PrintDuring the debate over health care reform, much of the discussion centered on the perils of people who were uninsured or had no access to health care. Medical over-treatment ? unnecessary tests, treatments and, worse yet, dangerous side effects of scans and medications ?
may be just as problematic. This is just as significant a problem with regard to patient care and cost containment. Somehow, insurance and government health care program reimbursement models need to discourage the inappropriate use of treatments, medications and screening tools that can pose a danger to patients. Physicians are relatively poorly paid for spending time with patients and helping them make choices about their care. Meanwhile, there are considerable financial incentives for delivering certain kinds of care. Some physicians fear lawsuits, so they practice defensive medicine, ordering tests that may not be medically necessary but provide evidence that a high standard of care was offered. At the same time, patients have become increasingly demanding of their caregivers. They are unwilling to give their bodies time to recover from illnesses or injuries. Instead, they demand surgeries or medications. For instance, a very small percentage of people with back pain are good candidates for surgery. Yet, complicated back surgeries are on the rise. In fact, back pain remains the No. 1 overtreated condition in the U.S. About one in five patients who undergoes an initial back operation will wind up having another in the next decade. Meanwhile, they may undergo repeated MRI scans that can't pinpoint the problem. This contributes to Americans being exposed to the most medical radiation in the world, which can increase the risk of cancer. A new Associated Press report on the most overused medical practices, which included an extensive review of medical studies and interviews of medical experts, found that thousands of people who received stents for blocked heart arteries should have tried medication first. Although medical science has long known that prescribing antibiotics for viruses such as colds is futile, tens of millions of such prescriptions are written each year. Clearly, a lack of medical coverage and/or access to care can result in premature deaths or poor quality of life. Conditions that could be readily managed through diet, exercise, appropriate medication and regular physician visits can become life-threatening if they are ignored. But this Associated Press report suggests that over-treatment carries its own risks. Responsible caregivers need to guide patients in a manner that produces good outcomes and spares them from unnecessary risk. Patients, too, need to quit making unreasonable demands of caregivers and be willing to take a conservative approach to care and treatment before insisting upon tests that may pose other problems or treatments that have a low percentage of success.
