September 26, 2012 | Posted By Hayley Dittus-Doria, MPH

An article about the concept of overtreatment recently caught my eye. We live in a world of excess-bigger houses and larger food portions, among others. These are necessarily bad, just perhaps more than we need. The same goes for medical treatment. Like many things in the U.S., people equate “more” or “bigger” with “better.”

The problem with this mentality when it comes to healthcare procedures is the large cost that comes with it. According to the article, overtreatment is costing the U.S. healthcare system $210 billion each year. And spending that money doesn’t earn us high marks in terms of our health outcomes compared to the rest of the world. Between “one fifth and one third of our health care dollars” are spent “on care that does nothing to improve our health” according to Shannon Brownlee, author of “Overtreated.” In a 2009 New Yorker article, Dr. Atul Gwande also points out the fact that simply because you’re receiving more aggressive healthcare doesn’t necessarily mean you’re healthier. 

Overtreatment has additional, non-financial ramifications as well. Emotional consequences can be quite serious. What if you had a cough for a few weeks? And when looking into the cough, you discover something else? And when looking into that new diagnosis, yet another problem comes to light? When your expectation was just to be treated for your cough, would you want to find out all of the other illnesses you might have? Maybe. But maybe not. Perhaps, other than your cough, you felt fine, but now your days are spent getting test done, blood work run, procedures scheduled.

Polypharmacy, or the use of multiple medications, is another consequence of overtreatment. Adverse drug reactions and complications can negatively affect a patient. Elderly patients in particular are most affected by polypharmacy. These patients are often found to be less functional due to the side effects of these multiple medications than because of the actual illness.

Patients look to physicians as people they can trust. The doctor knows best, right? He or she knows which tests are necessary to run and the right decisions to make. I wholeheartedly believe that the majority of the time this is the case. However, sometimes it’s just too much. Maybe the physician still believes all of these tests and diagnoses are necessary and the right decision, but that doesn't mean it’s the right decision for that particular patient.

But the problem lies with patients as well. People see commercials about different medicines curing different illnesses and hear about the newest breakthroughs in medical technology. With our “bigger is better” mentality, we want the newest, biggest, best thing. And, after we self-diagnose with WebMD, we want the physician to support or refute our diagnosis using whatever means necessary.

We need to sit back, take a breath, and realize that “bigger” and “newer” isn’t necessarily better. We don’t always need to know every tiny little thing that may not be at 100% in our bodies. And we, as a country, don’t need to overtreat and spend the billions of dollars we currently spend with no improved health outcomes.

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website.

1 comments | Topics: Affordable Care , Drug Safety , Global Health , Health Care Policy , Patient Care , Pharmaceuticals , Public Health Ethics


sheila otto

sheila otto wrote on 09/26/12 3:25 PM

How true these comments are. Much has been written about routine screening for both prostate cancer and breast cancer. The data suggests that these tests are not always in every patient's best interests. More and more tests typically follow questionable results and that the cost of anxiety in addition to the billed costs often lead to a false positive or to interventions that may not change the course of the disease. The problem is that the individual pt. is too afraid NOT to do "what the doctor says or get what s/he ordered". The implications of these choices, however affect more than the individual. Public policy, insurance coverage, PR, etc. all come into play. One place where we can start is educating the pt as to his/her options, including the risks involved with doing nothing.

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