Assuming a physician has no vested interests in a treatment or a test, patients usually just want to know what, if anything, is ailing them. Sometimes, all it takes is better communication by the doctor (having a talk about the effects of aging, for example) or ordering a test to put the patient's mind at ease.
Doctors: "Nearly 85% said the reason for overtreatment was fear of [law]suits"
Authors: "but that fear is probably exaggerated."
Tort reform WAY overdue. Our current system burns out doctors and harms patients. These fears exists for a reason, and it is more than tiresome that others continue to dismiss physicians' concerns. What other profession has a 75-99% chance of being sued by end of career? Which of these authors carries career-ending legal liability for a broken system outside their control? Has anyone NOT seen the malpractice commercials offering "financial compensation"? The courts have become casinos where lawyers roll for big paydays by pitting doctor against patient.
Medical malpractice needs to be handled in an administrative court. Our current system is adversarial, prioritizes emotion over fact, and leads to frivolous lawsuits and defensive medicine. If we wish to continue holding doctors to high standards (and as a physician, I support this) then we need to let doctors practice medicine without fear of unjust lawsuits. We cannot sue 75-99% of docs (seriously, look at our professional liabilities) and not expect them to become defensive. Why so many tests and surgeries? Because we aren't sued for ordering too much, only too little; because we believe ANY missed diagnosis is grounds for legal retribution. Administrative courts free doctors to do what is right for patients while offering patients the justice and financial support they deserve.
1
We need to spend less and get better results with our health care dollars.
Fee for service results in overtreatment. My wife's neurologist said medicine is moving towards prevention. (See article about former head of CDC Tom Frieden: https://www.nytimes.com/2017/09/12/science/tom-frieden-heart-disease-epi.... We need to find out which treatments work and which don't (the ACA funds studies to do this).
The lack of universal standards for care and payment leads to enormous waste. Unfortunately the political will to create a better health care system has been MIA (I'm talking about you, Republicans).
I actually find that there is a fair amount of excessive prescribing done because of the limits imposed to limit waste - so, for example, I had a minor surgery. I was prescribed pain medication for post-surgical pain. It was Friday afternoon. I had no pain by the time I got home, as the anesthesia was still in my system, but I stopped by the pharmacy and asked whether I could fill only one day's worth of the prescription, but come back the next day for the rest if the pain was severe. I was told that it was all or nothing - so, since i had no way of knowing whether I would ultimately need it, I filled all. I ended up needing none.
I've had other circumstances where I would like to fill the prescription in part in case it doesn't work out, but can't as a practical matter, because the only way to get the rest of the prescription would be to go back to the doctor to get another prescription. For these, and other reasons, I have a box of drugs (for me and my family) that I have to get to a "take back" day every year. It always saddens me to see the waste.
On the other hand, the restrictions around ADHD medicine drive me nuts. It's not like my kid is not going to need the drugs next month, but I get to refill every 30 days instead of every 90 days - for no good reason. It costs my insurance less, because then I get three co-pays instead of one. (Oh wait, maybe that is the reason . . ..)
Basically, the system is a mess, and it doesn't work well for anyone.
I've had other circumstances where I would like to fill the prescription in part in case it doesn't work out, but can't as a practical matter, because the only way to get the rest of the prescription would be to go back to the doctor to get another prescription. For these, and other reasons, I have a box of drugs (for me and my family) that I have to get to a "take back" day every year. It always saddens me to see the waste.
On the other hand, the restrictions around ADHD medicine drive me nuts. It's not like my kid is not going to need the drugs next month, but I get to refill every 30 days instead of every 90 days - for no good reason. It costs my insurance less, because then I get three co-pays instead of one. (Oh wait, maybe that is the reason . . ..)
Basically, the system is a mess, and it doesn't work well for anyone.
1
Had single disc herniation, but former UCLA spine chief taking industry money removed a vertebrae in my neck and two two discs! It's like going in for a manicure, falling asleep, waking up and your finger is missing!
Overtreatment is insanely common. Just a few minutes before encountering this article, I was thinking myself, "I wish there was something that kept a check on doctors from over-prescribing medications". I routinely see patients that are on more than 10 medications. The patient I just saw had tremors of hands because of medications. This is very frustrating. Huge amount of money is being spent on medications and procedures unnecessary for the patients. In a recent report in Consumer Reports magazine, I found that $200 billion dollars are spent on unnecessary medications every year. This is a staggering number.
4
"More than 70 percent of doctors conceded that physicians are more likely to perform unnecessary procedures when they profit from them, while only 9.2 percent said that their own financial security was a factor."
In other words, doctors point the finger at the other guys but they themselves are not guilty of what they accuse their colleagues. Currently American physicians practice health care like a resturant. Turnover is the key to increasing income. Imagine if firefighters or police were of the same mind.
In other words, doctors point the finger at the other guys but they themselves are not guilty of what they accuse their colleagues. Currently American physicians practice health care like a resturant. Turnover is the key to increasing income. Imagine if firefighters or police were of the same mind.
2
Over treatment is an epidemic!
Ear infections, sore throats, coughs, etc rarely need antibiotics.
Seventy-five percent of all cardiologic testing is unnecessary.
PSA in men of 70 is contraindicated.
Healthy patient coming for operations need no testing whatsoever.
Ninety percent of all chest x-rays are not required.
A yearly check-up is a waste for > 99% of everyone.
Ear infections, sore throats, coughs, etc rarely need antibiotics.
Seventy-five percent of all cardiologic testing is unnecessary.
PSA in men of 70 is contraindicated.
Healthy patient coming for operations need no testing whatsoever.
Ninety percent of all chest x-rays are not required.
A yearly check-up is a waste for > 99% of everyone.
2
What you say is in fact true. The evidence to support PSA screening in men over 70 is weak.
But what happens if I don't do a PSA on a 72-year-old man and he comes down with prostate cancer that goes metastatic?
I am going to be sued, and probably won't win. Why should I risk my career my family, my kids education, my retirement and my marriage to save an insurance company $25? Wouldn't you do the same?
Until society provides some sort of protection for doctors that practice conservative medicine, this problem is not going to get any better.
I have been to court once, and I prevailed. I am never going back. The cost to defend the case, the stress, and the time spent away from my practice were enormous.
But what happens if I don't do a PSA on a 72-year-old man and he comes down with prostate cancer that goes metastatic?
I am going to be sued, and probably won't win. Why should I risk my career my family, my kids education, my retirement and my marriage to save an insurance company $25? Wouldn't you do the same?
Until society provides some sort of protection for doctors that practice conservative medicine, this problem is not going to get any better.
I have been to court once, and I prevailed. I am never going back. The cost to defend the case, the stress, and the time spent away from my practice were enormous.
1
Perhaps I'm in the minority, but while I've refused medication and interventions when I knew they were unsupported by evidence, never once have I insisted on treatment of any sort when none was offered, nor has any of my close friends and relatives. Where do all of these patients demanding unnecessary treatment come from, and is concern about patient satisfaction surveys or malpractice suits a reason to order or perform potentially harmful interventions that are known to be unnecessary?
2
"More than 70 percent of doctors conceded that physicians are more likely to perform unnecessary procedures when they profit from them"
Study after study, from torn knee meniscus repair to spinal fusion to coronary stents, shows that some of the most widely performed surgeries in the US are no more effective than "fake" surgeries, while exposing patients to lasting complications and risks.
The best way to avoid over-treatment is through an HMO (aka managed care) or Medicare Advantage plan, where the provider isn't paid more for extra treatment and has strong incentives to emphasize primary care and chronic care management.
Maybe that's why Medicare Advantage is growing rapidly.
But the Right has done a pretty good job of demonizing managed care, from the foul "Harry and Louise" ads during the Clinton universal health care effort to looney claims of "death panels" by certified whacko bird Sarah Palin.
Good grief, America!
Study after study, from torn knee meniscus repair to spinal fusion to coronary stents, shows that some of the most widely performed surgeries in the US are no more effective than "fake" surgeries, while exposing patients to lasting complications and risks.
The best way to avoid over-treatment is through an HMO (aka managed care) or Medicare Advantage plan, where the provider isn't paid more for extra treatment and has strong incentives to emphasize primary care and chronic care management.
Maybe that's why Medicare Advantage is growing rapidly.
But the Right has done a pretty good job of demonizing managed care, from the foul "Harry and Louise" ads during the Clinton universal health care effort to looney claims of "death panels" by certified whacko bird Sarah Palin.
Good grief, America!
8
I avoid overtreatment with a high deductible plan. The out of pocket $200 just to set foot in the doctor's office is a powerful incentive.
"Physician, heal thyself..." Apparently most of the unnecessary spinal surgery goes to "backbone removal" on physicians without any faith in their own professional judgement and cowed by the threat of litigation...
4
You have to know the problem and the treatments to ascertain whether the doctor are overdoing it or not
One has to do the research. This is especially in cancer.
One has to do the research. This is especially in cancer.
2
Over treatment in anesthesia is an epidemic without benefit of a brain monitor. The number generated from your forehead allows you to 'control' the dose of anesthesia you receive. Avoid the 30% over medication epidemic. https://www.change.org/p/prospective-surgery-patients-their-loved-ones-s...
1
The opposite can be true. When the anesthesiologist monitors your level of consciousness it isn't merely to avoid over medication. It is also to prevent increasing levels of consciousness when paralytics are also in use during surgery.
1
I just wish today's physician would look at me when I 'm answering their question or describing my problem or telling my history. Get you heads out of your computers.
And does anyone read those 8x11 information sheets you are given and told to complete besides the JCHO evaluators.
Here's an observation from a RN who practiced her profession from 1958 to 2012. Osteopaths generally have the best bedside manner.
Lastly, why are Doctors and Nurses on parallel paths?
And does anyone read those 8x11 information sheets you are given and told to complete besides the JCHO evaluators.
Here's an observation from a RN who practiced her profession from 1958 to 2012. Osteopaths generally have the best bedside manner.
Lastly, why are Doctors and Nurses on parallel paths?
3
One problem with this analysis, patients often withhold information about their symptoms making decisions by doctors harder to determine. Patients do not necessarily avoid telling the truth, they tend to downplay it or they straight out deny it because of fear. Doctors cannot read patient's minds. They work with the information they are given and make decisions for or against treatment.
I am a Family Practice Physician in the Kansas City area. I can tell you that a virtuous Doctor can starve if they don't, at times appease patient about their wants. Many patients will Doctor shop until they find someone who will give them what they want. Patients want immediately easy fixes. They want treatments or tests that likely are not going to change their outcome. Many years back I began giving patient "in case" prescriptions for an antibiotic to fill in case they weren't feeling better in 2-3 days. Many times I got a call within the hour from the Pharmacist that the medication was too expensive. Unfortunately there are Doctors willing to do what ever to keep patients happy and continue to make money. Defensive testing and treatment also add to the problem.
6
In an economy -- and health sector is a huge economic sector -- where profit is the sole criteria and health has been abdicated by the citizens on to doctors to such degree that at least more than half of us don't even bother to eat healthful, sleep sufficient hours, and move our bodies for basic levels of strength and flexibility, is there any wonder that we also ask for more pills, tests and procedures?
there is an inverse relationship: the more we depend upon our doctors, the less we tend to care on our own own, even, or especially, for matters that we can control. Taking care of our health fosters agency and sense of achievement; delegating it entirely to the doctor is to undermine our own health impulse.
there is an inverse relationship: the more we depend upon our doctors, the less we tend to care on our own own, even, or especially, for matters that we can control. Taking care of our health fosters agency and sense of achievement; delegating it entirely to the doctor is to undermine our own health impulse.
2
I think overtreatment is quite common in fee for service system. There is a doctor here in town who does 30 surgeries daily for four days of every week in a greater county area population of a million. I think that doctors like this exist in every area. This kind of number flies in the face of natural prevalence of diseases. Only way doctors like this can keep with this target volume is by doing surgeries on people who do not need them. Hospitals serves these doctors because these doctors are source of major revenue for them. Similarly, patients walking in get MRIs whether they need them or not because practice owns the MRI and the physical therapy. Patients are happy to get all this attention because it does no directly cost them out of their pockets..
5
At some point in the aging process, we all should decide between Quality of Life...and Quantity; i.e. greatest longevity. And then if we select Quality, be prepared to reject major treatment recommendations that would carry with them the risk of major side effects that would degrade the quality of our remaining years. Average life expectancy in the US is currently 79; UK 82 and Japan 84. But I find as I approach that number, my doctors have no interest in scaling back their treatment recommendations. In the interest of reducing overtreatment, and costs, in the final years of life, shouldn't some sort of sliding-scale be adopted by Medicare to ensure us seniors enjoy optimum Quality of Life?
8
As a physician I can see first hand that doctors are not only afraid of malpractice but also are also afraid of poor patient satisfaction surveys which can affect raises and bonuses. Press Ganey and other satisfaction surveys are contributing to defensive medicine. Doctors routinely give into patients all in the name if "production", "numbers", "RVUs" and great Press Ganey scores.
6
Right, & surveys are administered by bean-counting doofuses, who don't understand how to pose effective/legitimate questions, or to consider who is most likely to answer a survey.
Consider this: 20% of all patients have mental problems in the US. Who do you think bothers to answer surveys? Patients who are pleased with a provider think: "well, that's just what he's supposed to do--be competent & kind", They often don't answer surveys. (So the bosses never learn that provider was competent and kind.)
But indignant nutters DO answer surveys. So do patients with a grudge--often that the provider did not give him his requested opiates.
Do the administrators bother to follow up on a dissatisfied survey, to distinguish if the complainer has a legitimate gripe, or whether he's a nutter/addict who should be disregarded?
Do they have any proven indicators about how many dissatisfied patients answer surveys vs how many extremely satisfied patients DO NOT answer surveys? i.e. should one complaint be weighted the same as one praise-filled survey? Or do 20 complaints equal 1 praising survey, since the satisfied seldom respond?
Nope. They take patient satisfaction surveys as gospel, with no verification whatsoever.
So what's a provider to do? Play a defensive game. Cater to the patient's wish, even if it's idiotic or ill-advised.
Evidence-based medicine is all about using computers to count beans, intimidate providers, & hope to maximize profits. Not to improve medical care.
Consider this: 20% of all patients have mental problems in the US. Who do you think bothers to answer surveys? Patients who are pleased with a provider think: "well, that's just what he's supposed to do--be competent & kind", They often don't answer surveys. (So the bosses never learn that provider was competent and kind.)
But indignant nutters DO answer surveys. So do patients with a grudge--often that the provider did not give him his requested opiates.
Do the administrators bother to follow up on a dissatisfied survey, to distinguish if the complainer has a legitimate gripe, or whether he's a nutter/addict who should be disregarded?
Do they have any proven indicators about how many dissatisfied patients answer surveys vs how many extremely satisfied patients DO NOT answer surveys? i.e. should one complaint be weighted the same as one praise-filled survey? Or do 20 complaints equal 1 praising survey, since the satisfied seldom respond?
Nope. They take patient satisfaction surveys as gospel, with no verification whatsoever.
So what's a provider to do? Play a defensive game. Cater to the patient's wish, even if it's idiotic or ill-advised.
Evidence-based medicine is all about using computers to count beans, intimidate providers, & hope to maximize profits. Not to improve medical care.
3
I'm a veterinarian and we have a saying "80% will get better no matter what you do for treatment, 10% will get worse, and about 10% you can actually really help. Part of the art of medicine is knowing the difference". Probably holds true for humans as well!
8
in defense of doctors (I'm not one), if only diseased appendices were removed more people would die of a ruptured appendix. Doctors cannot know for sure that it is appendicitis until they open the patient up and look. Even if they find no appendicitis they remove it anyway because now the patient will have an appendectomy scar and the next doctor needs to know it is gone. That's the standard of care for appendix surgeries; take it out, diseased or not. This is not over treatment per se. Sometimes surgeries meant to help do not, or they make things worse, but sometimes they make things much, much better. Medicine needs to find better predictors for who will benefit and who will not. This is currently not an exact science.
9
"Doctors cannot know for sure that it is appendicitis until they open the patient up and look." Not true. Ultrasound, CT scan-a gold standard can identify. In Europe appendicitis is often treated with antibiotics.
4
@Barbara Siegman
"Medicine needs to find better predictors for who will benefit and who will not. This is currently not an exact science."
Outcome based medicine is alive and well in OECD countries that have single payer. As a patient in both France and the US, I can tell you from personal and family experience, the US system is focused on billable procedures whether they are warranted or not.
"Medicine needs to find better predictors for who will benefit and who will not. This is currently not an exact science."
Outcome based medicine is alive and well in OECD countries that have single payer. As a patient in both France and the US, I can tell you from personal and family experience, the US system is focused on billable procedures whether they are warranted or not.
5
Amen!
1
An informed consumer can make the best choices. We are able to read about treatment and medicine alternatives on the web. If you don't know the reliable sites that exist try medlineplus.gov or go to your local library for help.
5
I wish I were among the 'overtreated". Unfortunately I have a serious Immune Disorder and all of my treatments and medications are necessary to my survival.
However, it is true that many doctors over treat, and that Americans run for pills instead of life style changes. I have made many life style changes which have helped me, so I know. I am fortunate to have many medical family members, and to be highly educated, so I am able to negotiate our bizarre healthcare system. Most people don't have my resources, and are at the mercy of over treatment and TV advertising for prescription drugs, which is another reason for over treatment.
However, it is true that many doctors over treat, and that Americans run for pills instead of life style changes. I have made many life style changes which have helped me, so I know. I am fortunate to have many medical family members, and to be highly educated, so I am able to negotiate our bizarre healthcare system. Most people don't have my resources, and are at the mercy of over treatment and TV advertising for prescription drugs, which is another reason for over treatment.
5
The book: Less Medicine More Health by Dr. Gilbert Welch
7
It is probably more like 50%. People like David Eddy have shown that a large part of medical care is not supported by evidence.
9
September 7, 2017
New York Times
To the Editor,
It is presumptuous to state that because only 2 to 3 percent of patients sue doctors, doctors’ fears of malpractice suits are exaggerated. (“Overtreatment Is Common, Doctors Say”, Well, September 6).
Even if only 1 percent of patients sued doctors, their fears of malpractice suits would not be any less.
Why? Because a malpractice suit can go on for several years. During this time doctors are on tenterhooks wondering how their reputations and livelihoods will be affected. Some are consumed by anxiety. Others give in to depression.
Many of the suits against doctors are based on inconclusive evidence. Some are clearly driven by opportunism. Lawyers call them ‘frivolous suits’. Yet the courts tolerate them and allow them to go forward.
And because doctors don’t want to waste time in court or risk the publicity that can harm their reputations they settle these suits out of court.
Is it any wonder that contrary to what was stated in the article, doctors’ fears of malpractice are not exaggerated?
Edward Volpintesta MD (general practitioner)
New York Times
To the Editor,
It is presumptuous to state that because only 2 to 3 percent of patients sue doctors, doctors’ fears of malpractice suits are exaggerated. (“Overtreatment Is Common, Doctors Say”, Well, September 6).
Even if only 1 percent of patients sued doctors, their fears of malpractice suits would not be any less.
Why? Because a malpractice suit can go on for several years. During this time doctors are on tenterhooks wondering how their reputations and livelihoods will be affected. Some are consumed by anxiety. Others give in to depression.
Many of the suits against doctors are based on inconclusive evidence. Some are clearly driven by opportunism. Lawyers call them ‘frivolous suits’. Yet the courts tolerate them and allow them to go forward.
And because doctors don’t want to waste time in court or risk the publicity that can harm their reputations they settle these suits out of court.
Is it any wonder that contrary to what was stated in the article, doctors’ fears of malpractice are not exaggerated?
Edward Volpintesta MD (general practitioner)
20
What would you suggest as an effective remedy to medical malpractice?
Would you be stand up and reveal the ineptness or poor practices of a colleague, or hospital, or an accidental harm, if that physician didn't speak the truth to the patient?
Most doctors, hospitals and other medical groups do not open their records to patients.
A threat of a lawsuit or an actual suit is stressful; there is some data which suggests that being truthful with patients about bad outcomes is best and does not lead to more - but l fewer - lawsuits.
It is rarer than rare for a physician to be disciplined by "peer" organizations. And when a physician is disciplined via a state overseer, generally out of a report from a patient, the physician often does a plea bargain ( or whatever it is termed in a hearing, not court, situation. Some times I would guess it's because it's the easy path or the insurer doesn't want to go to court -- but the process of "neither admitting nor denying" the allegations raised at a hearing is also a way to avoid having the specific allegations recorded for the public to see. One can see that someone is on probation for a time, or may not do certain procedures or prescribe certain drugs, but without knowing the results of any investigation.
Yes, there are patients who are after some sort of jackpot, on flimsy evidence, but there are others who have been badly treated and should have a right to a full explanation, and compensation.
Would you be stand up and reveal the ineptness or poor practices of a colleague, or hospital, or an accidental harm, if that physician didn't speak the truth to the patient?
Most doctors, hospitals and other medical groups do not open their records to patients.
A threat of a lawsuit or an actual suit is stressful; there is some data which suggests that being truthful with patients about bad outcomes is best and does not lead to more - but l fewer - lawsuits.
It is rarer than rare for a physician to be disciplined by "peer" organizations. And when a physician is disciplined via a state overseer, generally out of a report from a patient, the physician often does a plea bargain ( or whatever it is termed in a hearing, not court, situation. Some times I would guess it's because it's the easy path or the insurer doesn't want to go to court -- but the process of "neither admitting nor denying" the allegations raised at a hearing is also a way to avoid having the specific allegations recorded for the public to see. One can see that someone is on probation for a time, or may not do certain procedures or prescribe certain drugs, but without knowing the results of any investigation.
Yes, there are patients who are after some sort of jackpot, on flimsy evidence, but there are others who have been badly treated and should have a right to a full explanation, and compensation.
6
Have you ever been the victim of a medical mistake? Have you ever had a doctor lie to you to protect themselves? Have you ever had surgery done, had a mistake made, and then been blamed for it by the surgeon? Patients wind up paying the price for medical errors. It costs us money, can cost us our jobs and livelihoods, can ruin our lives. Since most of us cannot afford to pay the full cost for our medical care and cannot truly afford insurance if we're not working, doctors, hospitals, and others are sued. If you want that to change a better way of paying for medical care needs to be put in place. If you want to be trusted you have to be willing to spend more time with your patients, start explaining things to them, don't make light of their fears, and be honest if you aren't sure what's wrong.
1
I have found that when I've gone to the doctor for an illness she'd write out prescriptions for antibiotics before I asked. But I had to remind her to write out a prescription for ear drops and cough medicine. And when I told her I didn't want to take the antibiotics she stared at me like I had just spoken Greek to her. The antibiotics don't help with the pain from an ear infection or the cough from bronchitis. They don't stop the pain of a sinus infection or one that has traveled into an ear.
Most people do not remember the remedies we used before antibiotics were around. I have friends who go to the doctor for a simple infection from a splinter because they've never heard of removing it themselves and disinfecting the area with alcohol. But the other side of the problem is that too many of us cannot get health care when we need it because health care has become a luxury. We may decide not to have a test because of the cost. We may regret that decision.
What this article doesn't state is that most health care providers do not take enough time with patients for them to feel that they are being treated properly for their problem. We've all experienced the eye roll when we ask why or if it's necessary. It seems to this reader that our health care system is not set up to care about the patients and that is a real problem because if patients feel they can't trust anyone to act on their behalf they have no reason to believe anything they're told.
Most people do not remember the remedies we used before antibiotics were around. I have friends who go to the doctor for a simple infection from a splinter because they've never heard of removing it themselves and disinfecting the area with alcohol. But the other side of the problem is that too many of us cannot get health care when we need it because health care has become a luxury. We may decide not to have a test because of the cost. We may regret that decision.
What this article doesn't state is that most health care providers do not take enough time with patients for them to feel that they are being treated properly for their problem. We've all experienced the eye roll when we ask why or if it's necessary. It seems to this reader that our health care system is not set up to care about the patients and that is a real problem because if patients feel they can't trust anyone to act on their behalf they have no reason to believe anything they're told.
22
"most health care providers do not take enough time with patients for them to feel that they are being treated properly for their problem."
Yes, and why don't they take more time with each patient?
Because they will be fired if they do so. Providers are held to strict productivity quotas by their facilities. It's not greed on the part of your providers--it's fear.
Yes, and why don't they take more time with each patient?
Because they will be fired if they do so. Providers are held to strict productivity quotas by their facilities. It's not greed on the part of your providers--it's fear.
9
Our healthcare system limits visits to 15 minutes but can be much shorter if earlier patients have required more time. Feeling rushed makes it difficult for the patient to explain and the dr. To understand. Result: frustration on both sides.
6