs and, as in this example, to harmful radiation exposure.
Take decisions jointly
Marc Jungi believes that doctors have to talk to patients in order to avoid unnecessary medical procedures. “Of course, the main responsibility lies with the family doctor. But it’s important to inform patients of the pros and cons of the procedures, to explain their options, offer support and take decisions jointly.” The “smarter medicine” association provides helpful material in this regard. “Information about the campaign is displayed on the screens in the waiting room of our practice.” The association’s website also provides useful material, such as five questions that you should ask doctors to help you make the right decision when it comes to medical procedures. The association also regularly publishes top 5 lists of commonly unnecessary medical procedures.
2011 lancierten Ärztinnen und Ärzte die Choosing Wisely-Initiative. Ihr Ziel: merh Offenheit und Diskussion zwischen Ärzteschaft, Behandelten und der Öffentlichkeit. Kernstück von Choosing Wisely sind «Top-5-Listen» jeder klinischen Fachdisziplin. Sie enthalten je fünf medizinische Massnahmen, die meist unnötig sind.
No test or procedure without clear justification
The need for a treatment depends on the situation, says Jungi: “I wouldn’t recommend knee replacement surgery to a 60-year-old patient with terminal cancer, but I would to a sprightly 80-year-old. Likewise, eye surgery in the initial stages of cataracts is often only necessary if it is causing problems in everyday life.” If a 20-year-old comes to the practice for a check-up, Jungi would want to know why. For people this age, there’s usually no reason to do blood tests.” In this case, it would be more appropriate to talk about vaccinations or risk behaviour relating to addiction and sexual activity. “There needs to be a clear justification for every therapeutic or diagnostic measure,” says Jungi.
Generally speaking, he advises patients to discuss the risks and benefits of tests and procedures with their family doctor. A good relationship with your family doctor helps guide you through the complexities of the healthcare system. “Establish a relationship of trust, prepare for your doctor’s appointments and ask for all the information you need so you feel comfortable with the choice of treatment,” advises Jungi. If you don’t have a family doctor and only ever turn up at A&E, you run the risk of only having the acute problem treated without taking your overall situation into account. “And if you’re unsure, get a second opinion – sometimes less is more.”