It’s everyone’s worst nightmare — a cancer diagnosis. And for senior citizens Rajesh and Sarita Mathur, the trauma of having her diagnosed with late-stage colorectal cancer was compounded by the stress of being asked to undergo an additional set of needless and exorbitant tests.
Sarita, 62, was diagnosed last month, after which the Bareily-based couple was advised to undergo genome sequencing, an expensive DNA analysis test that seeks to assess cancer risk.
Given the diagnosis, Rajesh felt the test would serve no purpose, and decided to consult his family physician, who agreed with his assessment.
“I was told that the test prescribed would detect a person’s chance of getting cancer. Since my wife had already been diagnosed with the disease, it wouldn’t have helped her and it would have cost us a fortune,” he says.
In fact, some experts believe that the test hasn’t even been validated in the Indian context yet. “These genetic tests are still evolving and in the Indian setting they have limited utility,” says Dr Vinod Raina, former head of the department of medical oncology at the All India Institute of Medical Sciences (AIIMS), Delhi. “Moreover, it wouldn’t be useful for someone who is already in the fourth stage of cancer, as there’s a standard line of treatment that’s followed in late stages.”
For Rajesh, the realisation that they might have wasted precious time and money on needless tests has been frightening. “How can one be sure that one isn’t being fleeced; after all, for the lay person, a doctor’s word is final,” he says.
The Mathurs, sadly, aren’t the exception, either in India or abroad.
A study recently published in the American Journal of Managed Care found that as much as 30% of US healthcare expenses each year are thought to be unnecessary.
The study was conducted by the department of preventive medicine and community health at the University of Texas Medical Branch in Galveston, in collaboration with researchers from Massachusetts General Hospital and Harvard Medical School.
“Unnecessary medical practices may cause unneeded emotional and financial stress for patients and their loved ones,” says lead author of the study Dr Sapna Kaul, assistant professor of health economics at the department of preventive medicine and community health of The University of Texas Medical Branch at Galveston.
In India too, chances are you have either faced a similar problem of being prescribed needless tests and procedures, or know someone who has.
When Mumbai resident Nishant Chawla, 24, twisted his ankle while playing football two months ago, for instance, his friends took him to a nearby super-specialty hospital, thinking he would probably need an x-ray.
By the time they got to the emergency room, Chawla’s leg had started to ache, throb and swell.
The consulting doctor told him he probably had torn tissue, recommended an MRI and a deep vein thrombosis test and said he would need to be admitted immediately.
“I was so scared,” says Chawla, a marketing executive. “I thought it was just a sprain and here the doctor was asking me to undergo tests that would have easily cost me Rs 15,000 — and worse, telling me I needed to be admitted.”
Before agreeing to the tests, Chawla telephoned his mother, who insisted he speak to the family doctor first.
The GP advised Chawla to go home, soak his foot in warm water with salt, keep his leg elevated on a pile of pillows and call him back in a few hours.
“Within two hours the pain had subsided,” says Chawla. All his leg eventually needed was time, rest and a crepe bandage.
“In two days it became clear that there wasn’t even any need for an x-ray as Chawla’s pain had subsided considerably,” says the GP, Dr Uday Bhate. “It was a confirmed case of muscle sprain.”
“Over-subscription of tests here is higher still in chronic disease cases, says cardiovascular-thoracic surgeon Dr Ramakanta Panda, vice-chairman and managing director of the Asian Heart Institute, Mumbai.
“Almost 30% of patients who come to me for a second opinion on recommended surgeries and tests require neither. They can be treated with medication and better lifestyle management.”
“Sometimes the doctor has a reason for recommending multiple tests — maybe the symptoms are confusing or conflicting; other times patients could be pressurising doctors to make them well overnight and hence the need to get a confirmed diagnosis as quickly as possible,” Dr Panda adds.
Dr VK Bahl, head of cardiology department at New Delhi’s All India Institute of Medical Sciences (AIIMS) agrees that over-diagnosis has become a problem.
“Blood tests to detect sugar levels, cholesterol, lipid profile etc can be done at any time, but one has to be careful about prescribing sophisticated tests such as CT angio, tread mill test, echocardiogram etc; although these are non-invasive tests done to detect coronary artery disease yet must be prescribed as confirmatory tests in high-risk cases only,” he says.
There could be vested interests at play, feels Abhijit More of health NGO Jan Swasthya Abhiyaan, as many labs pay commissions to doctors for referrals.
Either way, as a patient, there are things you can and should do to keep from being subjected to needless tests.
“I would suggest that patients ask their doctors many questions before undergoing a test,” says Dr Panda. “Ask if the test is really required; how it will help aid diagnosis or treatment; if there is an alternative test; what the risks are if the test is not done. And always seek a second opinion.”
WHEN IN DOUBT
1. If you are unsure about the relevance of tests and procedures being prescribed...
2. Ask your doctor questions. Why is it necessary? How will it help the patient? What are the risks involved if the tests isn’t undertaken? Is there an alternative to the test?
3. Reassure the doctor that you are not looking for an overnight fix. Some doctors say patients are in such a hurry to ‘get well’ and return to their routines, that doctors hesitate to wait for the symptoms to evolve.
4. In case of chronic diseases, always seek a second opinion.