Health Issue: Overtreated

Over treated: More medical care isn't always better

Washington: More medical care won't necessarily make you healthier - it may make you sicker. It's an idea that technology-loving Americans find hard to believe.

         Anywhere from one-fifth to nearly one-third of the tests and treatments we get are estimated to be unnecessary, and avoidable care is costlyin more ways than the bill:It may lead to dangerous side effects.

         It can start during birth, as some of the United States' increasing C-sections are triggered by controversial fetal monitors that signal that a baby is in trouble when really everything's fine. It extends to often futile intensive care at the end of the life.

       For example, Americans get the most medical radiation in the world, much of it from repeated CT scans. Too many scans increase the risk of cancer. Then there are thousands who get stents for blocked heart arteries when they should have tried medication first.

      Again, doctors prescribe antibiotics millions of times for viruses such as colds that the drugs can't help. Back pain stands out as the No.1 over treated condition, from repeated MRI scans that can't pinpoint the trouble to spine surgery on people who could have gotten better without it. About one in five who gets that first back operation will wind up haveing another in the next decade.

      Over treatment means some one could have fared as well or better with a lesser test or therapy, or maybe even none at all. Experts say that avoiding over treatment is less about knowing when to say no, than knowing when to say, "Wait, doc, I need more information!"

     "This is not, I repeat not, rationing," said Dr Steven Weinberger of the American College of Physicians, which this summer begins publishing recommendations on overused tests, starting with low back pain.
      It's trying to strike a balance, to provide appropriate care rather than the most care. Rare are patients who recongnise they've crossed that line. "Yet let me tell you, with additional tests and procedures comes significant harm,"said Dr Bernard Rosof, who heads projects by the nonprofit National Quality Forum and an American Medical Association panel to identify and decrease overuse.
       "It's patient education that's going to be extremely important if we're going to make this happen. so people begin to understand less is often better," he said Not even doctors' families are immine.
        A hospital appropriately did six CT scans to check Dr Steven Birnbaum's 22-year-old daughter for injury after she was hit by a car. But the next day, Molly had an abdominal scan repeated as a precaution despite having no symptoms. When a doctor ordered still another, "I blew a gasket," said the New Hampshire radiologist, who put a stop to more.