Doctors continue to provide treatment to patients that is often unnecessary and even harmful, confirms a study published this week in JAMA, which reviewed a year of research on so-called medical overuse.
The new study sought to highlight evidence of unnecessary care from clinicians, and turned up plenty of examples, including:
- Treatment for early-stage prostate cancer often led to harm without measurable benefit. In a group of 1,643 patients whose prostate cancer was detected via a prostate specific antigen (PSA) test, about 1 percent died from their cancer. Researchers found no survival differences between those who received radiation, had surgery, or opted for “active monitoring,” where doctors keep an eye on the patient but don’t begin any treatment immediately. And yet the first two groups were at a high risk for becoming impotent or incontinent due to the treatment.
- The most common knee surgery in the U.S. did not help those who received it. This research looked at surgery to repair meniscal tears in the knee, among patients with what doctors call “mechanical” symptoms: where the knee seems to click or lock. “There’s a myth that if you have mechanical symptoms, then surgery benefits,” says study author Daniel Morgan, M.D., an associate professor of epidemiology and medicine at the University of Maryland School of Medicine. But even in this group, there was no difference in outcome among those who got real surgery and those who got a placebo (a sham surgery, where their knee was cut open but surgeons did not repair it).
- There was a sharp rise in the use of CT scans in emergency rooms. Between 2001 and 2010, the number of CT scans quadrupled among patients who showed up at the ER with respiratory symptoms. This exposes patients to potentially dangerous radiation when they may have something as simple as a cold, says Morgan, and yet “it’s not unusual for CT scans to be ordered before a doctor has even talked to a patient.”
What Should Consumers Make of These Findings?
“Sometimes medicine gets it wrong, and does too much to the point of harming the patient,” says Morgan. “It’s important for patients to ask questions that make doctors aware they don’t want to err on the side of doing too much.”
What You Can Do
Consumer Reports’ Choosing Wisely campaign, which aims to help patients and doctors counteract medical overuse, suggests that patients ask these five questions whenever their doctor suggests a test or treatment—especially if it is something invasive, such as a surgery:
- Do I really need this test or procedure?
- What are the risks and side effects?
- Are there simpler, safer options?
- What happens if I don’t do anything?
- How much does it cost, and will my insurance pay for it?
“You should not feel intimidated. You’ll get better care if you ask questions,” says Marvin M. Lipman, M.D., Consumer Reports’ chief medical adviser. “And if you don’t get satisfactory answers, get a second opinion.”