Are You Getting Too Much Medical Care?

First, do no harm—that’s what medical students are taught. Yet unnecessary drugs and tests, along with overly broad definitions of health conditions, can set you up for unexpected damage  

by Christie Aschwanden
Photograph: Illustration: Brian Stauffer

The risks of overtreatment
Unnecessary tests and treatments account for as much as 34 percent of the health care in the U.S., wasting an estimated $226 billion each year, according to a study published last year in the Journal of the American Medical Association. Despite these costs, the movement among medical professionals to reduce overtreatment isn’t simply about money; it’s about protecting patients from the damage that overtreatment can inflict, says Glen Stream, MD, a California family physician who’s a past president of the AAFP board.

The damage isn’t always obvious. Suppose you have a sinus infection. Whatever you do, you’ll probably be fine in a few days, but if your doctor prescribes antibiotics, you may mistakenly attribute your improvement to the pills. Sinus infections almost always arise from a viral infection, which antibiotics are powerless to treat. Taking those antibiotics isn’t just a waste of time and money; they’ll kill off protective bacteria in the vagina, which may spur a yeast infection. The drugs may also leave you more susceptible to antibiotic-resistant infections. So the medicine you’re happy to get may actually hurt rather than help you, says Rosemary Gibson, a health care expert and author of The Treatment Trap.

Yet “despite consistent recommendations to the contrary, antibiotics are prescribed in more than 80 percent of outpatient visits for acute sinusitis,” the AAFP says. Why do physicians continue to follow practices that haven’t been supported by research? “Doctors, like all human beings, are creatures of habit. Our default is to continue on the path we’ve always trod,” says Danielle Ofri, MD, PhD, associate professor of medicine at New York University School of Medicine and author of What Doctors Feel.

A single unnecessary test can start a series of interventions, some unpleasant or even painful, that cost you time, money and peace of mind, says Leana Wen, MD, director of Patient-Centered Care Research at George Washington University and coauthor of When Doctors Don’t Listen: How to Avoid Misdiagnoses and Unnecessary Tests. Up to 40 percent of imaging tests of the abdomen, pelvis, chest, head and neck spot so-called incidentalomas—findings that look like tumors but are unrelated to the purpose of the test, according to a report in the Archives of Internal Medicine. While a few of these accidental findings do turn out to be cancerous, most are benign. But once an incidentaloma is detected, it may take several more tests (involving more doses of potentially harmful radiation) and multiple trips to the doctor to find out for sure, Wen says. A true cancer will surface eventually, when it causes symptoms.

How cancer screening can hurt rather than help
Cancer has long been seen as a progressive disease that will kill us unless it’s treated in time; hence the drive, over the past few decades, for people to be screened regularly. But that definition of cancer isn’t necessarily accurate, says H. Gilbert Welch, MD, professor of medicine at the Dartmouth Institute for Health Policy and Clinical Practice and coauthor of Overdiagnosed: Making People Sick in the Pursuit of Health. Most people have a few cancer cells inside them, but these will be eliminated by our immune systems before they can cause harm, says Deborah Grady, MD, a professor at the University of California, San Francisco, School of Medicine. Even when cancer cells evade the immune system, they are not always fatal. Autopsies show that many people who die of other causes have undetected cancers that never caused trouble. Yet those cancers would probably have been treated if the person had been screened. In addition, there is the problem of false positives, test results that indicate a tumor is present, triggering further testing, when in fact there is no tumor.

First published in the December 2013/January 2014 issue

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