Tuesday, May 5, 2015

The fight against overtreatment

I've read a lot of stuff about the overtreatment that runs rampant in the American medical industry: tests being ordered that aren't needed, drugs being prescribed when they shouldn't, etc.  Sometimes it's because doctors are told that's what they're supposed to do, but there was an article on NPR the other day about how sometimes it's in spite of the recommended procedures.

Why Many Doctors Don't Follow 'Best Practices'

Dr. Steven Brown, a professor of family medicine at the University of Arizona, has studied doctors' reasons for ordering unnecessary tests before a scheduled surgery. A lot of it has to do with perceived safety, he says.

"They think, somehow, that this is going to make the patient more likely to do well in surgery," he says. "It's not."

Brown says some doctors don't know the latest guidelines, which is somewhat understandable, since there can be hundreds to follow.

But often, he says, doctors order extra tests because they think someone down the line — another surgeon or anesthesiologist — will require them.
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"[It becomes] this game of tag," he says, "where you're doing something because you think somebody else wants it, even if you don't really want it."
The article points out that this is when the science and the recommendations are clear -- and that the situation is more dire when it's not, such as in the case of breast cancer screenings.
After analyzing the best studies, the influential panel now suggests most women get a mammogram every other year, beginning at age 50. Guidance from this task force largely determines which tests will be covered by Medicare, Medicaid and insurance companies.

Meanwhile, the American Cancer Society and the American College of Radiology still recommend annual screening mammograms for women beginning at age 40.

"There's really a lot more ambiguity about what is the right thing — what's appropriate [and] what's not appropriate," says Dr. Albert Wu, an internist and professor at the Johns Hopkins Bloomberg School of Public Health.
Personally, I think that this is kind of scary, but it's also a strong case for knowing the research and the recommendations yourself.  It's hard to know everything your doctor knows, as the patient, but you should at least know as much as you can so that you can make better-informed decisions in defense of your own health.

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