Monday, June 7, 2010

Overtreated: More medical care isn't always better. Doctors must lead change.

The Associated Press recent article "Overtreated: More medical care isn't always better" reiterated a commonly known fact which is not understood by the public. This problem of doing more and yet getting little in return is a common issue which plagues the US healthcare system and was illustrated quite convincingly by Shannon Brownlee's book. Americans get more procedures, interventions, imaging, and tests but aren't any healthier.

In fact they are often worse off. Too many unnecessary back surgeries. Too many antibiotics for viral infections, which aren't at all impacted by these anti-bacterial therapies. Too many heart stents which typically are best used when someone is actually having a heart attack. Research shows that those that are treated with medications do just as well. As all patients with cardiac stents know, they also need to be on the same medications as well.

Eliminating unnecessary treatments is a good thing, particularly when it is based on science.

Already over the past year, cancer screening guidelines have been updated based on reviews of the latest medical evidence. Prostate cancer screening with blood test PSA does not appear to be helpful in determining which men have the life threatening aggressive form requiring treatment and which men have the indolent version which will never impact their health. Some medical experts have suggested that breast cancer screening with mammograms should be moved from age 40 to age 50 based on the review of studies.

You would think the public would be happier that they would be poked and prodded less as scientific evidence shows that it is safe to do so. We should want the healthcare system to be in the mindset of continual learning and not mired in old traditions just because that is the way it was always done.

Yet despite this reality, some people view this as rationing of medical care or the beginning of socialized medicine.

It's not. It's the time of rational medicine. Doctors need to lead the change and get away from the hype and more to the science. That is what patients really want. What is particularly disappointing is that overtreatment is well known and already profiled in various articles two years ago. Change is occurring very slowly. It is unclear why. Despite being bombarded with pharmaceutical advertisements, body scans, and easy access to medical information, patients still trust doctors the most for advice.

If we as doctors fail to lead, then patients will be left to figure it out themselves.

And they are already fearful.

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