Hair-raising: Overtreatment in medicine

Filed Under: Patients, Providers

For a catalog of some of the things that are seriously wrong with the American health-care system, run, don’t walk over to Well, the New York Times blog. Tara Parker-Pope, the extraordinary curator and writer and community-developer over there, wrote a story about overtreatment in medicine, and invited comment.

Of course, overtreatment is often cited as one of the main drivers of rising health costs. I don’t believe that’s a primary driver, but it’s clear that there is a lot of overtreatment in the system, which is anecdotally reflected here in a nonscientific sampling of rants and pleas and utter sadness from hundreds of people with stories to tell.

Since I know The Times moderates its comments, I am certain there are hundreds more that didn’t make it onto the site.  (Here’s the moderation policy, in case you’re interested.)

When I last checked there were 850-some comments. A sampling:

A women in a hormone study: “Last summer I appeared for an annual mammogram, which revealed a lump in the left breast. Estrogen gives you breast lumps, which I had had premenstrually anyway; but I went in for a send mammogram. This found a second lump, on the other breast. So I had an ultrasound. The ultrasound exonerated the original lump, but they decided on an MRI. The MRI deemed both lumps harmless but found a third with suspicious, ‘wash out’ characteristics. A biopsy was scheduled for both breasts (I never did find out why) but after a pre-biopsy ultrasound the biopsy of the right breast was cancelled, and I underwent a biopsy of the left. I went home to await the results, which were negative–a single benign papilloma; alls well that ends well, except for a painful phlebitis I was still nursing from the MRI contrast medium. Then, two weeks later…another call! Not all the cells from the papilloma had been removed (that’s why you call it a ‘biopsy’) and there was ‘no way to be sure’ that it would not turn into cancer someday. Since it is impossible to prove a negative: ‘We are sending you to a surgeon.’ I told them they were sending me nowhere, ever again. I quit the study.”

An E.R. room visitor: “I went to the ER due to dizziness last Thanksgiving. It turned out to be a massive sinus infection, but the medical professionals wanted to eliminate heart disease and stoke. So my 24 hour stay ended up costing over 60K – covered mostly by Medicare. I was willing to go home after all preliminary testing came back healthy. But I was encouraged to spend the night in cardiac care with continuous monitoring just ‘in case.’ No one was at fault – fear of misdiagnosis was the elephant in the room.”

Another E.R. visitor: “Went to an emergency room for a simple test. Test was fine but DO in charge expanded exam to check heart rythem I already knew and I ended up getting x-ray, CT and a night in the ICU all for a benighn condition. Have since gotten agreement with the hospital to reverse total charges of over 12000 except for the initial test.”

A mother: “On the flip side of this story….my son was experiencing what we thought were ‘growing pains.’ After a few days of pain, I took him to the doctor, who ordered an x-ray, which seemed normal…and blood tests, which seemed excessive at the time. Little did I know that three weeks, another blood test, and two MRIs later….the diagnosis would be leukemia. My doctor’s thorough consideration of everything is what spared us months of pains and wondering. Thorough is not necessarily a bad thing.”

A doctor: “We recently switched to a high deductible, low premium health care insurance to (hopefully) save costs overall for our family. I am a physician, and this is the first opportunity I have had to take a very critical look at the real costs of tests that are ordered. Trust me, we will exercise our voice in health care decisions for our family!”

A son: “In 2007, my then 73 year old father had a stroke. He had an understandable serious of tests and was prescribed a blood thinner, blood pressure medicine and cholesterol medicine, also understandably. But then the doctors in the hospital insisted he was depressed and referred a psychiatrist who prescribed two anti-depressants. Of course he was depressed, he was in the hospital. After those anti-depressants were prescribed he started to have bizarre hallucinations. He was then diagnosed with vascular dementia, and declared incapacitated. He ended up in a nursing home for six months. During that time I became suspicious about these medications, some of which had the possible side effect of hallucinations. I pressured the nursing home doctors to change the medications, which by now included anti-psychotics. They did, probably out of fear. His dementia magically went away, even though there is no cure or treatment for dementia. He had to go back into court and have his capacity restored. He is still alive today at 79, living alone and taking care of himself. But he was left almost bankrupt by the ordeal.”

A patient: “I went to a primary care doctor who, as a matter of course, ordered all sorts of tests on all his patients. Among those tests, he wanted a yearly lung x-ray. I submitted to it the first time, thinking that maybe he had suspected something specific and needed to see an x ray of my lungs only to find out, as stated above, that this was standard practice for him for all his patients. My results came back and looked ‘ambiguous’ so an MRI was ordered. I thought for sure that I had lung cancer only to find out that the x ray technician had flubbed it, he had made me stand in the wrong position so, basically, everything was fine. For the next year’s check up, the nurse gave me the paperwork to go get my lung x-ray and I refused. I know that I was in a minority as far as patients to refuse. This doctor also regularly wanted all sorts of other tests: neurological, cardiac, excessive blood tests, etc. I realized this guy was probably getting kickbacks and changed doctors.”