Unnecessary Healthcare is Unnecessary
In a world of patient complexity and overload, it is not surprising that physicians tend to over test and over treat millions of patients each year.
Why is this practice so egregious in our country? I offer four specific thoughts as to why this might be the case.
Physicians in the United States are scared. I can’t count how many times I’ve been asked if I’ve been sued yet. Since my answer currently is no, the next response to come usually sounds something like this, “Well, your time will come.” This is sad.
We know that medicine is imperfect. There is no way to get the diagnosis correct in every patient. But because of the fear of lawsuit, we practice defensive medicine, some more than others. This often entails excessive testing and treatment even when it might not be indicated.
There is no obvious solution to this problem. Financial compensation for missed diagnoses or complications would be a great start, such as a health insurance for all system, but physicians also need to be mindful when they are choosing a test or treatment for defensive purposes. Education and good patient relationships can be better lawsuit prevention and often offers better patient care than over testing and over treatment.
Whether conscious or not, many physicians feel that they must do something for every patient. Perhaps this is because there is a perception that a patient will be more satisfied with a visit if they are given a medication, or if a test is performed. I submit that doing nothing can be just as satisfying if physicians take the time to listen to their patients and educate them on their condition.
In fact, this discussion with the patient is what doctors are doing for their patients. They come in for an evaluation by a specialist, and physicians give their expert opinion. Just because a patient has a viral URI and does not require a prescription doesn’t mean that they don’t need information regarding their diagnosis, an explanation of why they don’t need an antibiotic, and how to care for themselves at home.
This often takes more time than writing a prescription but can give the patient a much better understanding of their condition, better care, and ultimately more satisfaction during their visit.
Being unsure of a patient’s diagnosis is par for the course in medicine. There are so many difficult diagnoses — the rash that could be dermatitis or shingles, the sinusitis that is at the stage between viral and bacterial, or the pain around the belly button that seems too vague or early to be appendicitis. There are a number of times when physicians walk out of a room unsure of the best treatment plan.
Yet, many times doctors decide to test or treat to “err on the side of caution.” Sometimes this is appropriate, but many times it could be avoided. Observation at home or a trial of over-the-counter medication might be the better option and it’s okay for a patient to return if their symptoms progress or worsen.
Physicians don’t always get it right the first time and that is the honest truth — not because they are “bad” physicians, but because medicine is complex and imperfect. Some diseases take time to progress and others require more testing after symptoms do not improve. But physicians do need to educate their patients regarding the plan, when to return or see their primary doctor, and why it is the best course of action to take.
How often do physicians test or treat purely out of convenience? It’s certainly easier to write an antibiotic script than to educate a patient — less time and more satisfaction, right? It’s easier to admit an elderly patient that cannot walk then to work on an outpatient plan or try to admit directly to a nursing home. And it’s easier to order a CT scan of the head rather than use appropriate decision rules that can avoid the test.
Doctors are asked to move faster than ever before and see a multitude of patients. But what is the best care for the patient? Taking the time to be patient-centric by recognizing the needs and appropriate treatment for individual patients is always better than a cookie cutter model of diagnosis, treatment, and disposition. Convenience is never the answer.
I believe in patient-centered care. Often, our healthcare system creates difficulties through multiple stressors on physicians — namely to be efficient and diagnose 100% correctly.
If we take our time with each patient to educate them on their condition and the possible options, we can work to eliminate the unnecessary wastes that over testing and over treatment place on society. Not surprisingly, this also prevents personal risk, and ultimately improves the entire healthcare system.
Unnecessary Healthcare is Unnecessary
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