Newspaper article MinnPost.com

Reducing Medical Overtreatment Will Require Large-Scale Political Mobilization

Newspaper article MinnPost.com

Reducing Medical Overtreatment Will Require Large-Scale Political Mobilization

Article excerpt

Despite all the reports about overdiagnosis and overtreatment in the United States (and estimates are that almost a third of all medical interventions in this country are unnecessary), many doctors want to take a more reasoned and less wasteful approach to medicine.

But those "lone ranger" doctors are up against a powerful medical industrial complex that "just keeps on delivering treatments patients don't need," as journalist Shannon Brownlee ("Overtreated: Why Too Much Medicine Is Making Us Sicker and Poorer"), now senior vice president of the Lown Institute, explains in a recent article for the website KevinMD.

Brownlee describes the experiences of a young doctor who, after attending a Lown Institute conference during medical school on how to avoid overtreatment, "vowed to avoid hurting his own patients with useless treatments during his residency" at a Boston hospital. (Brownlee doesn't name the hospital, and gives the young doctor a pseudonym, "Gene," to protect his privacy.)

But, as the young doctor explained to Brownlee in an email, he quickly ran up against formidable obstacles. Writes Brownlee:

For example, he and a patient decided together that she does not need or want a mammogram, a perfectly reasonable decision given the evidence on mammography. When he told his preceptor of the decision, Gene was instructed to order the mammogram anyway.

Why? Because the hospital's risk management company recommends it. "The risk management company doesn't care about this woman's anxiety about constant testing," Gene wrote, or about the emerging evidence on mammograms. It just cares about protecting the hospital from a potential lawsuit.

Another of Gene's patients, a diabetic, is doing badly on an oral diabetes medication plus insulin. When Gene suggested to his preceptor that the patient go off insulin except when he has symptoms, a recommendation that's backed up with sound scientific evidence, his plan was treated as "absolute heresy."

Gene, not surprisingly, is feeling a bit demoralized. …

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