Is it really always only the others who are to blame? GP’s view on medical overuse. A questionnaire study. Abstract Background Medical overuse is a common problem in health care.
Preventing unnecessary medicine is one of the main tasks of General Practice, so called quaternary prevention. We aimed to capture the current opinion of German General Practitioners (GPs) to medical overuse. Methods A quantitative online study was conducted. Results Response rate was 18%. Discussion Medical overuse is an important issue for GPs. Citation: Pausch M, Schedlbauer A, Weiss M, Kuehlein T, Hueber S (2020) Is it really always only the others who are to blame?
Editor: Monika R. Received: August 15, 2019; Accepted: December 18, 2019; Published: January 15, 2020 Copyright: © 2020 Pausch et al. Data Availability: All relevant data are within the paper and its Supporting Information files. Funding: The authors received no specific funding for this work. Competing interests: The authors have declared that no competing interests exist.
Introduction Medical overuse is a common problem in health care [1, 2]. Measures A. Pharmacists uniquely poised to reduce unnecessary prescriptions. Two recent articles, one by and another , highlight the problems associated with polypharmacy, the term for taking many different medications daily.
Research points to almost 90 percent of Medicare beneficiaries 65 years of age and older taking a prescription drug, and of those taking at least one prescription drug a day, almost half reported taking five or more different drugs a day. Brody’s article says people in their 60s take an average of 15 prescription drugs a year. These are a lot of drugs, by whatever measure. Martin Marshall: GPs need to do less, but it’s not what patients want to hear. The NHS does too much medicine”.
These are surprising words to hear uttered by a GP, given their role as gatekeepers to the NHS – the doctors who send patients to hospital for tests, surgery or other treatment. But Martin Marshall, the new chair of the Royal College of General Practitioners, firmly believes that part of the reason the NHS is so overstretched is that doctors (GPs and hospital doctors) overdiagnose illness – and as a result patients have too many exploratory tests and too many unnecessary treatments.
Getting a grip on that, he believes, would help relieve the pressure on the health service in general and the nation’s overworked family doctors in particular. Marshall, 58, has just begun a three-year stint as the profession’s leader and main mouthpiece, replacing Helen Stokes-Lampard. He believes “medicine has overstretched itself” and its limits need to be “rethought”, to be scaled back. Socioeconomic status and benzodiazepine and Z-drug prescribing: a cross-sectional study of practice-level data in England.
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You can change your cookie settings at any time. <a href=" Find out more</a> Skip to Main Content. The U.S. Leads the World in Health-Care Spending. It was in his self-neglect, rather than his hostility, that my father found common cause with the tens of millions of American patients who collectively hobble our health-care system.
For years, the United States’ high health-care costs and poor outcomes have provoked hand-wringing, and rightly so: Every other high-income country in the world spends less than America does as a share of GDP, and surpasses us in most key health outcomes. Recriminations tend to focus on how Americans pay for health care, and on our hospitals and physicians. Surely if we could just import Singapore’s or Switzerland’s health-care system to our nation, the logic goes, we’d get those countries’ lower costs and better results. Where to draw the line between mental health and illness? Defining mental disorders and illnesses is not straightforward.
Notions of whether a certain phenomenon should be classified as an illness or disorder, or something falling within the category of normal emotional fluctuations or personality traits, have changed significantly over the years, and continue to do so. In a study carried out with a Finnish dataset, an international group of researchers looked into which mental conditions from a group of 20 were considered illnesses and which were not by five different groups of people. The questionnaire was distributed to 6,200 individuals, of whom 3,000 were Finns chosen randomly from the Population Register. The rest included 1,500 physicians – a number of psychiatrists and other specialists – 1,500 nurses and, in addition, all of the 200 members of the Finnish Parliament. The Role of Disease Labels in Patient Perceptions and Treatment Decisions. Key Points Question What role does disease label play in patients’ treatment decision making in the setting of low-risk epithelial malignant neoplasms such as papillary thyroid cancer?
Findings The disease labels cancer, nodule, and tumor played a considerable role in patient decision making, with participants willing to accept a 4-percentage-point increased risk of progression or recurrence (from 1% to 5%) to avoid their disease being labeled as cancer in favor of nodule. The strength of the preference for the nodule label instead of cancer was similar to the preference for active surveillance instead of surgery. Meaning Omitting the word cancer from the disease label of low-risk epithelial malignant neoplasms may reduce overtreatment. Importance The cancer disease label may lead to overtreatment of low-risk malignant neoplasms owing to a patient’s emotional response or misunderstanding of prognosis. Too much medicine: not enough trust? Dilemmas of medical overuse in general practice - A focus group study. - PubMed - NCBI. Medical Overuse as a Physician Cognitive Error: Looking Under the Hood. Medical overuse, or health services for which potential harms outweigh benefits, is common and persistent.
Medical overuse is assumed to exist when regional variation occurs without improvements in outcomes and is believed to be driven largely by perverse financial incentives and local cultures of care.1 In this issue of JAMA Internal Medicine, Schwartz and colleagues2 quantified variations in primary care physician provision of low-value services (largely representing overuse) among Medicare beneficiaries and characterized associations with physician characteristics such as age, training, and research activities. Although practice varied widely within organizations, little variation was due to observable physician characteristics. Half of older patients exposed to potentially inappropriate prescribing. Around half of older patients are exposed to potentially inappropriate prescribing, each year, and hospitalisation is independently associated with an increased risk, finds a study in Ireland published by The BMJ today.
Inappropriate prescribing can include the intensification of existing drugs and the failure to stop or reduce doses of certain drugs after discharge from hospital. The findings suggest that better coordination of care is needed to reduce avoidable medication related harms among these patients. Potentially inappropriate prescribing is common among older adults and is associated with adverse outcomes including emergency hospital attendances and admissions, adverse drug events, and poorer quality of life. Yet research to date has focused on characteristics of patients and general practitioners as risk factors for poor prescribing quality. Breaking good news: an essential skill for avoiding too much medicine? Physician Characteristics Associated With Ordering 4 Low-Value Screening Tests in Primary Care. Looking for trouble? Diagnostics expanding disease and producing patients - Hofmann - 2018 - Journal of Evaluation in Clinical Practice. Novel tests give great opportunities for earlier and more precise diagnostics.
At the same time, new tests expand disease, produce patients, and cause unnecessary harm in overdiagnosis and overtreatment. How can we evaluate diagnostics to obtain the benefits and avoid harm? One way is to pay close attention to the diagnostic process and its core concepts. Its-hard-for-doctors-to-unlearn-things-thats-costly-for-all-of-us. RACGP - Managing de-implementation in general practice. Drivers and strategies for avoiding overuse. A cross-sectional study to explore the experience... - Europe PMC Article - Europe PMC. Four ways to shift the culture of overuse - Lown Institute. If you’re a regular reader of our blog, you know that medical overuse is a widespread, costly, and harmful problem.
At least 20% of all health care spending goes towards treatments, drugs, tests, or surgeries that patients do not need, wasting hundreds of billions of dollars and sometimes causing serious complications for patients. Clinicians themselves recognize that overuse is prevalent. In a 2017 survey of physicians, on average doctors estimated that 20.5% of care provided in their specialty is unnecessary. However, even for doctors who want to reduce overuse, there are still plenty of barriers to providing the right care, including perceived patient demand, fear of malpractice suits, safety concerns, and discomfort with uncertainty. In a new article in the Journal of Patient Safety, medical students at the Icahn School of Medicine Sara Pasik and Sigal Israilov, chief of internal medicine at the Memorial Sloan Kettering Cancer Center Dr.
Small area variations in health care delivery. - PubMed - NCBI. Location Matters. Patients with common conditions such as back pain, headaches and upper respiratory infections are more likely to receive tests and services of uncertain or little diagnostic or therapeutic benefit—so-called low-value care—when they seek treatment in primary care clinics located at hospitals rather than at community-based primary care clinics, according to a nationwide study led by researchers at Harvard Medical School and the David Geffen School of Medicine at UCLA.
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