Any physician uncomfortable being doubted needs to find other work, so I have to be comfortable when a patient asks this question: “Doc, are you sure I really need that test / medication / treatment / surgery / X-ray you have suggested?”

The simple question can have a powerful effect on physicians and patients because many tests and treatments in medical care are unnecessary, or of marginal benefit over other options. “Do I really need this?” is a question that should prompt a good “risk versus benefit” discussion, which might in turn confirm the original recommendation, or lead instead to safer, cheaper alternatives.

Millions of such conversations would be useful, given the tremendous amount of wasted care in American medicine. Patients get tests and treatments they really do not need because they don’t know better (resulting in antibiotics for viral colds, for example), because our physicians are paranoid about being sued (resulting in defensive X-rays and other tests), and because many physicians and patients ignore guidelines suggesting when some tests and treatments can be avoided.

Money is another key reason for unnecessary tests and treatments. The majority of patients do not pay for all of their health care, providing them some protection from the financial ramifications of unnecessary tests and treatments. Why shouldn’t I have an ankle X-ray just to be sure I don’t have a tiny fracture if it doesn’t cost me anything? Perhaps as important, no one providing health care gets any revenue when a test or treatment does not get done, which means the business model of health care benefits from all testing and treatments, regardless of the benefit to the patient.

Fear also plays a role. If a test or treatment is not done, the patient may be unhappy or be harmed by a missed diagnosis, and the physician might get sued. By comparison, a test or treatment that costs money but seems unlikely to cause harm is a small price to pay.

The result of all this? Treating and testing are often easier than not treating and not testing in America, and by some estimates a third of the tests and treatments we get may be unnecessary or avoidable. For example, as many as one in three ankle and knee X-rays for acute sprains in adults could safely be avoided. Antibiotics are widely and unnecessarily prescribed for viral colds, which are immune to antibiotics. Rates of common surgeries such as hysterectomy vary by two- to threefold from one community to another, suggesting many of those surgeries are probably unnecessary. Billions of health care dollars are spent annually by physicians ordering tests in order to avoid being sued. We spend more billions each year treating conditions that could be treated more safely, effectively and cheaply by diet and exercise.

A classic example of this power of the patient or family to suggest alternatives is the 3-year-old child with an ear infection. We now know that most children with ear infections do not need antibiotics for treatment, because most of those infections are caused by viruses; time and pain medication will usually take care of the problem. Unfortunately, it takes precious time and energy to convince a mother who expects an antibiotic for the child that it is really unnecessary, so physicians often just prescribe instead.

On the other hand, if the mother suggests she is willing to consider the alternative by asking, “Does my child really need that antibiotic?” the physician knows the mother is less likely to be angry if antibiotics are not prescribed, and is less likely to complain “I told you so!” if antibiotics are not prescribed initially but become necessary later. She will probably take less time to be educated about a no-antibiotic option.

The same kind of question from a heart patient about the need for a cardiac catheterization, a woman about the need for a hysterectomy, or a patient with a cold about the need for antibiotics, could lead to good conversations about safe alternatives to other expensive tests and treatments for some patients.

Among the many steps we are going to have to take in order to rein in medical costs in America, we are going to have to quit spending money on tests and treatments we do not really need. We as patients can take the lead in helping to make that happen by having the first words out of our mouths when told we need a new treatment or test be “Doc, are you sure?” rather than, “Sure, Doc, whatever you say.”

The medical community, insurers and government should take steps to support such conversations, because one little question could go a long way to better, more affordable health care for all.

Erik Steele, D.O., a physician in Bangor, is chief medical officer of Eastern Maine Healthcare Systems and is on the staff of several hospital emergency rooms in the region.