Overkill: America's Epidemic of Unnecessary Care | The New Yorker

Atul Gawande writing with his usual, uncommon brilliance about unnecessary medical care:

Well, as a doctor, I am far more concerned about doing too little than doing too much. It’s the scan, the test, the operation that I should have done that sticks with me—sometimes for years.

We’re more afraid of doing too little than of doing too much. And patients often feel the same way. They’re likely to be grateful for the extra test done in the name of “being thorough”—and then for the procedure to address what’s found.

Much of the debate on unnecessary tests and procedures has focused on our fee-for-service reimbursement system and doctors profiting from “doing more”. The two quotes above highlight what I think is a much more important pressure on physicians—we don’t want to miss something. We truly want to find a cause for our patients’ complaints and treat them. This is done with the notion that we are providing the best care for them. We dramatically underestimate the consequences of overtesting and overdiagnosis. It is a bias and part of the culture of medicine; we feel like we have to do something.

Right now, we’re so wildly over the boundary line in the other direction [of wasteful care] that it’s hard to see how we could accept leaving health care the way it is. Waste is not just consuming a third of health-care spending; it’s costing people’s lives. As long as a more thoughtful, more measured style of medicine keeps improving outcomes, change should be easy to cheer for. Still, when it’s your turn to sit across from a doctor, in the white glare of a clinic, with your back aching, or your head throbbing, or a scan showing some small possible abnormality, what are you going to fear more—the prospect of doing too little or of doing too much?

This is the ultimate battle, both for doctors and patients. When its your health or your patient’s health on the line, you don’t want to fall on the side of doing too little. This is a struggle I deal with daily in trying to provide the best care for my patients.

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