Patients Should Strive to Be More Educated Healthcare Consumers

Most people spend a lot of time researching and weighing options for a large purchase or a decision like changing a job. When it comes to healthcare, however, most people don’t do much research or consider options at all. A 2010 Gallup poll showed that 70% of people feel confident in their doctor’s advice and don’t feel the need to do their own research or get a second opinion. This can lead to poor outcomes, unnecessary treatments, increased costs, or treatments that don’t match patient goals. So what can you do to become a more educated healthcare consumer? One important strategy is to ask questions to understand what your options are, what is being recommended, and why. Some good questions to start with are:

  • What are the risks and benefits of this treatment?
  • What other options do I have?
  • Why is this treatment better than the alternatives?
  • What will this treatment cost?
  • What would happen if I chose to do nothing or to wait before starting care?

A great example of a common treatment that patients should research significantly before agreeing to is back surgery. Without researching and considering alternative treatments, many patients expect to have back surgery and then to be pain free. In this case, reality is far from perception. Outcomes from back surgeries are statistically terrible. One large study of 1450 patients in the Ohio worker’s compensation system showed that after 2 years only 26% of patients who had surgery returned to work. Comparatively, 67% of patients who didn’t have surgery returned to their jobs. There was also 41% more ongoing use of painkillers in the surgical group compared to those who did not have surgery.

There are a many other treatments for back pain that have been proven to lead to better outcomes, less surgery, less use of expensive imaging and less opioid use. Physical therapy is one of those treatments.  Working with a physical therapist is significantly less costly than surgery, and entails essentially no risk.  A large study of 122,723 subjects showed that people with back pain who got physical therapy in the first 14 days after the beginning of a back pain episode lowered their healthcare costs for the “episode” of symptoms by 60%. Despite the known effectiveness of physical therapy, the low risk, and the low cost to patients and the health care system, only a small percentage of people who seek care for back pain start with physical therapy. This is a great example of why patients need to ask questions and understand all their treatment options before deciding on one.

A general rule of thumb that applies to back pain but also a multitude of other health conditions is as follows: it is good practice to try to address issues with the least risky and/or invasive treatments first before deciding whether or not it is appropriate to consider more risky and invasive treatments.  Another example of how we have been learning this lesson as a community is in regard to the use of opiod pain medications.  We have discovered that the risks of addiction and dependence and overdose are extremely high.  A 2019 document from the US Department of Health & Human Services estimates that 9.7 million people misused prescription pain relievers during the past year.  As a result, guidelines are changing to encourage the use of non-opiod medications as much as possible.  Over the counter medications are much less costly and less risky and have been demonstrated to have good outcomes in a variety of situations.  If the use of over the counter medications and other common pain control strategies such as the application of ice or protective equipment such as a sling or a brace do not sufficiently control pain, then other treatments might be considered.  Other classes of medication such as anti-inflammatories or anti-seizure medications can control pain with fairly minimal risk for most people.  Opiods may be indicated and prescribed in some cases, but hopefully are only needed in extreme situations and for brief intervals.

The examples of back surgery and pain medication are only two of a large variety of health care treatments that warrant careful consideration by the healthcare consumer.  It is a good idea to try to learn as much as possible about the options for any sort of medical treatment.  Asking the questions listed above is a good start.  Seeking out the opinion of more than one health care practitioner about your individual circumstances and about the plan that you have been given is also a good idea.  Taking some time to think about your options and to consider further questions before making a decision about proceeding with treatment is a third strategy to use.  Weighing your options and giving some concentrated thought to your health care choices can help you to make the best decision possible for you and can improve the probability that you will be satisfied with your decisions.