We’ve long highlighted the risks of getting too much medical treatment, and now a national survey of physicians finds that they, too, believe their colleagues order unnecessary tests and provide unnecessary care.
As summarized by KaiserHealthNews.org (KHN), 3 in 4 physicians believe that fellow doctors prescribe an unnecessary test or procedure at least once a week. And the reasons for the extraneous and costly care? Fear of being sued, the impulse to be extra careful and the desire to confirm their own assessment of the patient, respondents said.
But consider this: The survey of 600 physicians was commissioned for Choosing Wisely, a campaign by a wide range of medical specialists to identify procedures they believe are unnecessary or ineffective. As we wrote last month, a report showed that the Choosing Wisely specialists, by and large, enumerated treatments that didn’t affect their bottom line, only that of other caregivers.
Does that less-than-noble observation undermine the whole Choosing Wisely effort, or the results of its survey? Not necessarily; cutting back on needless medical care is smart for the patient and the people who pay the bills. But it does mean that programs sponsored by Choosing Wisely should be examined carefully for bias. As should all such reports within the medical-industrial complex.
As the KHN story recounts, Choosing Wisely wants to encourage communication between patients and doctors about the suspect treatments it identifies. In the doctors’ survey, nearly half said one patient a week requests something unnecessary. Most doctors said they believe they intercede, but almost half said that when a patient insists, they advise against it but still order the test. About 5 in 100 docs said they just order the test.
Clearly, patients should use medical services responsibly, should ask questions and not just accept things they hear, whether it’s about a drug advertised on TV, or the nonsense about childhood vaccinations some people ignorantly promote.
Few of the doctors participating in the survey agreed with the idea that the financial rewards that come from extra procedures are a major reason why they are ordered. Given the recent story about Choosing Wisely’s protection of self-interest, we’re skeptical of the mere 5 in 100 of the surveyed physicians who said they are influenced by the presence of new technology in their offices. As we wrote a couple of years ago, expensive technology often drives treatment decisions – when a practitioner or facility has a device that needs to be financed, it tends to get a lot of use.
Is anyone surprised that only 5 in 100 docs believe that the fee-for-service-system of payment, which pays providers for each thing they do rather than a lump sum for keeping a patient healthy, plays a role?
And it’s probably also not a surprise that doctors cling to the never-proven and illogical idea that fear of malpractice suits drives overtreatment. Nobody sues unless there’s been a serious injury, and so a test ordered that might prevent a lawsuit is really a test ordered that might save a life, so that’s a good thing, if it happens. More likely, though, direct financial incentives such as fee-for-service payment and ownership of expensive testing equipment are the economic drivers behind unnecessary care.
The president of the foundation that organized Choosing Wisely recently said the campaign’s initial efforts have been a success – 1 in 5 doctors said they were aware of it, and most of them said they have reduced their incidence of ordering unneeded tests and procedures.
We hope so. But it’s up to us to help make sure.