For some time there has been a nationwide effort to cut back on unnecessary medical tests, over-prescribed drugs and surgery that doesn't end up helping people feel better.
But old habits die hard.
Dr. Emma Trejo knows that only too well. As an internist practicing in the South Bay city of Lawndale, she says patients frequently come to her office with their minds set on what medical services they want.
And sometimes, the doctor says, it doesn't matter that her experience tells her there's a better way to treat what ails them.
"Oftentimes, the patient is already convinced.... They come with their list and that's all they want from you," she says. From these patients, she says she often hears: "I don't need you to tell me if I need the treatment or not."
What patients often don't consider is that all medical tests and treatments come with some risk.
Over-treatment is also needlessly expensive. It's estimated to cost upward of $226 billion in wasted healthcare in the U.S. each year, according to a 2012 study published in the Journal of the American Medical Assn.
A national campaign called Choosing Wisely is pressing for better doctor-patient communication as an important way to avoid unnecessary treatments of all kinds. It is an initiative of the American Board of Internal Medicine and it has much to say about all this.
Its website at http://www.choosingwisely.org is packed with information for patients and doctors that may amaze you.
There are reports on allergy tests: when you need them and when you don't. You can find a number of reports on use and misuse of antibiotics for skin ailments, pink eye, urinary infections and more.
And do you want to know when it's time to consider procedures such as EKGs, brain scans, stress tests, chest X-rays, bone density tests, PSA screening for prostate cancer — and when it's not? Check it out.
The website includes links to lists of questions for doctors and patients to consider, many of them dealing with medical tests and procedures as well as "patient-friendly" resources.
Here are a few fairly common tests and treatments that experts recommend patients discuss carefully with their doctors.
MRIs for lower back pain: MRIs for lower back pain are commonly prescribed, despite evidence that they aren't helpful when administered before allowing roughly six weeks for the pain to subside on its own.
One of the biggest risks with MRIs, experts say, is they come with a significant chance of false-positive results. That means they often show results that lead doctors to believe they've identified a problem where none actually exists. This often leads to unnecessary surgeries.
"We're not saying you have back pain and if you call the doctor he'll send you away," explains Dr. Christine K. Cassel, president and chief executive of the National Quality Forum, a nonprofit, nonpartisan organization working to improve healthcare quality. "You stay in touch, and have it monitored and check on it."
An MRI of the lower back in L.A. costs an average of $1,200 but can run as high as $3,200, according to a recent analysis by Castlight Health, a San Francisco technology firm.
CT (or cat) scans for kids with minor head injuries: According to the American Academy of Pediatrics, about half of all kids brought to the emergency room for a head injury are given a CT scan to assess their condition, despite evidence that they produce little value.
What's more, both CT scans and X-rays expose patients to radiation, which builds up with repeated exposure and can increase the lifetime risk of cancer. That's especially concerning for children whose brain tissue is more sensitive to the radiation, experts say.
When many parents realize they're exposing their child to radiation, they may want to think twice about rushing to use these tests, says Dr. John Santa, medical director for Consumer Health Choices, an arm of Consumer Reports and a Choosing Wisely partner.
A CT scan of the head in Los Angeles County can cost as much as much as $1,700, according to the Castlight Health analysis.
Ultrasound tests for ovarian cysts: Ovarian cysts are common in women and, in most cases, are not cancerous. They are often identified during a routine exam. A rush to do an ultrasound, experts say, leads to anxiety for the patient and more unneeded testing to allay her fears of the cyst being cancerous.
Surgery to remove the cyst or even the ovary is not uncommon, even when the likelihood of cancer is low.
In addition to the risk of unneeded surgery, there is a financial cost. According to Choosing Wisely, a vaginal ultrasound can cost from $250 to $580. Surgeries to remove an ovarian cyst can range from $7,000 to $10,000.
Antibiotic use for colds and sinus infections: Antibiotics are highly overused in our society and are often prescribed even though they don't fight viruses, which cause common colds and flu, sinus infections and sore throats.
A great danger in overusing antibiotics is that they can lead to antibiotic resistance. That means that if patients use antibiotics too often, the drugs may lose their effectiveness. In severe cases, it can cost as much as $29,000 to treat infections that are antibiotic-resistant, the Choosing Wisely campaign says.
As the campaign suggests, all these concerns are important topics for doctor-patient conversations.
Ask your doctor about the natural course of your particular illness. Often, patients are surprised to learn how long it can take to get rid of a cough or cold or for back pain to subside. This understanding can help to quell anxiety and avoid unnecessary treatment.
Also question your doctor about the needs and risks associated with tests.
"A test should answer a question," says Dr. Christine Castano, a medical director at Health Care Partners Medical Group in California. If it won't change the course of treatment, she says, don't have it.
Dr. Trejo, the Lawndale internist, says she applauds patients who educate themselves about their conditions and treatments.
But she cautions against the danger of patients being too sure of their own medical knowledge. "There is a lot more to it than what we read online, and a lot of treatments may not apply to us."