Discussing the underlying causes of overtreatment

Recent research from PLOS One estimates half of all stents could be unnecessary.

No matter how aware and vigilant cardiologists—and, of course all physicians—are in the face of overtreatment, that single statistic is alarming.

“This study is essentially the voice of physicians about the problem,” said the senior author, Martin A. Makary, a professor of surgery at Johns Hopkins. “We’re told that there are too many operations done for narrowed blood vessels in the legs. Spine surgeons say that a quarter of all spine surgery may not be necessary. Half of stents placed may be unnecessary. These are significant opportunities to improve quality and lower costs.”

What can cardiologists and others do to combat this epidemic? There’s no helping the unscrupulous who leverage overtreatment for personal profit. But examine the two most commonly cited causes for overtreatment: fear of malpractice and patient pressure (third is difficulty accessing medical records).

The study pointed to appropriateness criteria as one method of reducing the waste associated with overtreatment. Properly formulated and regularly updated practice guidelines is another approach to reduce superfluous care—including unnecessary stents.

Finding the goldilocks zone—not too much, not too little, but just right—isn’t as simple as a children’s tale. Overtreatment has numerous symptoms and cannot be eradicated with a single cure. Efforts on the macroscale include CMS’s emphasis of value-based payment programs for Medicare beneficiaries. Those initiatives closer to ground level include modifying education and training systems.

“Future work should focus on the most high-volume over-utilized tests and procedures by specialty,” they wrote. “Medical school and training should include guidance on the subject of appropriateness before doctors are exposed to the factors identified in this study as factors contributing to the problem.”

Overtreatment is a complicated problem with a complicated remedy that we all need to work hard to achieve.