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U.S. physicians say up to 30 percent of medical services are unnecessary

U.S. physicians say up to 30 percent of medical services are unnecessary
REUTERS/Jim Bourg
The top three reasons the physicians cited for overtreatment was fear of malpractice, pressure from patients, and difficulty accessing the prior medical records of patients.

Most physicians believe that a significant portion of the medical care dispensed in the United States is unnecessary, according to a recent study published in the journal PLOS One.

They also believe that medical overtreatment causes patients preventable harm and wastes health care resources, the study found.

Such beliefs are not new, even in the medical community. In 2012, for example, the Institute of Medicine (now the National Academy of Medicine) reported that of the $750 billion wasted each year by the U.S. health care system, $210 billion was squandered on unnecessary services.

But the current study is apparently the first one to ask a large, nationwide group of physicians from a range of specialties their thoughts about overtreatment.

“Most doctors do the right thing and always try to; however, today ‘too much medical care’ has become an endemic problem in some areas of medicine,” said Dr. Martin Makary, the study’s senior author and a professor of surgery and health policy at Johns Hopkins University, in a released statement.

A detailed survey

For the study, Makary and his colleagues conducted an online survey in 2014 of 2,106 physician-members of the American Medical Association. The respondents included primary care physicians (internal medicine practitioners, family medicine practitioners and pediatricians), as well as those from a variety of specialties, such as cardiology, endocrinology, geriatrics, oncology, rheumatology and sleep medicine. Most of the respondents worked in urban settings (67 percent), for academic institutions (66 percent) and received a salary (64 percent) rather than fee-for-service payments. Almost half of the respondents had at least 10 years of medical experience post-residency.

The survey asked the physicians a series of specific questions about overtreatment, its causes and its solutions. An analysis of their answers revealed that a majority of them — 64.7 percent — believe that at least 15 percent to 30 percent of medical care is not needed. On average, the response from physicians was that 20.6 percent of overall medical care is unnecessary, including 24.9 percent of tests, 22 percent of prescription medications and 11.1 percent of procedures. 

Even more troubling was the finding that 71 percent of the respondents said physicians are more likely to perform unnecessary procedures when they personally profit from them. That particular belief was strongest among specialists and physicians with at least 10 years of post-residency experience.

A fear of malpractice suits

The top three reasons the physicians cited for overtreatment was fear of malpractice (84.7 percent), pressure from patients (59 percent) and difficulty accessing the prior medical records of patients (38.2 percent). Other reasons cited included inadequate time spent with patients, pressure from colleagues and medical institutions or management, as well as concerns about “looking good” in performance evaluations.

The problem of malpractice may be overblown, however. As Makary and his colleagues point out in the study, “perceptions on the prevalence of malpractice suits … may be greater than the reality of the problem.”

“Only 2-3% of patients harmed by negligence pursue litigation, of whom about half receive compensation,” they explain. “Paid claims have declined by nearly 50% in the last decade, and it has been suggested that honest disclosure and an offer of an apology by the physician can further mitigate litigation.”

Fixing the problem

What do physicians believe should be done about the problem of overtreatment? The three most cited solutions (the only ones to receive a majority of the surveyed physicians’ votes) were 1) training medical residents to better understand the criteria for appropriate care (55.2 percent), 2) making outside medical records easier for physicians to access (52 percent) and 3) developing more evidence-based guidelines for physicians to follow in their practices (51.5 percent).

“Guidelines should consider overtreatment consequences rather than simply increasing screening or diagnosing for a particular patient population,” Makary and his colleagues write.

A much smaller percentage (29.1 percent) of the physicians said a potential solution to overtreatment lay in decreasing fee-for-service payments and giving physicians a set salary instead.

Choosing wisely

And what can patients do? The study doesn’t address this question, but it does mention the five-year-old Choosing Wisely campaign, which was launched by the American Board of Internal Medicine Foundation in collaboration with Consumer Reports to help physicians and patients choose medical care that is evidence-based, free from harm and truly necessary.

The campaign has compiled detailed but easily accessible resources to help patients identify the hundreds of medical tests and treatments that often are either overused or that provide little benefit — and in some cases cause harm. The recommendations come from several dozen medical societies in the United States.

The campaign also recommends that each of us ask our doctors these five basic questions before we undergo any test or treatment:

1.  Do I really need this test or procedure?

2.  What are the risks and side effects?

3.  Are there simpler, safer options?

4.  What happens if I don’t do anything?

5.  How much does it cost, and will my insurance pay for it?

I recommend writing down those questions and taking them with you to your next doctor’s appointment. I also recommend bookmarking the Choosing Wisely website so that you can quickly access it the next time your visit your doctor.

FMI: You can read the new study in full on the PLOS One website.

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Comments (8)

Reigning in tort lawyers was

Reigning in tort lawyers was to be a key piece of the GOP plan to replace Obamacare.

Instead, we are goung to backfill the hole they dig with tax dollars. Oh, and I'd be remiss not to observe our national debt just exceeded $20 trillion dollars.

I, for one, am speechless.

Its difficult to understand your post

given that actual suits against Doctors was just 2 to 3% of patients harmed with only half of those 1 to 1.5 % receiving a cash settlement. So for your comment to make any sense whatsoever the numbers behind that 1-1.5% would have to be HUGE. Are our doctors really that bad that vast numbers of patients are being harmed and compensated?

That's the key though

Pop culture tells us lawyers are evil, and with such a tiny fraction of patients actually requiring redress for negligent action, its an easy target. Since the folks being harmed, those physically damaged by doctor's negligence, are so few in number, their plight becomes a meaningless abstract, happening to "other" people.
Thus meaningless action against a virtually non existant portion of the problem, tort reform, can be used to deflect from the more odious "solutions" proferred for the meaningful problems with healthcare reform. Same old games that conservatives have always played.

Tort Lawyers

The key to courtroom justice for the middle class.

(quote) The study examined

(quote)

The study examined the medical malpractice claims made against 54,099 physicians from 2005 to 2014. Sixteen percent of physicians in the study had two or more paid claims against them. Four percent had three or more claims.

Perhaps the most shocking finding of the study was that only one percent of the physicians surveyed were responsible for 32 percent of the reported paid claims.

http://www.powers-santola.com/blog/2016/02/one-percent-of-physicians-acc...

(end quote)

Perhaps if you want to decrease the civil legal penalties for malpractice, the worst 2 or 3 percent of doctors which spawn the majority of malpractice should face criminal penalties--or at least removal of their license.

look more closely

The doctors who are sued are not necessarily the "bad apples." They are just as likely to be practicing in a field with higher risks and less long-term relationship with the patient (neurosurgery for instance) or in a community where lawyers are more likely to sue.

Exactly.

Not only that, look at the examples of claims the link shares:

"Failing to diagnose an illness or injury"
"Misdiagnosing an illness"

Automobiles are thoroughly documented; we know exactly how they work and what kinds of things go wrong, and yet, everyone that has ever taken a car to a mechanic to fix, has gotten it back with the same problem at least once.

But doctors are expected to get it 100% right 100% of the time; it's crazy.

Daytime TV is flooded with commercials for accident lawyers ("And I'll FIGHT to get you the compensation you deserve") and invitations to join class action lawsuits (literally, the Golden Fleece of injury law). It's a multi-billion dollar business, and yet, there are those out here that will defend it.

What needs to be reined in

What needs to be reined in are drug costs. That's where the true outrages lie.

And, of course, in the policy abominations that the GOP Congressional leadership tried to foist off on us in their shifty attempts to repeal Obamacare (they had no "health care" plans to replace it).

One has to laugh at someone trying to make tort attorneys some kind of evil force in this!