The Upshot reflects: Patients overestimate benefit and underestimate harm of tests & treatments

In February, an excellent systematic review article appeared in JAMA as part of their "Less is More" series. Patients’ Expectations of the Benefits and Harms of Treatments, Screening, and Tests: A Systematic Review by Drs Tammy Hoffman and Chris Del Mar provides a comprehensive overview of patients views of the risks and harms of various tests, procedures, and treatments.

Their Conclusions and Relevance section explains the take-away it nicely:

The majority of participants overestimated intervention benefit and underestimated harm. Clinicians should discuss accurate and balanced information about intervention benefits and harms with patients, providing the opportunity to develop realistic expectations and make informed decisions.

This week, the NY Times Upshot - a source I'm finding myself reading more and more often - posted their reflection on the article, If Patients Only Knew How Often Treatments Could Harm Them. They beautifully wove together some of the data from the article to make it easier to digest and understand.

For example, they highlight the 2012 Annals of Family Medicine study that looks at patient estimates of the benefits of screening for bowel cancer. 

94% of patients overestimated the benefits of bowel cancer screening.

Simple and persuasive examples like that help explain the problem with our current care, and the article culminates in a summary written by Drs Frakt and Carroll that is completely in line with the principles that drive the Less is More in Medicine approach:

Many of the studies in the systematic review show that people report that they would opt for less care if they better understood benefits and harms. Improved communication could better serve patients and might improve the efficiency of our health system if patients focus on getting the types of care for which the benefit outweighs risk of harm.

Since they've done such a great job expounding the article, I feel no need to provide my own explanations or reflection.

 These kinds of articles come into my email and RSS reader and across my twitter landscape in droves; being overrun with articles and action in the field of overdiagnosis/testing/treatment is a delightful problem to have.


The CMPA: "Striking the proper balance"


The Canadian Medical Protective Association (CMPA)'s most recent Perspective magazine has, on the cover, an article entitled The right test at the right time: Striking the proper balance (read here).

This is the first time I've seen the organization, which provides medico-legal advice, education, and assistance to its paying physician members, tackle the subject head-on. They have indirectly contributed to this body of knowledge in the past, exploring the concept of 'defensive medicine' and providing references for physicians dealing with the question of providing futile medical care, for example.

For the CMPA to open this article by emphasizing "fiscal prudence" shows that the organization has the freedom to comment in a way that other Canadian organizations find politically uncomfortable. Many others, the Canadian Medical Association (CMA) included, suggest that improved cost will be a result of appropriate care though it is not considered a guiding factor.

The reality is that we all want the same thing: better care for patients, less risk, and a lower cost so that we can sustain high-quality care. Hearing the same message from such a diverse array of medical, political, and citizen groups – in Canada and around the world – breeds hope that we are getting closer to creating the system we envision.