“In its 1999 report To Err is Human, the Institute of Medicine report estimated that as many as ninety-eight thousand Americans are killed each year by medical error. Another ninety thousand to four hundred thousand patients are harmed or killed by the incorrect use of a drug–they received the wrong drug, or the wrong dose of the right drug, or two drug that interacted in the wrong way.”
“…preventable hospital error [is] the eight leading cause of death annually, ahead of motor vehicle accidents (43,458), breast cancer (42,297) and AIDS (16,516).”
Most health policy articles and books look at how to get more medical care to those who need it. How can we lower the cost of medical care? How can patients receive higher quality treatment? How can we decrease the number of uninsured? Shannon Brownlee’s book Overtreated looks at the medical care from a different perspective. She claims that Americans are too anxious to receive medical care and that the excessive amounts of medical treatment are actually hurting the average health levels of the American population.
Her well-written book uses a mix of anecdotes and statistics to document how unnecessary medical care is not only increasing health care costs, but also harming patient health. Examples where physicians do not take into account a drug or medical procedure’s side effects abound. Orabilex causes potentially fatal kidney damage. Spinal fusion surgery is frequently preformed but likely benefits only a small percentage of back-pain sufferers. Drugs such as Prozac and Ritalin are certainly over-prescribed. Diabetes patients receive recommended care only 24% of the time (McGlynn et al. NEJM 2003).
Why does this overtreatment occur? Brownlee, gives 5 main reasons.
- Defensive Medicine. Doctors fear malpractice suits and would prefer to preform more tests and give more treatment in order to avoid being sued.
- “Do something” mentality. Patients want the doctor to ‘do something’ even if the best medicine would be non-treatment and rest. Patients often believe that every disease can be cured with enough treatment.
- Lack of evidence. Doctors are pressed for time and can not read through the copious amounts of journal articles available (although people working for the Cochrane Collaboration, InfoPOEMs, and UpToDate are trying to change this). Thus, doctors may be misinformed. Further, different studies often provide contradictory suggestions as to what the physician should do.
- Lack of training to interpret evidence. Even when doctors are diligent about reading journal articles, they often misinterpret the results and do not critically review the paper to be sure the researchers methodology is sound.
- Money. When physicians are paid on a fee-for-service basis, they have a financial incentive to provide more medical care.
The book is non-technical and the first 9 chapters document the way in which and the reasons why Americans get so much medical care. Chapter 10 offers some solutions to these health care problems. These solutions are similar to the ones expounded in Ms. Brownlee’s article in the October 2007 edition of the Washington Monthly (see my comments here).
- Brownlee S, (2007) Overtreated. Bloomsbury, New York, 1st ed.