Reducing Overtreatment, Overtesting, And Overdiagnosis

Dec 3, 2013

I had a chance to speak to Department of Health director Dr. Michael Fine this morning as he traveled to a conference in Boston. The gathering, put on by the Lown Institute, is "From Avoidable Care to Right Care," convenes "...clinicians, patient advocates, and civic leaders to deepen our mutual understanding of the cultural, scientific, and ethical issues surrounding the overuse of medical services." (Dr. Bernard Lown, the institute's namesake, won a Nobel Prize in 1985 for starting International Physicians for the Prevention of Nuclear War; he also helped pioneer the cardiac defibrillator and was a co-founder of Physicians for Social Responsibility).

Dr. Michael Fine, director of Rhode Island's Department of Health
Credit Rhode Island Department of Health

So what is the "overuse of medical services" and why is Dr. Fine so concerned about it? He told me overuse is everything from the extraordinary measures we often take to prolong life at the end of a person's life, even if it means a lower quality of life, to the use of treatments for which we don't have a lot of evidence of their effectiveness. He's concerned about overuse because it exposes patients to unnecessary risks, doesn't always lead to better health, and costs more.

Curbing overuse and overtreatment, Fine said, isn't about denying people medical care, but delivering smarter care for better outcomes. What we need, he said, is more primary care centered around patients' needs, a real health care system, not health care businesses. The new model of "patient-centered medical homes" could help, Fine told me, but maybe they don't go far enough. Could they include, for instance, more mental health, and home health care?

But based on the tweets coming out of the conference today (#Lown2013), it looks like there are still no easy answers. Are fears of medical malpractice suits to blame, causing doctors to do more, prescribe more, test more? Is it that doctors would rather offer some kind of treatment than say "I don't know?"