Dr. Kussin: Over-Treatment: It’s Your Fault Too

October 5th 2012   ·   2 Comments

By Dr. Steven Z. Kussin, MD, FACP

We’ve been talking these past several weeks about unnecessary care. Up to now, I’ve focused on my colleagues and the evils of the medical-industrial system.

But now it’s time to talk about you.

Direct to Consumer Ads

Advertisements for medications and medical devices saturate media space, especially on TV. They flood the airways, and profits flood the bank accounts of the purveyors of “cures” and ‘quick-fixes.”

Doctors more youthful than wise and more glamorous than ethical sell things to you, and sell out in the process. It’s bad to sell your body for money. It’s worse when you sell your mind. So young to be so cynical, hawking products and devices destined to be recalled. Male doctors smile with bright eyes and even brighter white teeth. Women physicians bat their eyelashes alluringly. They shill; you thrill. And off you go. Still… these odious conditions? Well, most:

• don’t exist or are exaggerated
• don’t require treatment even if they did exist
• don’t benefit from their product when they do require treatment

Hordes of public relation gurus, economic and behavioral psychologists and the creative minds of artistic savants waste effort to pursue the pitch-perfect, perfect pitch.

“TV advertising makes use of these drugs seem like an everyday convenience rather than an important decision worthy of serious consideration.”

Even the warnings, demanded by law, are placed so strategically that they rarely register. If you listened and thought about it carefully, would you really risk death for mild joint pain? http://www.ncbi.nlm.nih.gov/pubmed/17168811 Would you really take the chance of getting severe liver damage for feeling a little blue now and then?  (And P. S. they don’t work too well for a mild case of chronic “down-ness.”  Would you risk fractures when you are trying to prevent them?)

When you ask your doctors for these quick fixes and fixed hoaxes, it’s hard for us to say “No!”  Many if not most of us think we will hurt the physician-patient relationship if we say no. Doctors want you to be happy. Satisfied patients don’t sue us, disgruntled ones do.

Happy patients make wealthier doctors.

Your Love of Technology

We love cutting edge medical technology. The latest and the greatest are advertised like toothpaste. The reality is that much of this stuff is the latest, but not often the greatest.

The best example is robotic surgery–all the rage now. The sad thing is that when it comes to the the many doctors who perform these innovations, few do them well. Most prostate cancer surgery is now done through the robotic technique. Know what? There’s not a shred of evidence they are better than the old fashioned operations that many doctors do and many do well. In fact, for the things that count, the complications from robotic surgery are higher.  You know, guys, those pesky things like impotence and wetting your pants?

Another example is the overuse of imaging technology to see things never destined to be seen. The deplorable truth is that much of what doctors see is better off staying invisible.

The real growth in imaging technology is in a different kind of growth–real cancer risk. Patients are routinely exposed to between 20 and 50 millisieverts of radiation, a level that the International Commission on Radiological Protection says is unsafe.

And Hey, You’re Paying For the Care…Right?

Patients who get “totally free” care over- utilize physician services. Insured and insulated from financial risks, you will be less concerned about medical risks than if you paid the full price of care.

Your employer-provided health insurance policies are tax-exempt compensations. This makes even the most comprehensive and service-rich policies seem cost-free. But your health care insurance does come at a cost. The more you and your neighbors use your policies for unnecessary care, the higher the rates. And the premiums do come out of your hides through lower salaries and fewer raises.

And if you realize just how much you are paying, why not cash in on it? In the rush to see the benefits from your health insurance policies, your heirs could get the benefits of your life insurance policies. Over-treatment and over-utilization are not only wasteful and expensive, they endanger your health.

You Just Want to Be Happy

The myth of happy patients=healthy patients is pervasive but false.  Satisfied patients are, in fact, more likely to be hospitalized.

If you demand the highest level of satisfaction with your care, you are more likely to need it. Compared to the least happy patients, you have a better chance of getting an inpatient admission. And when there are hospital admissions, mortalities will follow. The 12% greater admission rates and 26% greater death rates make you wonder why you want to feel so happy with your care. http://www.econlib.org/library/Enc1/HealthCareIndustry.html

So How Do You Know What’s Necessary and What’s Not?

The last of this series comes next week.

 

By Richard