How Much Healthcare Do You Need?

More care isn’t always better, and too much may be harmful.

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The following article comes from the U.S. News ebook, How to Live to 100, which is now available for purchase.

When you need the best care medicine has to offer, chances are you can find someone with the required skills in the United States. Whether it involves repairing a sick heart or blasting a cancerous clump of cells deep within the brain with a precisely targeted beam of radiation, advanced care is so widely available that America's health system long claimed bragging rights for providing the best care on Earth.

Then came a scathing report, now 13 years old, from the Institute of Medicine, a quasi-government think-tank known for tackling some of the toughest issues in healthcare. It charged that errors and unsafe practices in U.S. hospitals may kill nearly 50,000 patients a year, possibly even twice that number. A flurry of studies released since then show that the hazards in U.S. healthcare persist today—nasty bugs passed on to patients in hospitals and clinics, unneeded and risky tests and procedures, medications that hurt more than help, treatment guidelines that are overlooked or ignored, doctors who base treatment decisions on instinct rather than evidence, computerized health information technology that should make care safer and more efficient but too often does the opposite—and the list is still growing.

[See: When a Hospital Is Bad for You]

The question, then, is: How can you take advantage of the strengths of the U.S. healthcare system and not be harmed by its weaknesses? The answer, in six words: Get only the healthcare you need.

The less you put yourself at the mercy of doctors and hospitals, the less likely you will be harmed. That means staying healthy. It means getting the right kind and right amount of preventive care, not too much and not too little. It means—and this isn't easy—not overreacting to information that sounds alarming. It also means getting a second opinion when you need one, preferably from a doctor who can be objective and doesn't have a stake in the outcome of your case.

"Be skeptical, ask questions, get information from different sources. Be more assertive and inquisitive," says David Goodman, a principal investigator at the Dartmouth Atlas of Health Care, a research project that has shown, among other things, that patients don't necessarily fare better in places where doctors and hospitals are more aggressive, and that far too often they do much worse.

[See: 9 Signs You Should Fire Your Doctor]

What does the right amount of preventive care mean? That depends on the state of a person's health, along with age, sex, and family history. Not everyone needs an annual physical exam, as long as he or she is healthy and without a family history of premature disease. "One basic principle," Goodman says, "is that if you're living well and feeling healthy, don't go looking for trouble." Unless you're overweight, you should get your blood pressure checked every two years after the age of 18, and more often once you turn 40. Most women don't need annual Pap smears. The U.S. Preventive Services Task Force (USPTF) says it's okay to hold off for up to three years. Keeping vaccinations current is a valuable way to stave off a list of preventable illnesses, from flu to cervical cancer (through human papilloma virus vaccine). Flu and pneumonia shots are especially important for people 65 and older, both to avoid the diseases and their potentially dangerous complications. Take your doctor seriously when she talks about good and bad fats in the diet and the value of dropping even a few pounds. Colonoscopy, unpleasant as it is, can be a life-saver. It's recommended at least once every five years for people 50 and older, because colonoscopy reduces the risk of dying from colon cancer by as much as 77 percent. Each year, a million people are diagnosed with colon cancer worldwide, and 500,000 of them die.

Too much of the wrong kind of preventive care can actually get you in trouble. Examples abound in a system that punishes doctors for omitting tests, rewards them for ordering unnecessary ones, and creates dubious borderline conditions such as osteopenia—a step short of osteoporosis—that too often lead to treatment with expensive drugs. And while the test itself may not seem so bad, especially if it's an imaging test that isn't invasive, the consequences of an unnecessary test can be profound, even life threatening. Steven Nissen, chief of cardiology at the Cleveland Clinic, tells of one such case, involving a 52-year-old nurse who agreed to a routine imaging test as added reassurance that her heart was healthy. Tests, for cholesterol, artery inflammation, and rhythm disturbances were normal. But her doctor suggested she undergo an extra test, called catheterization, which would allow doctors to flood her coronary arteries with a dye that reveals blockages. The tube delivering the dye tore one of the heart's main arteries, causing a massive heart attack. A bypass operation to repair the damage ultimately failed. The nurse ended up needing a heart transplant. "I have five more cases like it," Nissen says.