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The Pitfalls of Overtreatment: Why More Care is not Necessarily Beneficial

Abstract

Overtreatment refers to interventions that do not benefit the patient, or where the risk of harm from the intervention is likely to outweigh any benefit the patient will receive. It can account for up to 30% of health care costs, and is increasingly recognised as a widespread problem across nations and within clinical and scientific communities. There are a number of inter-related factors that drive overtreatment including the expanding definition of diseases, advertising and the influence of the pharmaceutical industry, how doctors are trained and remunerated, demands from patients (and their families) and the fear of complaints leading doctors to practise defensively.

This paper discusses a number of ethical and practical issues arising from overtreatment that doctors and patients should be aware of. It also considers the flow-on effects of overtreatment such as the increased cost of care, increase in work load for health professionals, and wastage as resources are diverted from more genuine and pressing needs. In addition, there are references to a number of Medical Council of New Zealand statements about what good medical practice means in an environment of resource limitation. The paper concludes with a few measures that doctors and patients could take to reduce overtreatment but acknowledges that health care is extremely complex so it would be unrealistic to eliminate overtreatment entirely.

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Notes

  1. For example, the USA spends substantially more per person on health care than any other country, yet health outcomes for the USA patients, whether measured by life expectancy, disease-specific mortality rates or other variables, are the same or worse than those in other countries (Emmanuel and Fuchs 2008).

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Acknowledgements

I am grateful for the helpful feedback that Dr Steven Lillis and Dr Kevin Morris provided on earlier versions of this paper.

A special thank-you to Dr Calvin Ho for the opportunity to present an initial version of this paper at the International Seminar on People-Centred Universal Health Coverage organized by the Asian Bioethics Review in Singapore on 28–29 January 2019. My sincere thanks also to Dr Karel Caals who worked tirelessly behind the scenes to organise and make that seminar possible. While I regret that this paper was not submitted before Dr Ho concluded his tenure as Editor-in-Chief, I remain deeply appreciative that he saw the value of my work at MCNZ and encouraged me to share that with an international audience.

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Correspondence to Kanny Ooi.

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Conflict of Interest

I have been a Senior Policy Adviser and Researcher with the Medical Council of New Zealand (MCNZ) since December 2014. MCNZ is responsible for registering doctors who practise in New Zealand, and setting standards for the way our doctors practise. A large part of my role involves researching and writing those standards which are used to assess a doctor’s conduct and competence. I am often contacted by doctors, patients and members of the public about our standards and how they apply to a particular situation. I also facilitate consumer panel discussions about our standards so that the needs and perspectives of consumers are reflected in the standards we set. In addition, I am part of MCNZ’s Triage Team that makes initial decisions on how complaints about doctors should be handled.

I researched and wrote the following MCNZ statements mentioned in my paper:

Advertising

Safe practice in an environment of resource limitation

Informed consent: helping patients make informed decisions about their care.

MCNZ endorses Choosing Wisely’s campaign, and a number of its principles are reflected in our statements including Safe practice in an environment of resource limitation, and Informed consent: helping patients make informed decisions about their care.

I was a member of the Editorial Board of Cole’s medical practice in New Zealand when it was updated in 2017. (Cole’s is a handbook published by MCNZ for new doctors and doctors new to medical practice in New Zealand.)

While my paper references two chapters from Cole’s and a number of MCNZ statements, the views expressed in my paper are my own, and are not to be attributed to MCNZ.

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Ooi, K. The Pitfalls of Overtreatment: Why More Care is not Necessarily Beneficial. ABR 12, 399–417 (2020). https://doi.org/10.1007/s41649-020-00145-z

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Keywords

  • Overtreatment
  • Uncertainty
  • Doctors
  • Patients
  • Best practice
  • Medical Council of New Zealand