Doctors Are Creating Too Many Patients

Hugh Pickens writes "H. Gilbert Welch writes in the LA Times that the threshold for diagnosis has fallen too low, with physicians making diagnoses in individuals who wouldn't have been considered sick in the past, raising healthcare costs for everyone. Part of the explanation is technological: diagnostic tests able to detect biochemical and anatomic abnormalities that were undetectable in the past. 'But part of the explanation is behavioral: We look harder for things to be wrong. We test more often, we are more likely to test people who have no symptoms, and we have changed the rules about what degree of abnormality constitutes disease (a fasting blood sugar of 130 was not considered to be diabetes before 1997; now it is).' Welch says the problem is that low thresholds have a way of leading to treatments that are worse than the disease. 'We are trained to focus on the few we might be able to help, even if it's only 1 out of 100 (the benefit of lowering cholesterol in those with normal cholesterol but elevated C-reactive protein) or 1 out of 1,000 (the benefit of breast and prostate cancer screening),' writes Welch. 'But it's time for everyone to start caring about what happens to the other 999.'"

Comments

Diabetes? Bad example

[MisterBuggie]

Diabetes is something you're never cured from. No matter what such and such a diet might say, it may greatly improve things, but the diabetes is still there. Fasting blood sugar over 126 is a sign that something is up. Starting lifestyle changes and/or beginning treatment early on helps slow down the progression, and avoids later complications. In this case it actually reduces the number of patients with severe complications... It's not a case of declaring people diabetic who aren't really. It's a case of getting it under control before it progresses too much. Because if you hit 130, without at least diet changes, the diabetes is most definitely going to get worse.

Lawyers

[Anonymous Coward]

In a court of law the question to be asked "Was there a test to determine the problem with my client's husband that would have saved his life if you had done it?" That single question is the reason for all of this, because if the answer is "yes", which is always is even if there were no legitimate reason to run said test, then the doctor is guilty of malpractice. He does that three times, he is no longer a doctor.

Stop blaming the people trying to help you, who have to protect themselves from the lawyers. Blame the root cause.

Re:Kind of agree...

[0100010001010011]

My girlfriend, a doctor, agrees. I just texted her the article and her response:

"We make more patients bc we practice defensive medicine. No one wants to be sued".

That might be in the US....

[Windwraith]

Because where I live, I suffered from a crippling disease for 5 years that almost ended up fatally, and going week after week after week to the medic, treated like a liar or an attention whore, coming back home every day without results.
Until, finally, after years of calamity, they found what it was. About f*cking time if you ask me, it ended up being a serious intestinal disease combined with a esophagus and a circulatory thing and lots of inconvenient little things.

Please take note of the time. 5 years of my life lost without being able to go out of home and unable to work, socialize or well, just about anything that wasn't being yellowish in color.
Because of medics, who could have detected this much earlier, I lost the best years of my life, the ones between young adulthood and proper adulthood. I am like a hermit who just came out of a cave. All because medics didn't want to do a bit of work and do science stuff.

Here, where free healthcare exists, medics are only concerned about getting their taxpayer-founded salary every month, and don't give a crap if the patient dies or not.
After seeing medic after medic and having to hear "it must be psychosomatic" for years, I have very little respect for the medical guys.

A medic like the ones described in the article would have saved me 5 years of my life. That's not something trivial.

Re:This is just stupid

[Christoph]

I agree.

My late brother's doctor told him his swollen lymph nodes were nothing -- he had no symptoms, and a routine white count showed no infection.

That's how lymphoma presents. The next year he was in the ER due to wheezing, and was diagnosed with stage 3 Hodgkin's lymphoma, which eventually killed him (photos of his last years). He had a bone marrow and stem cell transplant...not looking for lymphoma in someone asymptomatic turned out to be pretty expensive as well as fatal for the patient.

This story is not rare, either. After speaking to a handful of other Hodgkin's patients, they all had similar experiences. And those were the survivors.

Re:Kind of agree...

[nomadic]

No offense to your girlfriend, but do you really think she's going to say "oh, yeah, we definitely are to blame"?

The Medical Malpractice Myth.:

What do we know?

First, we know from the California study, as confirmed by more recent, better publicized studies, that the real problem is too much medical malpractice, not too much litigation. Most people do not sue, which means that victims—not doctors, hospitals, or liability insurance companies—bear the lion’s share of the costs of medical malpractice.

Second, because of those same studies, we know that the real costs of medical malpractice have little to do with litigation. The real costs of medical malpractice are the lost lives, extra medical expenses, time out of work, and pain and suffering of tens of thousands of people every year, the vast majority of whom do not sue. There is lots of talk about the heavy burden that “defensive medicine” imposes on health costs, but the research shows this is not true.

Third, we know that medical malpractice insurance premiums are cyclical, and that it is not frivolous litigation or runaway juries that drive that cycle. The sharp spikes in malpractice premiums in the 1970s, the 1980s, and the early 2000s are the result of financial trends and competitive behavior in the insurance industry, not sudden changes in the litigation environment.

Fourth, we know that “undeserving” people sometimes bring medical malpractice claims because they do not know that the claims lack merit and because they cannot find out what happened to them (or their loved ones) without making a claim. Most undeserving claims disappear before trial; most trials end in a verdict for the doctor; doctors almost never pay claims out of their own pockets; and hospitals and insurance companies refuse to pay claims unless there is good evidence of malpractice. If a hospital or insurance company does settle a questionable claim to avoid a huge risk, there is a very large discount. This means that big payments to undeserving claimants are the very rare exception, not the rule.

Finally, we know that there is one sure thing—and only one thing—that the proposed remedies can be counted on to do. They can be counted on to distract attention long enough for the inevitable turn in the insurance cycle to take the edge off the doctors’ pain. That way, people can keep ignoring the real, public health problem. Injured patients and their lawyers are the messengers here, not the cause of the medical malpractice problem.