In Germany, many tests, therapies or operations are carried out, although they are not necessary at all. Patients should be aware of this.
An artificial joint, although it wouldn’t be necessary for a few years, the wrong medicine or examinations that don’t work. The doctor and science journalist Werner Bartens warns of incorrect assessments and diagnoses. In his book “Is this medicine or can it go away?” (Gräfe and Unzer) he informs about the most unnecessary tests, therapies and operations. In an interview with the news agency spot on news, he explains why Germany is world champion in OPs. Bartens also gives patients decision-making aids.
In your book you criticize unnecessary tests, unnecessary therapies and questionable operations. How do such mistakes come about?
Werner Bartens: On the one hand, this is due to false economic incentives, i.e. examinations and some treatments are better paid for than waiting or doing nothing. This is generally true in medicine. Things that involve a lot of laboratory effort or are invasive are paid significantly better than not doing these interventions. And of course there is not only the personal interest in profit, but unfortunately also in the meantime in hospitals the dominance of businesspeople who know exactly which interventions, which examinations, which treatments are rewarded and how well. They tell the doctors that their departments are not lucrative. There are also bonus payments. A chief physician receives this at the end of the year if he has carried out a certain number of examinations. Take the example of cardiac catheter examinations. You can do it, you can leave it with some patients. That is done rather than left.
But I would like to emphasize clearly that doctors are not rip-offs and criminals. Many doctors perform examinations or surgeries because they are afraid of missing out on something or of being prosecuted for not doing something. This gives rise to the action “Better one time too much than one time too little”. As an example: The caesarean section rate would be ten to a maximum of 15 percent for purely medical reasons. For years, however, it has been over 30 percent in Germany.
In addition, one often finds minor findings, small deviations from the norm that unsettle the patient. Then you are quickly inside an examination mill. However, imaging, X-rays, magnetic resonance imaging or certain prescriptions for drugs would not be necessary at all. Waiting and checking would often be the better method.
There are also local customs. In some places the number of caesarean sections is 50 percent, elsewhere it is 20 percent. This is often due to “chief physician traditions”. Another point: some doctors are simply not good at keeping up to date with science and do not get enough information, for example through advanced training.
Which examinations and operations are unnecessary in most cases – and why?
Bartens: Germany is the world champion in terms of the frequency of cardiac catheter examinations per inhabitant. That would only be necessary in 30, 40, at most 50 percent of the cases. Germany is also a world leader in joint replacements, such as artificial hips or artificial knees. X-rays of the back are also very common and superfluous. More than 90 percent of back pain goes away on its own, without pictures, injections or operations; it is often psychological.
Two thirds of all general practitioners give antibiotics for flu-like infections, although you actually learn that in high school, but at the latest in medical school, that flu-like infections are triggered by viruses. Antibiotics, on the other hand, only help against bacteria. I could give many more examples …
Isn’t it better to do a few unnecessary examinations instead of not missing any and perhaps missing something important?
Bartens: Identified early, treated quickly, live longer, everyone thinks. Here is a counterexample: If 1000 women between 50 and 70 years of age have their breasts x-rayed every two years – that is the recommendation – a lot of studies have shown that in ten years three out of 1000 will die of breast cancer if the women go for a mammogram . If you don’t go for a mammogram, four in 1000 will die. That is, the benefit is there, but relatively small. In addition, of these 1000 women, 150 will receive a false alarm in ten years. It is also known that of these 150 between five and ten are also being treated for cancer even though they do not have any.
How can that be?
Bartens: In some cases it is not easy to tell whether it is really cancer or a small change or preliminary stage, which in the vast majority of cases does not lead to cancer at all. More and more early forms are being discovered through mammography. For me it is not at all about saying “Dear women, don’t go to mammography”, but about sensible, balanced education. And then every woman can decide for herself whether she should be examined.
As a non-medical professional, how can I decide whether I really need something or not?
Bartens: The important thing is not to trust “Dr. Google”. Anyone who looks up symptoms on the Internet should go to reputable sites, such as informedhealth.org. I advise anyone undergoing an examination to ask the doctor what they would advise their own partner, child or grandmother and grandpa. The “How would you do it for yourself?” may induce medical professionals to recommend that certain surgeries or examinations be paused.
It is important to obtain sufficient information during the conversation. I recommend writing down what you want to know and then proceeding from it. Not that you go into practice with questions and leave it unanswered. In addition: Don’t be satisfied with the explanations and answers if you haven’t understood them, but rather investigate. And only stay with your doctor if you feel comfortable with him and have the impression that he can help you. Don’t hesitate to tell if you feel uncomfortable. Another very important point is: Anyone who suffers from psychological complaints and emotional stress should not be shy and address them, as pain and many other complaints can be explained by the psyche.
Does it make sense to get a second opinion?
Bartens: You can get a second opinion – but only after you’ve heard and understood the first. Of course, at the second meeting you can also come across someone who comes to the same conclusion. Take documents, findings, x-rays with you beforehand – you have a right to do so.