Overtesting, Overdiagnosis, & Overtreatment

As promised, today I’m talking about the other article that connects to the one discussed in my previous post.

Atul Gawande, a surgeon, professor, and the bestselling author of Being Mortal, was eating lunch and clicking through medical articles. One in particular that caught his eye was a study of more than a million Medicare patients: “They studied how often people received one of twenty-six tests or treatments that scientific and professional organizations determined to have no benefits or to be outright harmful. . . . In just a single year, the researchers reported, twenty-five to forty-two per cent of Medicare patients received at least one of the twenty-six useless tests and treatments.”

In his article, “Overkill,” Gawande uses this Medicare study as a starting point to cover a range of medical topics including overtesting, overdiagnosis, and overtreatment.

Connecting with the above quote, some key points Gawande mentions are:

  • “Millions of people are receiving drugs that aren’t helping them, operations that aren’t going to make them better, and scans and tests that do nothing beneficial for them, and often cause harm.
  • “Researchers have come to refer to financial as well as physical ‘toxicities’ of inappropriate care—including reduced spending on food, clothing, education, and shelter.”
  • “The United States is a country of three hundred million people who annually undergo around fifteen million nuclear medical scans, a hundred million CT and MRI scans, and almost ten billion laboratory tests.
  • “One study found that between 1997 and 2005 national health-care expenditures for back-pain patients increased nearly two-thirds, yet population surveys reveal no improvement in the level of back pain reported by patients.”

I find these points disturbing, and I also understand all the blame cannot be placed on the medical community. Gawande highlights the dilemma faced by doctors: “We’re more afraid of doing too little than of doing too much. And patients often feel the same way.” Connecting with this, he talks about removing a patient’s thyroid, because she feared a small tumor that was discovered.  He writes he was against the operation: “The surgery posed a greater risk of causing harm than any microcarcinoma we might find . . . .”

Gawande also discusses another perspective—individuals who are fortunate enough to have healthcare providers who do not jump to surgery and utilize various medical specialists to treat their patients’ conditions.

He spends some time discussing the WellMed model whose president, Carlos Hernandez views “the primary care doctor as a kind of contractor for patients, reining in pointless testing, procedures, and emergency-room visits, coordinating treatment, and helping to find specialists who practice thoughtfully and effectively.” This approach, in part, addresses the above points on the Medicare study.

These providers took time with their patients. As an example of replacing unnecessary care with care people need, Gawande talks about a man with diabetes whose blood-sugar levels were dangerously high, but his body had developed a tolerance to spikes in blood sugar. This man’s doctor spent 45 minutes with him and explained his condition and how to treat it.

Then, a nurse who was also a certified diabetes educator, spent another 45 minutes with him. She also arranged to call him every other day for a week and to bring him back into the office if necessary. This individual was a Medicare patient, and his doctor was a WellMed physician. Such steps have resulted in “a large reduction in the overuse of care and better outcomes for patients.”

In part, Gawande’s article provides an alternate perspective on the usual medical model. Is it a cure-all? He himself wonders: “Could a backlash arrive and halt the trend?” “If doctors are rewarded for practicing more conservative medicine, some could end up stinting on care.” These and other issues must be raised in the ongoing healthcare debate. Gawande points out the possibility of better care for patients as well as reduced medical costs.

I have only provided highlights of this article. In fairness to Gawande, please read his piece when you have a chance.

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