“Doctor, is this really necessary?”
Oslo neurosurgeon Christer Mjåset, vice president of the Norwegian Medical Association, says that he experienced a jolt when a woman asked him this question, he recalls in a TEDxOslo talk. It was a first in his career — he’d never had a patient say this to him.
It occurred after Mjåset suggested spinal surgery to her; she was troubled by intense pain caused by a herniated cervical disc. While he’d performed this procedure many times before, it did come with risks — with paralysis from the neck down being one of the most serious. This led the patient to ask: “Doctor, is this really necessary?”
“You know what I realized right there and then?” Mjåset says. “It was not.”
When he looked more deeply at his motives, he saw that he’d been largely driven by enthusiasm for his work. He says, “I have to admit: I wanted to operate. I love to operate. Operating is, after all, the most fun part of my job.”
There’s a stark imbalance in the healthcare system in much of the world — while medical treatment is extremely difficult and expensive for some to access, it’s overly easy for others. Thanks to this patient, Mjåset has shifted his worldview about the latter category of care. Researchers, he says, suggest that “ 3 out of 10 times your doctor prescribes or suggests something that is completely unnecessary. You know what they claim the reason for this is? Patient pressure.”
For many of us, the whole process of receiving healthcare — making an appointment, waiting for it to arrive, rearranging our schedule so we can go, showing up for it — takes considerable time and energy. We may feel, consciously or not, that our efforts need to yield a concrete result. We want to leave our encounter with a doctor bearing a diagnosis, plan of action, prescription, or some other decisive, active response.
Mjåset believes that both physicians and patients need to be vigilant about excessive care. He says, “A good doctor sometimes says no, but the sensible patient also sometimes turns down an opportunity to get diagnosed or treated.” When he spoke to his colleagues about his patient and her question, they said they’d also never been asked: “Is it necessary?”
He suggests 4 questions that we should pose to our doctors the next time they recommend a medication, procedure, test, treatment or surgery.
Is this really necessary?
What are the risks?
Are there other options?
What happens if I don’t do anything?
Mjåset knows raising these questions is easier said than done. It’s especially true given the limited time most people have with healthcare providers. In a 2017 study, doctors’ appointments in the 18 countries that accounted for half the world’s population lasted for five minutes or less; even countries like Sweden and the US had average appointment lengths of 22 minutes and 20 minutes, respectively. But he urges us to speak up. He says, “You need to get in the front seat with your doctor and start sharing decisions on where to go.”
Asking these 4 questions, he says, will help us and our doctors. They can reduce the burden and cost of unnecessary care on our overall system and prevent us from suffering complications and side effects that could have been avoided. As he puts it, “People like me need your help.”