It’s OK to ask questions – Dr Anna Colwell
Dr Anna Colwell
Deputy Chief Health Officer
Department of Veterans’ Affairs
You have tweaked your back bending over to pat the dog and now you can hardly walk. You go to the GP, but she doesn’t send you for an x-ray. Instead, she tells you to stay active rather than resting in bed. How can this be right?
We know that about 90% of episodes of lower back pain don’t need an x-ray. There is no difference between doing an x-ray immediately and starting with pain management, physiotherapy and keeping moving. Staying in bed any longer than a day or 2 causes people to lose muscle strength and balance, with a greater chance of ongoing pain and re-injury. But getting moving as soon as possible helps with ongoing movement and decreased pain.
Rarely, there will be something about your pain that means the doctor wants to rule out a serious condition. Having an x-ray when you don’t need it can cause unnecessary worry. It might show changes in your spine that are unrelated to your pain.
But once you know they are there it can worry you or it may lead to more scans to figure out if the changes matter or not.
Low value care
Low value care refers to health tests, treatments or operations that give little or no benefit to patients, or where the risk of harm exceeds the likely benefit. Potential harms include over-diagnosis, over-treatment, antibiotic resistance, operation complications and radiation exposure.
Very large amounts of money are spent on unnecessary tests and treatments. One study in NSW public hospitals estimated up to 9,000 low value operations were performed in one year, which used almost 30,000 hospital bed days that could have been used for other patients. Low value care results in wasted health care and risk of harm, often at the expense of more effective health care.
No test or treatment should be provided without a conversation between you and your doctor about the benefits and harms, and your preferences.
Choosing wisely
The Choosing Wisely program has been going in Australia since 2015. Led by some of our top health organisations, it encourages health care providers and their patients to have better conversations about what care is truly needed for each person. It also identifies treatments that are rarely helpful. More is not always better when it comes to healthcare!
The right choice should be based on the best available evidence and a discussion between the patient and their healthcare team.
Choosing wisely is not about cutting costs, but minimising harm and unnecessary testing or treatment. Choosing Wisely suggests the following 5 questions to ask your doctor or other healthcare provider before you get any test, treatment or procedure.
- Do I really need this test, treatment or procedure?
- What are the risks?
- Are there simpler safer options such as lifestyle changes, eating healthier foods, exercising more?
- What happens if I don’t do anything?
- What are the costs – financial, emotional, time? Is the cost reasonable or is there a cheaper option?
Some veterans aren’t used to asking questions or making decisions about their healthcare. You as a patient can help make better healthcare choices by:
- booking a longer appointment if your issue is more complex so there is time for discussion and a shared decision
- asking the above 5 questions
- telling your doctor if you don’t understand (sometimes doctors seem to talk a different language, don’t be embarrassed to ask them to explain)
- taking a relative or friend to important appointments in case you miss something
- discussing it calmly if you think you need a particular test or treatment. (If your doctor doesn’t order a test, it is usually because that test isn’t going to be helpful. It is your right to ask questions or to get a second opinion if you are not happy with the treatment plan.)
How can DVA help?
You might be eligible to book a funded Veterans’ Health Check with your GP to look at your current issues and have some extra time to talk about a treatment plan.
Your GP can organise a DVA-funded Home Medicines review to ensure you understand what each of the medications you take is for and why you need it. Your GP can help you access DVA-funded allied health treatment to help you establish some lifestyle changes or exercises to help with common health conditions.
DVA supports funding the necessary health care that you are eligible for. We encourage you to make wise choices after you talk with your healthcare team about what health care you really need.
Examples of low value care
Arthroscopy
Arthroscopy (inserting a telescope) of the knee used to be very common for osteoarthritis and degenerate meniscal tears. The evidence now suggests that this procedure is no better than non-surgical treatment (like physio) in uncomplicated knee arthritis or meniscal tears, but has more complications. It should be avoided in people over 50 years of age.
Antibiotics
Using antibiotics when they are not needed can lead to them no longer working to treat infection as the bacteria become resistant. Most colds and flus are caused by a virus and antibiotics won’t help you get better any faster (but might give you diarrhoea). This is why your GP is reluctant to prescribe antibiotics for these illnesses.
Other unnecessary medications
Sometimes a person will start a new medicine – from their doctor or bought at the chemist – and they just keep taking it, even though the reason they started taking it has improved. Sometimes they get a side effect from the medicine, like nausea, and another medicine is added to treat that.
Their GP may not be aware of everything a person is taking if it was started by another doctor or at the chemist. You can see how easily people can end up on several medications that are no longer needed. The more medications you take, the greater the risk that you will get a side effect, or that they will interact and cause harm. The Choosing Wisely website (www.choosingwisely. org.au) can help you with tips about preparing for appointments and talking with health providers.