Do Patients Want More Care or Less?

As readers of this blog know, I promote the point of view that sometimes in Medicine, Less is More. The title of my blog is “First, Do No Harm.” So this article from the NYTimes illustrating how not only patients, but physicians also are starting to see the benefit in opting to do nothing. I will emphasize a few points in the article, but those interested in this topic, please go to the link and read the whole thing. I will provide links to my previous blog posts that covered some of the topics here. (For more on my practice please click here.)

April 4, 2012, 4:11 pm
Do Patients Want More Care or Less?

By DAVID NEWMAN, M.D.

…While diagnosing bronchitis, a common respiratory infection, is often easy, treating the condition is more difficult. Medicines may calm the symptoms, but the only cure is time. Most notably, antibiotics, though commonly prescribed, are no better than a placebo for bronchitis.

“Traditionally, newer and more aggressive interventions were often assumed to be better.” But there are hints of a shift, he says: “When patients are fully informed, they tend to be more conservative.”

After decades of presuming that more health care leads to better health, public consciousness may be moving toward a leaner view.

Today, a group of nine medical specialty boards is recommending that doctors perform 45 common tests and procedures less often, and is urging patients to question these services if they are offered. The move is the latest by the medical community to acknowledge that many tests and procedures are performed unnecessarily, leading to excessive costs, false positives, additional testing and even harm to patients. By some estimates, unnecessary treatment constitutes one third of medical spending in the United States...

Dr. Barry also points to news reports that may also be shifting attitudes. In just the past year, medical headlines have covered record-setting fines paid by pharmaceutical companies, the overuse of potentially carcinogenic medical radiation, medical device recalls and the rise of prescription drug deaths (which now outnumber illicit drug deaths). Even once-sacred interventions like screening for cancer are under scrutiny, with a better understanding of both limited benefits and growing harms. That randomized trials of prostate specific antigen (PSA) testing, for instance, had shown little or no lifesaving benefit was hardly noticed until last year, when the United States Preventive Services Task Force drew attention to sexual and urinary problems and prostate biopsy complications, all common fallout from positive PSA results.