For many people, going to the doctor comes with the expectation of getting a test done and a medication prescribed. But study after study show that more care does not mean better care. And too much care is having a real impact on our healthcare system and our wellbeing.

The Institute of Medicine estimates that one third of our healthcare expenditures – around $750 billion – don’t improve health. As anyone who has ever had a test done knows, they aren’t cheap. For years, doctors have overused medical tests, performed unnecessary procedures, and prescribed unneeded medications.

So why do they do it? According to a physician survey published in the Archives of Internal Medicine (now JAMA Internal Medicine) in 2011, 42 percent of primary care physicians believe that patients receive too much care. The most common reasons cited for over-testing were fear of malpractice suits, clinical performance measures, and, interestingly, as a substitute for not being able to spend more time with the patient. Perhaps most concerning is the recognition that diagnostic testing would be reduced if it didn’t bring in revenue, especially for medical subspecialists.

Last week I began noticing posts on social media sites urging patients to ask more questions of their doctors. I eventually clicked my way to a page full of lists for patients and healthcare providers, explaining when a medical test or procedure is necessary and when it should be passed over.

What I’d found was a push for the Choosing Wisely campaign, an initiative from the ABIM Foundation that promotes conversations between physicians and patients by helping patients choose care that is:

• Supported by evidence
• Not duplicative of other tests or procedures already received
• Free from harm
• Truly necessary

Organizations representing more than 500,000 physicians, such as the American Academy of Pediatrics, the Society for Vascular Medicine, and the American Geriatrics Society, came up with their own lists of tests and procedures that should be questioned or discussed. The website also includes patient-friendly resources from specialty societies and Consumer Reports advising patients on the right and wrong situations for certain tests or procedures.

The key word here is “choose.” The novel idea of patient empowerment is growing in popularity as we begin turning to the Internet for health information. According to Pew’s 2013 Health Online Report, 59 percent of American adults have looked online for health information in the past year, and 35 percent have looked online specifically to try to diagnose a medical condition they or someone else might have.

I’ll be the first to admit I have an addiction to WebMD. But a Google search can’t always replace a doctor’s visit. Despite the rise in online health seeking behavior, the reality is that when we actually step into a doctor’s office, we often clam up. Patients are often too afraid or embarrassed to reveal all of their health issues to their doctor and often don’t ask questions during their visits.

Doctors are one of the most trusted groups in the US — behind the military and nurses — so when a physician tells us we need a test, we’re unlikely to argue. We’ve been brought up to believe that doctors have our best interests at heart, and not to question a doctor’s orders. While a physician obviously knows more than I do about medicine, treatment and care, that’s not to say that I shouldn’t own my health and be an informed patient. The Choosing Wisely campaign marks a shift towards patient education — while a doctor may be to blame for ordering too many tests to get paid, we often share that blame. Parents demand antibiotics for their kids’ colds, and many demand tests like CT scans for headaches when they aren’t the doctor’s first choice.

These practices can physically harm patients by exposing them to more medical errors and adverse events from medications, alter their quality of life, and they contribute to the country’s outrageous levels of healthcare spending.

Some of the recommendations you find in the lists seem extreme, or counterintuitive – like no Pap tests for women under 21. And as someone who suffered from frequent sinus infections as a youngster, learning that antibiotics may not have always been the right way to go was jarring. But that’s part of the problem. We become resistant to changes in guidance, especially when we learn that something so common for so  long may not have been the best idea.

This initiative really is an example of partnership, and patient care, at their greatest. Efforts like this can have an impact on the national level, by reducing costs associated with healthcare, and on the individual level, by expanding patient education and improving health. And it’s all presented in a neat, user-friendly website.

As someone who is always thinking about health – for my work, for myself and for my family – these lists are a huge resource. I just hope that others find the same value in them, instead of leaning on tradition and conspiracy theories the way Americans are inclined to do lately.

Direct medical costs associated with going to the doctor and indirect costs like lost productivity and disability affect everyone. One way Georgia businesses are trying to gain control of this problem is by implementing workplace wellness programs, and the state is beginning to fund initiatives geared toward healthier lifestyles for children and adults alike.

Check out the story at Like the Dew or Georgia Health News.

Check out the story and the video my classmate Chelsea Toledo  and I produced.

My profile for the Med School Project was on an amazing local family practitioner. Dr. Suzanne Lester is not your typical primary care provider. She’s bilingual, has tattoos and a nose piercing, and she gives her profession meaning by helping everyone, not just the people who can afford her. She’s providing medical students at the Med School Partnership with a role model unlike those you typically find in med school.

Although she now works in a private practice, that’s not initially why she came to Georgia. After finishing her residency in California, Lester moved to Athens to help fill the need for primary care physicians, but also to provide community care for vulnerable populations like non-whites and Spanish-speaking immigrants, who are abundant in Clarke County. She worked at the Athens Neighborhood Health Center for a few years and then moved to Athens Primary Care after feeling a bit too restricted by the community clinic scene. But even in private practice, she sees a lot of patients who often get the short end of the stick when it comes to health care in the US.

And now Lester has found a way to teach future doctors the importance of serving such disadvantaged groups. As a part-time instructor at the Med School Partnership, she’s able to actually show medical students what it’s like to work with all types of patients. Students get to come into her office to meet her patients, people they might never encounter otherwise. She hopes that by giving them that experience they’ll be motivated to work in community practice, or even just primary care, which is lacking in many areas around the country along with Georgia.

Check out my video and print story about Dr. Lester together here, along with my classmates’ videos about equally awesome players in the community and at the Med School.

HPV isn’t just about preventing cervical cancer. While that’s the reason most people have heard about the vaccine, HPV can cause several types of cancer in both men and women, in addition to genital warts. All the more reason to routinely vaccinate against the infection.

But as long as our society continues to support ideas like the link between vaccines and autism, or that the HPV vaccine can result in mental deficiencies, we’re never going to have the coverage needed to effectively reduce the incidence of cervical cancer, or the numerous other rarer cancers associated with HPV infection.

Sadly, just because boys are now recommended to get the vaccine doesn’t mean they will. How many parents will pay that much money to vaccinate their preteen against a sexually transmitted disease to either protect them from a socially stigmatized disease like anal cancer, or to help prevent the spread of HPV to girls to prevent cervical cancer?  Probably not that many.

And it all goes back to money. This time last year it was considered more cost effective to just try harder to get the coverage rate of girls up than to include boys in routine vaccination. If we really want to work on achieving higher coverage rates for the HPV vaccine, the current price of the vaccine isn’t going to cut it. Add in the fact that it comes in a series of three shots to be taken at different times… well, the effort just doesn’t seem worth it unless you’re extremely educated on the issue and concerned about public health along with your child’s health.

My classmate Chelsea Toledo and I produced this video of simulated patients at the Georgia Health Sciences University/UGA Medical Partnership. While we don’t often hear about the role of simulated patients in medical education, they play a huge part in the development of clinical skills as well as interpersonal skills for doctors-in-training.

Fake patients train as performers, help future doctors learn skills - Georgia Health News

I’m a little late on the uptake, but that’s what grad school does to me sometimes. The CDC’s weekly morbidity and mortality report from a few weeks ago contained some interesting findings regarding antibiotic prescribing habits among pediatricians in the US. Using data from the National Ambulatory Medical Care Service, the CDC found that patients age 14 or younger received fewer antibiotics from pediatricians’ offices from 2003-2004 than from 1993-1994.

My first thought: big whoop.

I know it’s progress, but a 24 percent decrease doesn’t set off confetti and balloons in my mind when it’s well established that antibiotics are overused, both in the animal industry and in the doctor’s office.

Since I spoke with experts on the subject of antimicrobial resistance last semester, I’ve been acutely aware of my own antibiotic use, as well as my friends, family and random strangers in the health center. While it’s easy to believe that one person’s misuse of an antibiotic won’t make a difference, I’ve learned better; every time we take an antibiotic we don’t need, we’re simply adding to the growing number of resistant bacteria out there. It’s amazing to think of the impact these bacteria have had on the running of hospitals, the way physicians are being trained to administer medicine, and the campaigns implemented by such entities as the CDC to combat antibiotic overuse. It’s become common for hospitals to have entire divisions specifically for infection prevention, since resistant bacteria have increased the number of hospital-acquired infections that are often difficult to treat.

The study also brought up another point, one that people often miss in the rush to blame doctors for over-prescribing. It showed that 58 percent of the antibiotics prescribed during visits to the pediatrician were for five acute respiratory infections (ARIs): pharyngitis, the common cold, otitis media, bronchitis and sinusitis. In most cases, these infections do not require antibiotics, but a large part of the problem is parents demanding an antibiotic for something as simple as a cold. People don’t like to go to the doctor, especially if their kid is sick, and not come out of it with some kind of drug to magically make everything better.

It’s an issue with several sides, but ending antibiotic overuse in the doctor’s office should be easier than it has been. The everyday person might not be able to change policies on antibiotics being fed to our cattle, but he can learn to take a doctor’s advice and skip the antibiotic for his kid with a runny nose. And doctors can learn to just say no to pushy parents, even if it results in a disgruntled client. The cost of antibiotic overuse is way bigger than one unhappy patient.

My fatigue may have been due to the fact that I spent my last few days abroad with my butt barely on the seat, off-roading it on the rockiest roads known to man (or me) as we looked at schools on Unguja to be included in the elimination program.

What I saw, on the island with the lower prevalence of schisto, was surprising. Unlike Pemba, where the majority of schools had newer plastic water tanks with taps, Unguja had several schools with either no water or unreliable water.

On top of that, children were everywhere: in the road, hanging out of windows and playing football in fields. And seeing them brought me back to a question I asked myself at the beginning of the trip: why is schistosomiasis a neglected disease?

Schistosomiasis affects more than 207 million people worldwide and results in an estimated 1.7 million life years lost (DALY) per year. Infection can lead to bladder cancer and other urogenital issues, as well as scarification of internal organs. In children it has been linked to anemia, developmental issues and poor school performance and attendance. And while the disease is often outshone by the “big three,” HIV, tuberculosis and malaria, schistosomiasis can exaggerate these diseases. As a result, the economies of communities can suffer as complications plague children growing into adulthood.

As with many infectious diseases, schistosomiasis is a signifier of poverty, poor sanitation and a lack of resources. But its dynamics are different from high profile diseases like HIV and malaria, and what works for many other neglected diseases doesn’t work for schisto. You can’t use a bed net, bug spray or hand sanitizer to prevent infection, and the illnesses caused by long-term infection often don’t cause noticeable problems until years later.

Diana Karanja, head of schisto at CDC/KEMRI in Kenya, says the answer lies in the lack of knowledge of the disease because it is not highly publicized and doesn’t have the noticeable impact on quality of life that other diseases have.

She once had a reporter ask her what the “face of schistosomiasis” looked like. That’s just the thing: beyond some swollen bellies and the effects of later complications, schisto doesn’t have a “face.” You won’t see a television ad for children affected by schisto, and a google news search for the disease doesn’t turn up very much. This is very much in contrast to graphic images of lymphatic filariasis, other parasitic diseases, and the sunken faces of hunger.

Is this part of the explanation for why schisto and other NTDs don’t receive the funding or attention needed to properly control them? This is frustrating, especially when a safe, effective and relatively cheap drug exists to treat the disease.

Instead of needing to see a physical representation of how bad schistosomiasis can get, why can’t we just learn about the reasons schisto should be controlled, and in the best cases, eliminated?

Look at low school attendance, inactive children, poor academic performance and suffering productivity in villages throughout sub Saharan Africa. The effects of treatment, as seen even in the early stages of the studies done by SCORE,  make a noticeable difference in the lives of those affected by the disease. And while that may be all that’s needed to convince communities that treatment works, it takes a lot more than that to show the rest of the globe that schistosomiasis is a disease worth fighting.