"From the physician perspective, overtreatment is common."

PLoS One. 2017 Sep 6;12(9):e0181970. doi: 10.1371/journal.pone.0181970. eCollection 2017.

Overtreatment in the United States.

Lyu H1, Xu T2, Brotman D2, Mayer-Blackwell B2, Cooper M2, Daniel M2, Wick EC2, Saini V3, Brownlee S3, Makary MA2,4.

Author information

1

Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States of America.

2

Department of Surgery and the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America.

3

The Lown Institute, Boston, Massachusetts, United States of America.

4

Department of the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America.

Abstract

BACKGROUND:

Overtreatment is a cause of preventable harm and waste in health care. Little is known about clinician perspectives on the problem. In this study, physicians were surveyed on the prevalence, causes, and implications of overtreatment.

METHODS:

2,106 physicians from an online community composed of doctors from the American Medical Association (AMA) masterfile participated in a survey. The survey inquired about the extent of overutilization, as well as causes, solutions, and implications for health care. Main outcome measures included: percentage of unnecessary medical care, most commonly cited reasons of overtreatment, potential solutions, and responses regarding association of profit and overtreatment.

FINDINGS:

The response rate was 70.1%. Physicians reported that an interpolated median of 20.6% of overall medical care was unnecessary, including 22.0% of prescription medications, 24.9% of tests, and 11.1% of procedures. The most common cited reasons for overtreatment were fear of malpractice (84.7%), patient pressure/request (59.0%), and difficulty accessing medical records (38.2%). Potential solutions identified were training residents on appropriateness criteria (55.2%), easy access to outside health records (52.0%), and more practice guidelines (51.5%). Most respondents (70.8%) believed that physicians are more likely to perform unnecessary procedures when they profit from them. Most respondents believed that de-emphasizing fee-for-service physician compensation would reduce health care utilization and costs.

CONCLUSION:

From the physician perspective, overtreatment is common. Efforts to address the problem should consider the causes and solutions offered by physicians.