This post was originally published on this site
Thousands of U.S. children over one year received unnecessary medical services that didn’t benefit their health, a new study suggests. And while experts say much of the change must come from pediatricians, there are still ways for savvy parents to minimize the possibility.
Around 11% of nearly 7 million publicly insured children and 9% of 1.6 million privately insured children in 12 states received “low-value” services at least once in 2014, according to research published in the peer-reviewed journal Pediatrics. The authors defined low-value services as “health care interventions that are more expensive and equally or less effective than an alternative, including doing nothing.”
Using Medicaid claims data from 2013 to 2014, they looked at how often kids received 20 low-value imaging tests, diagnostic tests and prescription drugs, including cervical-cancer screening, sinus imaging, vitamin-D deficiency screening and a range of oral antibiotics.
Physicians may want to satisfy patients and parents, particularly if they have a long-term relationship with the family.
There are many reasons why a clinician might order a service that isn’t, on average, beneficial, said lead study author Kao-Ping Chua, a pediatrician and researcher at Michigan Medicine’s C.S. Mott Children’s Hospital. They may want to satisfy patients and parents, particularly if they have a long-term relationship with the family.
“It’s important to keep a good relationship, and some clinicians perceive that the best way to do that is to be really cautious and maybe order things that on balance probably aren’t necessary,” Chua told MarketWatch. Clinicians can also be overly cautious in general, he added, preferring to overtreat a child rather than risk under-treating a potentially serious condition.
“Parents come in; they are understandably worried about their children; they want their children’s suffering to be alleviated,” Chua said. “In some cases, the clinician is going to perceive that there’s an expectation from the parent that they receive an intervention.”
But some unnecessary medical interventions can have potentially lifelong consequences for kids, he added, starting with cancer risk from radiation exposure related to medical X-ray imaging. Antibiotic drugs can also spur adverse reactions in children, research has shown, and studies suggest they could lead to health risks down the line.
There’s also the financial cost to a young family with resources already stretched thin over child care and other expenses, Schefft said, not to mention potential pain and anxiety for kids.
The onus is on the clinician to not order unnecessary services, Chua said. “Because the vast majority of low-value health care requires an order from clinicians, they are ultimately responsible for that care,” he said. That said, there are steps parents can take to reduce the chances of receiving unnecessary care.
Here’s what experts suggest to avoid unnecessary treatments:
Don’t be shy. “Parents should ask questions and make sure that their pediatrician or any specialist isn’t trying to jump to the most extreme solution before trying some lower-intervention treatment prior to that,” said Erica Mobley, the director of operations at the Leapfrog Group, a health-care watchdog.
Vikas Saini, a cardiologist and president of the Lown Institute, a nonprofit that advocates against unnecessary medical care, suggested asking the doctor what she or he would do differently given the results of a particular test or procedure. What are the risks of getting the service, he added, compared to the risks of not getting it? “Asking questions is helpful — and it does, I think, moderate what’s otherwise an automatic tendency,” Saini told MarketWatch.
While doctors can’t forecast the future, Chua added, they can speak in general terms about the likelihood that something will help versus the likelihood that it won’t help — or even that it would be harmful.
Know when it’s OK to keep your kid at home. Conditions like fevers, stomach bugs, GI infections and the common cold probably don’t require a doctor visit, said Matthew Schefft, a pediatric hospitalist at Children’s Hospital of Richmond at VCU, as long as your kid is maintaining an appropriate weight, staying hydrated and going to the bathroom an appropriate amount. (This guidance likely doesn’t apply to a child who has conditions like cancer or inflammatory diseases, he added, for which something as minor as a fever would cause a higher level of concern.)
“For the average child in good health, the vast majority of illnesses and conditions get better on their own,” Chua said. Think twice before accepting an extreme treatment without due cause, he added. “I hate to put it this way, but it’s an opportunity to receive unnecessary care.” Usually, he said, “less is more.”
There are exceptions to this thinking, of course, and doctors “obviously want to catch things that are more serious,” Chua added. “Ultimately, if you’re worried about your kid and it’s keeping you up at night, bring them in.”
Choose the appropriate location for care. Try calling your pediatrician’s office before deciding whether to go in, and opt for the pediatrician in non-emergency situations before heading to urgent care or the emergency room, Schefft said. Telemedicine through your health plan could also save you a trip to the pediatrician, Mobley said, as could communicating with the doctor’s office via email or instant messaging, if those are options.
Do your best to find a doctor who practices in an evidence-based manner, Chua said — after all, it’s not realistic to expect parents to sift through pros and cons of testing and treatment possibilities on their own. “It’s really on us to help patients and parents do the right thing,” he said.
Maintain consistency in your kid’s medical care. While this may not be feasible if your family has moved locations or had a change in insurance, it helps to see the same providers, Mobley said. That way, doctors can get to know your child, become familiar with their medical history, and see how they develop over time. Parents who have greater familiarity with their kid’s doctor might also feel more comfortable asking questions and advocating for their child, she said.
The bottom line: “We don’t want to set up a dynamic where people are feeling reassured because something is being done,” Chua said. “The ultimate important thing in the end is that the right thing is done, not that something is done.” And sometimes, the right thing to do is nothing.
