Editorials

Getting Medicine Right: Overcoming the Problem of Overscreening, Overdiagnosis, and Overtreatment

 


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Am Fam Physician. 2015 Jan 1;91(1):18-20.

  Related editorials: Improving Quality by Doing Less: Overscreening; Improving Quality by Doing Less: Overdiagnosis; and Improving Quality by Doing Less: Overtreatment

In a widely publicized 1999 report, the Institute of Medicine estimated that as many as 98,000 Americans die each year from preventable medical errors, and that is just those occurring in hospitals.1  That would make this unreported phenomenon the sixth leading cause of death in the United States, ahead of Alzheimer disease and diabetes mellitus. In response to this and similar concerns, there has been an unprecedented international effort to combat the problems of medical errors and overtreatment, with multiple like-minded strategies in place (Table 1).24

Of course, practicing good medicine and avoiding unnecessary harm have always been principles of medical practice. But, along with the evidence-based medicine movement and the application of best evidence to inform collaborative treatment decisions, there is a new emphasis on reducing practices that are likely to have limited benefit and potential harm. As an indication of this, a recent PubMed search showed that there were 261 articles with the word “overtreatment” in the title; the first was from 1929, but there were only 20 or so articles until the 1970s, with 168 (64%) of them being from 2000 onward. Similarly, there were 395 articles with the word “overdiagnosis” in the title; the first one was from 1973, with 327 (83%) of them being from 2000 onward. And the word “overscreening” appeared in only five citations, the earliest was from 2010. Clearly, medical overuse is a topic of growing clinical importance.5

View/Print Table

Table 1.

Selected Resources for Best Practices: Avoiding Unnecessary and Potentially Harmful Medical Care

SourceSponsorComments

Choosing Wisely campaign http://www.choosingwisely.org

American Board of Internal Medicine Foundation

More than 200 recommendations from more than 60 medical societies

Choosing Wisely search tool2 http://www.aafp.org/afp/recommendations/search.htm

American Family Physician

Interactive search tool of primary care recommendations from the Choosing Wisely campaign

Also featured on:

Twitter: https://twitter.com/AFPJournal

Facebook: https://www.facebook.com/AFPJournal

AFP Home page: http://www.aafp.org/afp

Choosing Wisely public campaign http://consumerreports.org/cro/health/doctors-and-hospitals/choosing-wisely/index.htm

Consumer Reports

Patient-oriented information to make better treatment decisions

Less Is More series3 http://jamanetwork.com/collection.aspx?categoryid=6017

JAMA Internal Medicine

Articles, commentaries, and firsthand accounts of ways to reduce unnecessary care

Too Much Medicine series4 http://www.bmj.com/too-much-medicine

British Medical Journal

Publications and links to other resources

High Value Care program https://hvc.acponline.org/physres.html

American College of Physicians

Resources for physicians, including publications

RightCare Alliance http://lowninstitute.org/take-action/join-the-right-care-alliance/

Lown Institute

Personal stories of both good care and inadequate care

Preventing Overdiagnosis Conference http://www.preventingoverdiagnosis.net

Various

The 2015 conference will be hosted by the National Institutes of Health's National Cancer Institute


Information from references 2 through 4.

Table 1.

Selected Resources for Best Practices: Avoiding Unnecessary and Potentially Harmful Medical Care

SourceSponsorComments

Choosing Wisely campaign http://www.choosingwisely.org

American Board of Internal Medicine Foundation

More than 200 recommendations from more than 60 medical societies

Choosing Wisely search tool2 http://www.aafp.org/afp/recommendations/search.htm

American Family Physician

Interactive search tool of primary care recommendations from the Choosing Wisely campaign

Also featured on:

Twitter: https://twitter.com/AFPJournal

Facebook: https://www.facebook.com/AFPJournal

AFP Home page: http://www.aafp.org/afp

Choosing Wisely public campaign http://consumerreports.org/cro/health/doctors-and-hospitals/choosing-wisely/index.htm

Consumer Reports

Patient-oriented information to make better treatment decisions

Less Is More series3 http://jamanetwork.com/collection.aspx?categoryid=6017

JAMA Internal Medicine

Articles, commentaries, and firsthand accounts of ways to reduce unnecessary care

Too Much Medicine series4 http://www.bmj.com/too-much-medicine

British Medical Journal

Publications and links to other resources

High Value Care program https://hvc.acponline.org/physres.html

American College of Physicians

Resources for physicians, including publications

RightCare Alliance http://lowninstitute.org/take-action/join-the-right-care-alliance/

Lown Institute

Personal stories of both good care and inadequate care

Preventing Overdiagnosis Conference http://www.preventingoverdiagnosis.net

Various

The 2015 conference will be hosted by the National Institutes of Health's National Cancer Institute


Information from references 2 through 4.

American Family Physician is committed to being part of this movement to practice sound medicine, improve patient safety, and reduce harm. Our series of editorials on overscreening, overdiagnosis, and over-treatment, co-authored by AFP Deputy Editor Dr. Mark Ebell, outlines the challenges of too much medicine and provides practical guidance on reducing unnecessary medical practices.68 We encourage you to explore our Choosing Wisely search tool (http://www.aafp.org/afp/recommendations/search.htm), and welcome your suggestions for ways to help family physicians continue to provide the best care for their patients.

editor's note: Dr. Siwek is editor of AFP.

Address correspondence to Jay Siwek, MD, at siwekj@georgetown.edu. Reprints are not available from the author.

Author disclosure: No relevant financial affiliations.

REFERENCES

show all references

1. Institute of Medicine. To err is human: building a safer health system. November 1, 1999. http://iom.edu/Reports/1999/To-Err-is-Human-Building-A-Safer-Health-System.aspx. Accessed November 6, 2014....

2. Siwek J, Lin KW. More ways to improve health and reduce harm: Choosing Wisely phase 3. Am Fam Physician. 2014;89(5):329.

3. Grady D, Redberg RF. Less is more: how less health care can result in better health. Arch Intern Med. 2010;170(9):749–750.

4. Glasziou P, Moynihan R, Richards T, Godlee F. Too much medicine; too little care. BMJ. 2013;347:f4247.

5. Morgan DJ, Wright SM, Sanket Dhruva S. Update on medical overuse [published ahead of print November 3, 2014]. JAMA Intern Med. http://archinte.jamanetwork.com/article.aspx?articleid=1921756. Accessed November 6, 2014.

6. Ebell M, Herzstein J. Improving quality by doing less: overscreening. Am Fam Physician. 2015;92(1):22–24.

7. Ebell M, Herzstein J. Improving quality by doing less: overdiagnosis. Am Fam Physician. In press.

8. Herzstein J, Ebell M. Improving quality by doing less: overtreatment. Am Fam Physician. In press.



 

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