A key factor in preventable waste in the realm of health care is overtreatment. The Institute of Medicine (IOM) shed light on the problem in 2010 suggesting that “unnecessary medical services” led to roughly $210 billion in annual waste. A recent study was conducted to obtain information about overtreatment from physicians, which is a topic many doctors do not like to discuss publically.
Physicians have a special “front-line” viewpoint on this issue because they suggest, manage, and discern medications, testing etc. Roughly 2,100 physicians from an American Medical Association database provided feedback in the study. Some of the goals included determining the true extent of overutilization, the primary causes, and potential solutions. The physicians were chosen at random from the database and the study intentionally excluded mid-level medical professionals such as physician assistants and nurse practitioners.
The respondents included both primary care physicians as well as specialists, which made up 42% of the group. The initial part of the study engaged respondents in focus group settings and further at physician continuing education conferences and seminars. The Review Board at John Hopkins Medical confirmed the validity of the study.
The survey asked clinicians about what percentage of their overall care is unnecessary. Questions covered many aspects of care including prescription drugs, and testing such as diagnostic and lab work. In one previously conducted study, the findings showed that 30% of inpatient antimicrobial treatment, 26% of imaging, and 12% of acute percutaneous coronary interventions (nonsurgical blood vessel treatments) were not truly necessary,
Prevalence & Causes
This pool of physicians felt that approximately 20% of the overall care provided was not necessary with details as follows:
- Approximately 22% of medications were unnecessarily prescribed
- Tests are unnecessarily ordered 24.9% of the time
- 11.1% of procedures conducted were unnecessary
- The most common reason for overtreatment is based on a fear of medical malpractice (84.7%)
- Overtreatment is the result of patient request or pressure in 59% of cases
- Lack of access to existing medical records leads to 38.2% of unnecessary care
Leading Possible Solutions
- 55% of respondents felt that better training of resident physicians on appropriateness of care is a solution
- 52% felt access to external medical records was a solution
- 51.5% cited expanded guidelines of practice
One interesting finding was that nearly 71% of the physicians felt that unnecessary procedures are more likely when a physician profits from them. The majority of respondents felt that reducing fee-for-service based compensation for physicians would lower overtreatment and reduce wasteful costs.
Some examples of the harm to patients that are non-economic include overusing antibiotics, which leads to bacterial resistance to them, Clostridium difficile infection (diarrhea), and complications from unnecessary procedures. It appears clear from this study that physicians are cognizant of the problem of overtreatment and that “defensive medicine”, essentially a fear of medical malpractice is the primary reason for the waste.