Overtreatment May Cause More Harm Than Good

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A literature review published in JAMA Internal Medicine finds that many medical tests are overused and overtreatment is common and potentially harmful.

"This review of these 2018 findings aims to inform practitioners who wish to reduce overuse and improve patient care," the authors wrote.

The report is based on an analysis of 839 articles on medical overuse of which 117 were deemed as most significant with the 10 highest ranked articles served as the basis for the review.

The findings:

• Incidentalomas, or incidentally found asymptomatic tumors, are present in 22-38 percent of common magnetic resonance imaging or computed tomography studies.

• Mammographies are conducted in 9 percent of women with stage IV cancer.

• Low risk patients face greater harm when they undergo screening for computed tomography lung cancer, but stable benefit.

• Procalcitonin, a peptide that suggests inflammation due to bacterial infection or tissue injury, does not affect antibiotic duration in patients with lower respiratory tract infection (4.2 vs 4.3 days).

• Urgent care clinics overprescribe antibiotics. In 39 percent of all visits, patients received antibiotics.

• The treatment of subclinical hypothyroidism, or early mild hypothyroidism, has no effect on clinical outcomes.

• The authors questioned the use of opioids for chronic noncancer pain citing a meta-analysis that found no clinically significant benefit.

• The authors questioned the use of supplemental oxygen for patients with normal oxygen levels (mortality relative risk, 1.21; 95% CI, 1.03-1.43).

• And, the authors questioned the use of stress ulcer prophylaxis for intensive care unit patients. The procedure is used to prevent stress-related mucosal bleeding from the upper gastrointestinal tract (mortality, 31.1% with pantoprazole vs 30.4% with placebo).

“Individual physicians continue to be pressured to see more patients and pushed to take on too many responsibilities to do all things well,” wrote the authors who were led by Daniel J. Morgan, M.D., of the University of Maryland School of Medicine.

In many cases, the authors wrote, physicians are motivated to order unnecessary tests and treatments due to financial incentives offered by pharmaceutical companies or fee-for-service procedures or other health insurance metrics.

“Decreasing the burden of documentation, increasing the time spent in patient contact, and encouraging care delivery that is aligned with patients’ goals and best evidence may optimize value in health care with rewarding experiences for both patients and physicians,” the authors wrote.

The article was published online Sept. 9.

REFERENCE

Daniel J. Morgan, MD; Sanket S. Dhruva, MD; Eric R. Coon, MD; et al. "2019 Update on Medical Overuse A Review," Sept. 9, 2019. JAMA Internal Medicine. DOI:10.1001/jamainternmed.2019.3842