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Doctors Are Creating Too Many Patients

Hugh Pickens writes (1984118) writes | more than 3 years ago

Medicine 2

Hugh Pickens writes 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. Welch, a a practicing physician and professor of medicine at the Dartmouth Institute for Health Policy and Clinical Practice, says that 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 that the problem is that low thresholds have a way of leading to treatments that are worse than the disease and while clinicians are sued for failure to diagnose or failure to treat, there are few corresponding penalties for overdiagnosis or overtreatment so doctors view low thresholds as the safest strategy to avoid a courtroom appearance. "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.""

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I've been saying this for a long time. (1)

bobv-pillars-net (97943) | more than 3 years ago | (#36055430)

I haven't paid into the medical system for over ten years, and am looking forward to defending myself against criminal charges for my "negligence". During the same period, my neighbor has received three elective surgeries, courtesy of the health care system, and is under no such danger of prosecution. It's not just the doctors who are playing it safe.

medicine (1)

jbayston (2123024) | more than 3 years ago | (#36055656)

There is a balance that needs to be achieved here. I live in the Uk and the ( excellent ) NHS tends to go the other way, hoping for the best. Each procedure costs money and so doctors are reluctant to act unless there is clear evidence of illness. Money is at the heart of both issues. Taxes pay for healthcare here, and so governments are averse to seeming to be wasteful. As I understand it in USA, the drug companies are very keen to medicalise conditions so that they can increase their revenue streams. In his book, The Noble Lie, Gary Greenberg questions the actual medical causes behind conditions like addiction and some psychological illnesses. Is sex addiction an illness? and when was that defined as such? who profits from this diagnosis? I don't suggest a big conspiracy at this point, more an alignment of interests. Drug companies want to increase profits. If they successfully cure all disease, then they will go bust. So they find more diseases. Doctors are in a similar position. They need to offer the latest cure for the latest diseases to market themselves ahead of the curve. And then there are the lawyers, offering to sue any doctor who doesn't find what ever it is the patient may or may not suffer from. Meanwhile, this allows the insurance companies to up the payments, putting greater pressure on companies and employment, while not actually making much difference to public health. The conspiracy comes when all interested groups come together to try to stop improvement or change. George Bernard Shaw once said that professions are a conspiracy against the laity. I think you can argue that this is a good example.
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