Routine medical procedures are not risk-free, and patients should ask questions before consenting, according to oncologist and author Ranjana Srivastava. She argues that the distinction between something being medically available and actually being medically useful has become blurred.
Routine does not mean no-risk
Srivastava recounts how a friend's husband went into hospital for what was termed a routine procedure, but the surgery unleashed a bacterial shower, rendering him septic on the operating table. He spent days in intensive care receiving life-sustaining treatment and recovered, but the experience highlighted the potential dangers.
Another friend underwent a gastroscopy to re-examine a gastric ulcer and reported that the colonoscopy was "pristine." When asked why she needed a colonoscopy, she replied, "They just did it," and guessed it was routine.
Colonoscopy and antibiotics
Srivastava notes that colonoscopy is the gold standard test for early detection of bowel cancer, but it is not benign. Bowel preparation can cause dehydration and electrolyte imbalance, the procedure can result in bleeding and rarely perforation, and sedation carries its own risks. All risks are increased in elderly people.
She also highlights that 40% of the global population leave the doctor's office with an antibiotic prescription, and nearly 60% of these prescriptions are unnecessary. Antibiotics can alter the gut microbiome, predisposing to C difficile infection, and 70% of people who develop this condition have received antibiotics in the past 12 weeks. Antibiotic resistance is another concern, with more than a million people each year dying from drug-resistant infections.
Unnecessary care harms necessary care
Srivastava points out that IV insertion is the most common invasive procedure in hospitals today, with a billion such procedures a year, many done unquestioningly despite documented problems like pain and serious infection.
She argues that unnecessary care compromises necessary care, as healthcare is a finite resource. Money, time, and doctors' attention devoted to low-value care are diverted from people with genuine need. She advises patients to ask why they need a procedure, what the alternatives are, and what happens if they don't have it. Doctors should remember that familiarity does not equal harmlessness, and truly informed consent means telling patients honestly about how routine procedures can go awry.
