Too Much of a Good Thing is Bad

Rodney Warner
Rodney Warner

Why is the American healthcare system the most expensive in the world?  A recent article in The Atlantic magazine discussed one reason, the problem of unneeded and unnecessary medical treatment taking up 30% of all healthcare spending.

According to the article, in a 2011 survey published in the Archives of Internal Medicine, 42 percent of primary care physicians said that patients in their own practice were getting more care than necessary.

Why so much?

  • Doctors want to make sure their patients get enough care, so they do too much.
  • Doctors fear medical malpractice lawsuits, so order more tests than needed and more treatment than necessary so they won’t be accused of not doing enough for their patients. In the 2011 study, malpractice was cited far more frequently than any other factor as encouraging physicians to do more than they felt was clinically necessary.
  • Doctors’ incomes are largely driven by the quantity of healthcare that’s provided, not its quality or effectiveness. Financial incentives can impact treatment recommendations.  A study published in October in the New England Journal of Medicine found that urologists were much more likely to refer patients for radiation treatments if they had an ownership interest in the radiation practice.  According to the article:

    Over the five-year period from 2005 to 2010, the use of radiation therapy by self-referring urologists in private practice jumped 19.2 percentage points, whereas the rate among their non self-referring peers barely budged, going up just 1.3 percentage points… Earlier this summer, a report of the United States Government Accountability Office examined rates of referrals for biopsies and found that between 2004 and 2010, referrals for biopsies more than doubled among self-referring physicians, even while they increased only 38 percent among those who referred outside their own practices.

You might think that, from the patient’s perspective, an unnecessary test isn’t such a big deal.  But if the results are inconclusive, there may be a second, more invasive test.  There may be complications as a result, or a wrong diagnosis leading to treatment for a disease or condition that doesn’t exist. The article quotes Brenda Sirovich, a research assistant at the VA Medical Center in White River Junction, Vermont, the author of the 2011 article as saying,

As you intervene on patients who have less and less reason to intervene and less and less chance of benefiting, you still retain that probability of harming them… In a word, that is the biggest problem with doing too much—the risk of harm.

Next time your physician orders a test, CT scan or suggests a course of treatment, don’t be afraid to ask, do I really need this?  Is this really necessary? What other options are there? Unnecessary treatment or tests won’t do you any good, may do you harm, will just pad your medical bill and could result in higher health insurance premiums.

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