Tuesday, October 4, 2011

American Health Care Overly Aggressive?: How to Steer Toward the Path of Least Treatment

Has American health care become overly aggressive? Many primary care doctors think so, according to a survey published last week in Archives of Internal Medicine. More than 40 percent of 627 primary care doctors who responded to the survey thought their own patients were overtreated; only 6 percent thought the patients received too little care.

Why so many tests and referrals? Limited time to spend with patients, fear of being sued and financial incentives to do more were among the reasons cited by the physicians.

“Why is the most aggressive treatment becoming the standard of care?” Dr. Redberg asked in a telephone interview. “We know that when patients are given a choice between surgery and a medical treatment, they almost always opt for the least invasive, least aggressive treatment.”

Dr. Redberg and other experts have also been critical of what they see as the overuse of medication, including the increased use of opioids for chronic pain; the long-term use of proton pump inhibitors, linked to severe magnesium deficiency and other side effects, to manage acid reflux disease; and the widespread prescription of statins for patients without coronary artery disease, despite well-known adverse effects of the drugs.

In one study published in the journal, doctors who reviewed the charts of elderly patients were able to discontinue nearly half of their medications without any detriment to the patients.

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