A colleague referred her father to Orly Avitzur, medical adviser to Consumer Reports, with apologies. The 78-year-old retired businessman was visiting from Florida for the month and had asked his daughter to set up appointments for him with a half-dozen specialists.
Other than well-controlled high blood pressure, an enlarged prostate and a history of occasional bouts of pneumonia, the man was in good health. But he was worried about cancer, a topic of all-too-frequent conversation in his retirement community. He came to see Avitzur complaining of recent headaches and fears of a brain tumor. He had already seen a cardiologist, an internist and a urologist during his visit and was taking a variety of painkillers and muscle relaxants.
An article in the Sept. 26, 2011, issue of the Archives of Internal Medicine added to the abundant evidence that many patients receive too much care. According to the survey reported on in the journal, 42 percent of primary-care physicians in the United States think that patients in their own practice are receiving excessive care; only 6 percent said they were receiving too little.
Physicians sometimes have their own incentives for seeing patients too frequently or ordering too many tests — such as financial rewards or fear of malpractice — but patients might also contribute to the problem by mistakenly believing that more visits or more tests will keep them healthier.
In fact, when it comes to your well-being, less is often more. The combination of overtreatment and poor coordination of care by physicians, a threat that rises with the number of practitioners you see and the number of health-care systems involved, leads to a higher incidence of medical problems and increased dependency, especially for the chronically ill. That’s according to a March report in the Journal of the American Medical Association. Some specific risks include:
●Medication problems. Avitzur noted that when reviewing a new patient’s medication list, it’s not unusual to run across a duplication, as she did recently when seeing a patient for vertigo; the patient had been prescribed Antivert, a brand-name drug, by her primary-care doctor, and meclizine, the generic equivalent, by her ear, nose and throat doctor. It’s even more common to find people who are already on multiple medications being prescribed the same drugs again, such as auto-accident survivors who are over-sedated from multiple-prescription muscle relaxants and painkillers.
The likelihood of being on too many drugs increases with the number of providers you see. Keeping a list of medications that includes brand and generic names, and making sure all your doctors review them, can help. But there’s no substitute for streamlining the number of physicians you see.
●Too many tests. It’s not uncommon for a doctor to reorder a test that another doctor has just had done. Moreover, even minor abnormalities or incidental findings can lead to increasingly invasive testing with a risk of serious complications. In a health survey last year for Consumer Reports, many respondents said they completely or somewhat agreed that “it’s better to have a scare that turns out to be nothing than to not get tested at all.” Only a few recognized the risk of having a false alarm.
●Waste of time and money. While genuine medical problems should never be ignored, overtreatment takes time away from other activities. It’s estimated that overtreatment was responsible for $158 billion to $226 billion in wasteful spending in the United States in 2011, while failure to coordinate care cost $25 billion to $45 billion. Besides the overall implications for health-care spending and the threat to worthy government programs, your own pocketbook is affected. Even with the best insurance plans, co-payments for office visits, tests, procedures and pharmacy bills can add up quickly.
●Too much stress. Undergoing frequent tests, waiting for results and trying to make sense of conflicting opinions can cause undue tension. In the case of Avitzur’s colleague’s father, stress undoubtedly contributed to his headaches. And the multiple painkillers he was taking had contributed to a rebound effect. With reassurance and gradual discontinuation of the drugs, the headaches eventually resolved.