Nearly one-half of primary care physicians say their patients receive too much medical care. Only 6% say they are receiving too little. This is according to a random sampling of 627 practicing physicians published in the Archives of Internal Medicine. Doctors themselves admit that there’s way too much testing and overly aggressive screening. As a result, otherwise healthy individuals become “patients,” “suffering” from conditions that would never have caused a problem in the first place — a slightly increased cholesterol, a mildly elevated blood pressure, or a slowly developing prostate cancer. Once a diagnosis has been made, doctors are pretty much obligated to “do something” about it.
“When you do anything to somebody, whether it is an intervention or a test, you are putting them into the healthcare system in a way that exposes them to risk. Unnecessary care is potentially harmful,” says Dr. Brenda Sirovich of Dartmouth Medical School (Reuters interview). Dr. Sirovich’s medical school colleague Dr. H. Gilbert Welch agrees: “Too many people are being tested and exposed to the harmful effects of the testing process: the anxiety of false alarms and the vulnerability of ambiguous findings (‘you don’t have the disease, but you aren’t normal’). Not to mention the complications of diagnostic procedures.” Dr. Welch is the author of Less Medicine More Health, a thought-provoking, recently released book that challenges the assumption that more medicine is better medicine.
“Too much medical care has little value,” says Dr. Welch. “Obviously this is not a problem for everyone, and it certainly isn’t meant to deny that some people get too little medical care. But there has to be a growing recognition that the conventional concern about ‘too little’ needs to be balanced with a concern about ‘too much’.” He adds that “too many people are being treated with treatments they don’t need or can’t benefit from … interventions [that] can have substantial physical harms such as medication reactions, surgical complications, even death.”
The biggest fear of most physicians is that they will make a mistake by doing “too little” rather than by doing “too much.” What will it take to remove this pressure to do more rather than less? Malpractice reform is certainly part of the answer. So are realignment of financial incentives and simply having more time to spend with patients.
Ken Teufel, M.D., M.A.