The Medical Overtreatment Problem

It’s just as well that Tara Parker-Pope does not speculate about the cause of the problem. Sometimes it is sufficient to describe the problem and allow us to reflect on the cause.

The medical profession, Parker-Pope reports, has developed an unfortunate tendency to overtreat patients. Often, unnecessary treatment and tests make patients worse than they would have been otherwise.

In her words:

When it comes to medical care, many patients and doctors believe more is better.

But an epidemic of overtreatment — too many scans, too many blood tests, too many procedures — is costing the nation’s health care system at least $210 billion a year, according to the Institute of Medicine, and taking a human toll in pain, emotional suffering, severe complications and even death.

A few weeks ago Dr. Sanjay Gupta wrote an article—dutifully reported here—in which he attributed overtreatment to the fear of lawsuits.

You cannot get sued for ordering too many tests or too many hospitalizations.

A physician can inoculate himself against lawsuits by ordering tests that patients, mostly, do not have to pay for and overtreament becomes endemic to the system.

Parker-Pope gives me the impression that there is more to it than the fear of lawsuits.

She explains:

Some complained that when they switch doctors they are required to undergo duplicate blood work, scans or other tests that their previous doctor had only recently ordered. Others told of being caught in a unending maze of testing and specialists who seem to forget the patient’s original complaint. I heard from doctors and nurses, too — health professionals frustrated by a system that encourages these excesses.

Or, consider the experience of Kara Riehman:

Sometimes the toll of too much medicine is brief, but emotional. Kara Riehman, 43, of Atlanta was vacationing in California when she lost a struggle with an ironing board in her hotel room and ended up with a black eye.

As the bruising peaked around 10 days, she called her doctor to make sure everything looked normal. But instead of seeing her, the doctor, through a conversation with the nurse, ordered a CT scan. She had no symptoms other than a bruised eye, but the doctor never spoke with her or examined her. The scan came back with an ambiguous finding, and the nurse told her it could be a tumor. She was then given an M.R.I. and for two weeks while she waited for the results, she worried she had brain cancer. The nurse called to tell her the M.R.I. was fine.

“It was really terrible,” she said. “It was only two weeks, but there is a lot of cancer in my family. I never actually talked to my doctor through this whole thing.”

The total cost to her insurance company was about $7,000. “It did change how I think about interacting with the medical system,” Ms. Riehman said. “It made me much more of a questioning consumer.”

One does not, as a non-physician, want to start second-guessing physicians. In this case the physician might reasonably have wanted to be cautious. And yet, the physician did not examine her or speak with her throughout her ordeal.

Most of Parker-Pope’s examples are anecdotal, and yet, the research suggests that the problem is pervasive.

From reading her story, one must conclude that physicians themselves bear some responsibility for the problem.

Beyond the fear of malpractice lawsuits, physicians often have a vested interest in prescribing extra care or extra tests or additional follow-up visits. All of them generate income for someone.

Thanks to trial lawyers and patient advocates we have all been taught that every American deserves the best medical care. The more the better.

And every American has been inculcated with the notion that physicians are venal and error-prone, to the point where we need armies of lawyers to protect us against their predatory impulses.

In this culture the practice of medicine has become an adversarial procedure. If it is acceptable for the lawyers to rip off the system, why shouldn’t physicians do the same? If people are dying because of physician error why wouldn’t physicians overtreat and overprescribe… not because they think that it is the best way to help their patients, but because they believe it is the best way to protect themselves against lawsuits and to enrich themselves.

Some will read these stories and conclude that we need malpractice reform. They will note that since Obamacare scrupulously protects the vested interest of trial lawyers it will never succeed in correcting this problem.

Others will examine the facts and decide to double down. They will conclude that we need more regulation, more government control and more trial lawyers policing the system.