Overtreatment in the United States

Heather Lyu, Tim Xu, Daniel Brotman, Brandan Mayer-Blackwell, Michol Cooper, Michael Daniel, Elizabeth C. Wick, Vikas Saini, Shannon Brownlee, Martin A Makary

Research output: Contribution to journalArticle

Abstract

Background: Overtreatment is a cause of preventable harm and waste in health care. Little is known about clinician perspectives on the problem. In this study, physicians were surveyed on the prevalence, causes, and implications of overtreatment. Methods: 2,106 physicians from an online community composed of doctors from the American Medical Association (AMA) masterfile participated in a survey. The survey inquired about the extent of overutilization, as well as causes, solutions, and implications for health care. Main outcome measures included: percentage of unnecessary medical care, most commonly cited reasons of overtreatment, potential solutions, and responses regarding association of profit and overtreatment. Findings: The response rate was 70.1%. Physicians reported that an interpolated median of 20.6% of overall medical care was unnecessary, including 22.0% of prescription medications, 24.9% of tests, and 11.1% of procedures. The most common cited reasons for overtreatment were fear of malpractice (84.7%), patient pressure/request (59.0%), and difficulty accessing medical records (38.2%). Potential solutions identified were training residents on appropriateness criteria (55.2%), easy access to outside health records (52.0%), and more practice guidelines (51.5%). Most respondents (70.8%) believed that physicians are more likely to perform unnecessary procedures when they profit from them. Most respondents believed that de-emphasizing fee-for-service physician compensation would reduce health care utilization and costs. Conclusion: From the physician perspective, overtreatment is common. Efforts to address the problem should consider the causes and solutions offered by physicians.

Original languageEnglish (US)
Article numbere0181970
JournalPLoS One
Volume12
Issue number9
DOIs
StatePublished - Sep 1 2017

Fingerprint

Health care
physicians
Physicians
health services
Profitability
profits and margins
Patient Acceptance of Health Care
Delivery of Health Care
Unnecessary Procedures
Fee-for-Service Plans
Malpractice
American Medical Association
Medical Overuse
Health
Practice Guidelines
Compensation and Redress
Health Care Costs
Fear
Medical Records
Prescriptions

ASJC Scopus subject areas

  • Medicine(all)
  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)

Cite this

Lyu, H., Xu, T., Brotman, D., Mayer-Blackwell, B., Cooper, M., Daniel, M., ... Makary, M. A. (2017). Overtreatment in the United States. PLoS One, 12(9), [e0181970]. https://doi.org/10.1371/journal.pone.0181970

Overtreatment in the United States. / Lyu, Heather; Xu, Tim; Brotman, Daniel; Mayer-Blackwell, Brandan; Cooper, Michol; Daniel, Michael; Wick, Elizabeth C.; Saini, Vikas; Brownlee, Shannon; Makary, Martin A.

In: PLoS One, Vol. 12, No. 9, e0181970, 01.09.2017.

Research output: Contribution to journalArticle

Lyu, H, Xu, T, Brotman, D, Mayer-Blackwell, B, Cooper, M, Daniel, M, Wick, EC, Saini, V, Brownlee, S & Makary, MA 2017, 'Overtreatment in the United States', PLoS One, vol. 12, no. 9, e0181970. https://doi.org/10.1371/journal.pone.0181970
Lyu H, Xu T, Brotman D, Mayer-Blackwell B, Cooper M, Daniel M et al. Overtreatment in the United States. PLoS One. 2017 Sep 1;12(9). e0181970. https://doi.org/10.1371/journal.pone.0181970
Lyu, Heather ; Xu, Tim ; Brotman, Daniel ; Mayer-Blackwell, Brandan ; Cooper, Michol ; Daniel, Michael ; Wick, Elizabeth C. ; Saini, Vikas ; Brownlee, Shannon ; Makary, Martin A. / Overtreatment in the United States. In: PLoS One. 2017 ; Vol. 12, No. 9.
@article{5edc50a6f1cf495db7266bab9d26aaaf,
title = "Overtreatment in the United States",
abstract = "Background: Overtreatment is a cause of preventable harm and waste in health care. Little is known about clinician perspectives on the problem. In this study, physicians were surveyed on the prevalence, causes, and implications of overtreatment. Methods: 2,106 physicians from an online community composed of doctors from the American Medical Association (AMA) masterfile participated in a survey. The survey inquired about the extent of overutilization, as well as causes, solutions, and implications for health care. Main outcome measures included: percentage of unnecessary medical care, most commonly cited reasons of overtreatment, potential solutions, and responses regarding association of profit and overtreatment. Findings: The response rate was 70.1{\%}. Physicians reported that an interpolated median of 20.6{\%} of overall medical care was unnecessary, including 22.0{\%} of prescription medications, 24.9{\%} of tests, and 11.1{\%} of procedures. The most common cited reasons for overtreatment were fear of malpractice (84.7{\%}), patient pressure/request (59.0{\%}), and difficulty accessing medical records (38.2{\%}). Potential solutions identified were training residents on appropriateness criteria (55.2{\%}), easy access to outside health records (52.0{\%}), and more practice guidelines (51.5{\%}). Most respondents (70.8{\%}) believed that physicians are more likely to perform unnecessary procedures when they profit from them. Most respondents believed that de-emphasizing fee-for-service physician compensation would reduce health care utilization and costs. Conclusion: From the physician perspective, overtreatment is common. Efforts to address the problem should consider the causes and solutions offered by physicians.",
author = "Heather Lyu and Tim Xu and Daniel Brotman and Brandan Mayer-Blackwell and Michol Cooper and Michael Daniel and Wick, {Elizabeth C.} and Vikas Saini and Shannon Brownlee and Makary, {Martin A}",
year = "2017",
month = "9",
day = "1",
doi = "10.1371/journal.pone.0181970",
language = "English (US)",
volume = "12",
journal = "PLoS One",
issn = "1932-6203",
publisher = "Public Library of Science",
number = "9",

}

TY - JOUR

T1 - Overtreatment in the United States

AU - Lyu, Heather

AU - Xu, Tim

AU - Brotman, Daniel

AU - Mayer-Blackwell, Brandan

AU - Cooper, Michol

AU - Daniel, Michael

AU - Wick, Elizabeth C.

AU - Saini, Vikas

AU - Brownlee, Shannon

AU - Makary, Martin A

PY - 2017/9/1

Y1 - 2017/9/1

N2 - Background: Overtreatment is a cause of preventable harm and waste in health care. Little is known about clinician perspectives on the problem. In this study, physicians were surveyed on the prevalence, causes, and implications of overtreatment. Methods: 2,106 physicians from an online community composed of doctors from the American Medical Association (AMA) masterfile participated in a survey. The survey inquired about the extent of overutilization, as well as causes, solutions, and implications for health care. Main outcome measures included: percentage of unnecessary medical care, most commonly cited reasons of overtreatment, potential solutions, and responses regarding association of profit and overtreatment. Findings: The response rate was 70.1%. Physicians reported that an interpolated median of 20.6% of overall medical care was unnecessary, including 22.0% of prescription medications, 24.9% of tests, and 11.1% of procedures. The most common cited reasons for overtreatment were fear of malpractice (84.7%), patient pressure/request (59.0%), and difficulty accessing medical records (38.2%). Potential solutions identified were training residents on appropriateness criteria (55.2%), easy access to outside health records (52.0%), and more practice guidelines (51.5%). Most respondents (70.8%) believed that physicians are more likely to perform unnecessary procedures when they profit from them. Most respondents believed that de-emphasizing fee-for-service physician compensation would reduce health care utilization and costs. Conclusion: From the physician perspective, overtreatment is common. Efforts to address the problem should consider the causes and solutions offered by physicians.

AB - Background: Overtreatment is a cause of preventable harm and waste in health care. Little is known about clinician perspectives on the problem. In this study, physicians were surveyed on the prevalence, causes, and implications of overtreatment. Methods: 2,106 physicians from an online community composed of doctors from the American Medical Association (AMA) masterfile participated in a survey. The survey inquired about the extent of overutilization, as well as causes, solutions, and implications for health care. Main outcome measures included: percentage of unnecessary medical care, most commonly cited reasons of overtreatment, potential solutions, and responses regarding association of profit and overtreatment. Findings: The response rate was 70.1%. Physicians reported that an interpolated median of 20.6% of overall medical care was unnecessary, including 22.0% of prescription medications, 24.9% of tests, and 11.1% of procedures. The most common cited reasons for overtreatment were fear of malpractice (84.7%), patient pressure/request (59.0%), and difficulty accessing medical records (38.2%). Potential solutions identified were training residents on appropriateness criteria (55.2%), easy access to outside health records (52.0%), and more practice guidelines (51.5%). Most respondents (70.8%) believed that physicians are more likely to perform unnecessary procedures when they profit from them. Most respondents believed that de-emphasizing fee-for-service physician compensation would reduce health care utilization and costs. Conclusion: From the physician perspective, overtreatment is common. Efforts to address the problem should consider the causes and solutions offered by physicians.

UR - http://www.scopus.com/inward/record.url?scp=85028955254&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85028955254&partnerID=8YFLogxK

U2 - 10.1371/journal.pone.0181970

DO - 10.1371/journal.pone.0181970

M3 - Article

C2 - 28877170

AN - SCOPUS:85028955254

VL - 12

JO - PLoS One

JF - PLoS One

SN - 1932-6203

IS - 9

M1 - e0181970

ER -