Doctor, Do Less?

Now that the American Cancer Society has joined a growing chorus of experts and offered new screening guidelines for women with fewer mammograms and fewer breast physical exams, everything changes —  just like that, right? Not that easy.

As the New York Times points out, it will take time for patients to see these breast practice recommendations followed.

“Once physicians become conditioned to be more invasive, it’s hard for them to reverse course,” writes Aaron E. Carroll, a professor of pediatrics at Indiana University School of Medicine who blogs on health research and policy at The Incidental Economist. He looks to peer-reviewed, published research to see that, “after spending lots of money and many man-hours in interventions,” Canadian doctors reduced the too-high rate of Cesarean sections by meager amounts, from 22.5 percent to 21.8 percent.

Meantime, despite new and large studies showing that doctors should reverse course and avoid tight blood sugar controls for elderly patients in intensive care, this practice has increased, albeit more slowly.

Carroll is troubled by the reluctance by both physicians and patients to consider evidence-based care and to discuss and make hard choices about an individual patient’s needs.

“It is very hard to get doctors to do less,” he observes, adding, “Once physicians believe they are doing good, it is hard to get them to change their minds.” And he adds: “It will most likely be even harder to change the public’s expectations. For decades, we’ve been told, over and over, that more screening is better, that early detection is the key to a cure. That’s true, up to a point. We seem to have passed that point, though, and more and more experts are trying to reverse course.”

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