Doctor says medical profession 'over-tests' patients


Dartmouth College's Dr. Gilbert Welch says we all have abnormalities in our bodies but most are harmless.

"And thereby some people are being treated for things that will never bother them. And yet they can be harmed by treatment," said Welch, author of "Overdiagnosed: Making People Sick in the Pursuit of Health."

A recent study out of Norway estimates between 15 and 25 percent of breast cancers found by mammograms would not have caused any problems during a woman's lifetime, but were treated anyway.

"Maybe not starting mammograms at age 40 but starting them at age 50, and maybe not doing them every year but doing them every other year might actually be in their interest," said Welch.

Welch also believes there is too much testing for prostate cancer.

"Twenty years ago a simple blood test was introduced called the prostate-specific antigen and 20 years later about a million men have been diagnosed with a cancer that was never going to bother them," said Welch.

Ultimately, Welch says it comes down to finding the right balance.

"We need to tell them about both sides of the story," said Welch.

In a recent medical survey, 42 percent of primary care physicians thought their patients were over-treated. The reasons include malpractice concerns and not enough one-on-one time with patients. And 28 percent of the doctors in the survey admitted to practicing too aggressively.

BACKGROUND: Anywhere from one-fifth to nearly one-third of tests and treatments are estimated to be unnecessary, and they may lead to dangerous side effects. Overtreatment occurs because doctors engage in defensive medicine, or order tests and procedures to protect themselves against lawsuits. Also, the fee-for-service system compensates them for ordering more tests. It also has become much easier to order tests because of the Internet. Patients also contribute too, as they demand routine tests because they're bolstered by advertisements, medical information online, and doctors. For many, tests provide reassurance.

POTENTIALLY HARMFUL SIDE EFFECTS: Americans receive most medical radiation in the world, and much of it comes from repeated CT scans (too many scans increase the risk of cancer). Thousands who get stents for blocked heart arteries should have tried medication first. Doctors prescribe antibiotics tens of millions of times for viruses like colds that drugs can't help. Back pain is the number-one over-treated condition, from repeated MRI scans that can't pinpoint the trouble to spine surgery on people who could have gotten better without it. About one in five who gets that first back operation will wind up having another in the next decade. There are many reasons that one of three U.S. births now is by Cesarean section, but an inaccurate monitor strapped to women in labor may be to blame.

HOW OVERTREATMENT IS BEING ADDRESSED: Beginning next year, Medicare will penalize facilities where patients get a lot of hospital-acquired infections, and where a lot of patients are readmitted shortly after being discharged. The Affordable Care Act by the Obama Administration provided funding for a research center that compares existing treatments against each other, something that's not usually done when new drugs are approved. The American College of Physicians (ACP) is creating guidelines to help doctors better identify when patients should screen for certain diseases and when they can be spared the potentially costly and invasive procedures that follow. The Health Cooperative HealthPartners in Minnesota saw use of MRIs and radiation-heavy CTs growing between 15 percent and 18 percent a year, so the insurer began a new program: National radiology guidelines pop up on each patient's electronic medical record whenever a doctor orders a scan. It's not required, but it's a reminder of when certain tests are recommended. After 2 years, HealthPartners estimates it avoided 20,000 unnecessary tests, preventing dangerous radiation exposure and saving $14 million. An American Medical Association journal, Archives of Internal Medicine, just began a "Less is More" series to educate doctors about the risks of overused treatments. The journal Annals of Internal Medicine began publishing the American College of Physicians' guidelines for "high-value, cost-conscious care." To increase patients' awareness, around a dozen health centers around the country are testing "shared decision-making," a process using plain-English guides or DVDs to explain the advantages and disadvantages of test and treatment options.

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