In just 45 minutes, the problem of overdiagnosis, overtesting, and overtreatment is clearly summarized using examples from the Australian system. The costs and harms to patients are incredible, and an analogy – taking the wrong train and winding up where you never intended – is an effective illustration of the issues.
Some key messages:
Billions of dollars are spent on procedures that are not needed, simply because patients expect them and because doctors continue to lobby to be paid to do their 'favourite' procedures.
What is your estimate of how many of those knee arthroscopies are unnecessary? - Dr Normal Swann, Interviewer
Uh, I would say, at least half. - Dr. Ian Harris, orthopedic surgeon
This is no surprise. Dr James Rickert has been advocating for more appropriate care in orthopaedics, for example with an alternative Choosing Wisely list (despite what the article says, not just 'one guy's opinion' but rather a summary based on the best available evidence, presented most recently at Preventing Overdiagnosis), for years. But conflict of interest, particularly in industry lobbying and influence in the creation of guidelines, continues to be a problem. So does fee-for-service payment systems which encourage higher throughput rather than best care.
There are other pressures too:
Often the best medicine is no medicine at all, or the best intervention is no intervention at all. But those conversations with patients that take that time to explain that the evidence simply doesn't support doing a test or prescribing a drug - are long conversations and it's much easier in clinical practice to do things quickly and prescribe or order a test. - Dr Rachelle Buchbinder, rheumatologist
Patients and physicians are both uncomfortable with uncertainty, so tests 'just to see,' continue to be ordered, despite the evidence that they are needless and carry risks. We need to realign expectations, save the waste, and re-direct it into areas of health care that will really help people instead of harming them.
Watch the video for more cutting commentary and alarming statistics.
FULL VIDEO: FOUR CORNERS: WASTED