Photo (cc) by rbrwr
Two of the country’s largest medical organizations recently held a special meeting to solve a pressing medical problem that costs patients, taxes the U.S. health care system, and sometimes risks lives.
Go ahead, take a guess at the national topic debated by representatives from the American Medical Association and The Joint Commission, a nonprofit that accredits health organizations like hospitals. This year’s record-breaking West Nile virus outbreak? The recent uptick in suicides? A cure for Alzheimer’s disease?
Nope, nope, and nope. These doctors and researchers talked about overused medical treatments. That’s right: Even doctors admit there’s a problem.
“Overuse of medical tests, treatments, and procedures is a serious quality and patient safety concern that needs urgent attention,” says Dr. Mark R. Chassin, president of The Joint Commission. “Our aim is to help improve safety for patients by raising awareness about the inappropriate indications for these procedures and treatments. Widespread and effective dissemination of this important information will help physicians and patients make informed decisions and avoid overuse.”
So while the professionals educate their peers about the conclusions of the National Summit on Overuse, patients should educate themselves. Familiarizing yourself with overused treatments is the best way to ensure you don’t end up paying for one unnecessarily. Once you know what they are, you’ll know to discuss them with your doctor before you consent to one.
But these treatments can all serve a purpose – and can save lives – so don’t dismiss them automatically. Just be sure to quiz your doctor about their purpose for you. If you’re still unsure after that, consider a second opinion.
According to Dr. Steven J. Stack, an American Medical Association board chair, the goal is not to avoid these treatments but to “ensure that the right patient gets the right treatment at the right time.”
1. Heart vessel stents (aka percutaneous coronary intervention or PCI)
Stents are tiny tubes inserted into heart vessels during a procedure called an angioplasty, which increases blood flow to the hearts of patients with clogged arteries. Not all angioplasties involve stents, though.
According to Dr. Carl L. Tommaso, a cardiologist who attended the summit, stents are not considered overused in patients with acute coronary syndromes, which are heart problems that reduce blood flow to the heart, such as…
- Acute myocardial infarction, or heart attack (because for patients with this problem, stents are known to decrease chances of death)
- Unstable angina, a type of chest pain (because for patients with this problem, stents are known to reduce chances of future hospitalizations and improve symptoms)
- Non-ST-segment elevation myocardial infarction, a specific type of heart attack (because for patients with this problem, stents are known to reduce chances of future hospitalizations and improve symptoms)
Stent overuse is seen in patients with chronic stable angina who undergo elective angioplasties. The only benefit to an angioplasty or stent for such patients is to reduce symptoms, Tommaso says. So with rare exception, the procedure will not decrease chances of death or rehospitalization.
2. Blood transfusions (blood management)
A recent Johns Hopkins Medical study found “frequent” transfusions for patients who didn’t need it.
Not only is this wasteful, it can be dangerous: “The resulting overuse of blood is problematic, the researchers say, because blood is a scarce and expensive resource and because recent studies have shown that surgical patients do no better, and may do worse, if given transfusions prematurely or unnecessarily.”
Exceptions include trauma and hemorrhage, in which cases transfusions can save lives.
3. Ear tubes (tympanostomy tubes) for brief periods of fluid behind the ear drum
Usually, ear tubes are inserted to provide long-term drainage and ventilation of the middle ears of patients who have had “persistent fluid buildup, chronic middle ear infections, or frequent infections,” according to the Mayo Clinic.
In such situations, ear tubes can relieve symptoms like ear pressure, decrease the frequency of infections, and prevent hearing loss.
So the key to avoiding unnecessary ear tube surgery is the word brief: The summit attendees “agreed as a position statement that tubes should not be placed in children who have had isolated otitis media with effusion [an infection of the middle ear that involves fluid] of less than 90 days duration unless there are other medical or social exacerbating factors or special circumstances,” says Dr. David W. Roberson, an ear/nose/throat surgeon who attended the summit.
4. Antibiotics for the common cold (viral upper respiratory infections)
Antibiotics treat bacterial infections.
For viral infections like colds, “Waiting and monitoring is the best therapy,” says Dr. Donna E. Sweet, an internist who attended the summit. “It’s not antibiotics that [patients] need. It’s time to see if [their infections clear up] on their own, which they will for the most part.”
Even sinus infections caused by viruses don’t require antibiotics, according to the Infection Diseases Society of America.
Sure, antibiotics are generally cheap, but that doesn’t mean they don’t cost us. They kill good bacteria along with bad ones, and overuse leads to drug-resistant bacteria. A bacterial infection called methicillin-resistant Staphylococcus aureus, or MRSA, is difficult to treat because it’s resistant to multiple common antibiotics. Some patients must undergo surgery, including limb amputations, to beat the infection. Some patients succumb to it. In 2005, more people died of MRSA than AIDS in the U.S., WebMD reported.
5. Early scheduled births (early induction) without medical need
“Early” is defined here as any time before 39 weeks, according to Dr. Bryan T. Oshiro, a perinatologist who attended the summit.
If your doctor pushes for an early scheduled birth, consider getting a second opinion. Oshiro said one of the reasons scheduled births are overused is simply that obstetricians often prefer them because they’re more convenient for the doctor.