An unspoken truth is that three kinds of medical treatment are provided in the U.S. The first is treatment whose benefit is unquestionable. Surgery to treat a ruptured appendix is an example. Without it, death from life-threatening infection is almost certain. The life-saving medical care being rendered to earthquake victims in Haiti is in this category.
A second type of treatment is provided when uncertainty exists about benefits and risks. Doctors and their patients must balance the benefits and risks. The recent mammogram controversy fits into this gray zone.
The third type of treatment is when the possibility of harm exceeds the possible benefit. A panel convened by the Institute of Medicine years ago called it “overuse”. This is the subject of my new book, The Treatment Trap.
Health care tests and treatments today are like the colors of a traffic light. Life-saving treatments flash green. Where uncertainty exists, the light flashes yellow. With overuse, the light flashes red and tells us to stop.
We don’t stop at red lights in health care. In fact, we run right through them. In a survey conducted by the American College of Physician Executives, eighty percent of physicians who responded said they were very concerned or moderately concerned about their physician colleagues overtreating patients to boost their income. Fifty-four percent said they were concerned about their peers admitting patients to a hospital to increase their bottom line. The survey respondents are in leadership positions in hospitals, medical practices and other health care organizations.
Overuse is the third rail of modern American health care. The medical establishment and politicians don’t want to touch it. One person’s overuse is another person’s payment for college tuition or a mortgage on a McMansion.
Here’s why we should touch the third rail. Overuse is not just about money. Ask Ron Spurgeon, a California millwright who had bypass surgery for non-existent heart disease along with hundreds of other people who had needless cardiac procedures at a California hospital. Ron survived. Not everyone does.
According to a Commonwealth Fund survey, about one-third of Americans say that have had tests or treatment they thought was unnecessary. A lot of people are falling into the treatment trap, it seems.
In the health care reform debates, a new commission was proposed along with a commitment to test options to reform the “do more get more” payment system. Why wait for a commission or payment reform to curb overuse? Right now we can begin eliminating tests and treatment that yield no benefit. Let’s start with Pap tests performed on the ten million women who are not at risk for cervical cancer because they have had a total hysterectomy and no longer have a cervix. Yes, it’s true.
Even better, we can stop paying for surgeries that expose people to great risk and confer no benefit. When the Rand Corporation and the Harvard School of Public Health asked expert doctors to provide a second opinion on coronary angiograms, which show whether the heart’s blood vessels are blocked, the doctors found that one-third of people who were recommended for heart bypass surgery did not need it. This is what happened to Ron Spurgeon. It is one of many examples of surgeries, tests and procedures that are overdone.
Democrats and Republicans are concerned about ballooning budget deficits. It is hard to think of a more sensible public policy than to stop spending money on medical treatments and tests that cause more harm than good. It’s time to stop running red lights. It’s never good for your health.