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.
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.