Our inability to accept that mistakes inevitably happen has led to a culture of medical overdiagnosis and overtreatment in the western world, according to a study published in the UK.
This has pushed doctors to be risk-averse and to overreact in response to potential health problems in their patients.
The researchers refer to an Australian study which identified 156 potentially unsafe, ineffective, or inappropriate services in the Medicare Benefits Schedule.
In the British journal BMJ, Professor Jerome Hoffman and Veterans Affairs/Robert Wood Johnson fellow Hemal Kanzaria from the University of California argue that efforts to reduce overdiagnosis and overtreatment should focus on changing professional and public attitudes towards medical error and uncertainty.
There are many reasons why physicians engage in overtesting and overtreatment, including perverse financial incentives and commercial marketing designed to create demand for more testing, diagnosis and treatment.
Physicians themselves mostly cite fear of legal malpractice claims as the primary driver.
But the authors argue that malpractice reform will not be sufficient to resolve the problem.
Instead, they suggest that intolerance of both uncertainty and error – among physicians, in the
larger medical culture, and in general Western culture – may be the most important reason
physicians engage in medical excess.
“Both need to be confronted if we are to tackle the problem of ‘too much medicine’,” they say.
They point to efforts already underway, such as the UK’s National Institute for Health and Clinical Excellence “do not do” list and the American Board of Internal Medicine’s “Choosing Wisely” campaign.
Shared decision making programs have also been shown to lower health care costs and usage
while maintaining high quality care.
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