Too much medicine

Did you know ~30% of all medical care is considered to be low value or unnecessary?

I didn’t realise it was that high. I think we can agree, that’s not great.

You can hear Prof Paul Glasziou talk about it in this 15 min interview here :point_down:

He talks about two major problems with this low value care:

  1. There are harms to patients.
    No treatment is without problems. At the very least, it costs people their time and attention. At most, leaves them with lifelong consequences.
  2. It overloads the system
    This means lesser care for those who really need it.

Interestingly, low value care isn’t a problem that is an inevitable manifestation of our ageing population, it’s more to do with the unnecessary care per person.

Some of the major drivers behind this - we’ve got better tests and technology and our definitions of diseases keep changing which in many cases increase the number of people being diagnosed (aka potentially labelled with having the condition for the rest of their life)

We’re getting to the boundary where people are being harmed by the label

How does the health system need to change to try and address this?

  1. reduce overdetection :arrow_right: more targeted testing/screening)
  2. reduce overdefinition :arrow_right: reform the process for redefining disease states
  3. reduce medicalisation :arrow_right: understand treatment options and enable shared decision-making

What can we do as individual healthcare professionals?
Like most things with professionalism, a bit of self-reflection helps.
Here’s a perspective from neurosurgeon Christer Mjåset to help you think about it. One of the key things he notes is the pressure that patients place on healthcare professionals to do something.

Mjåset suggests that addressing the problem of low value care requires both physicians and patients to be more vigilent. He encourages patients to ask four questions of their doctors the next time they’re recommended a medication, procedure, test, treatment or surgery:

  • is this really necessary?
  • what are the risks?
  • are there other options?
  • what happens if I don’t do anything?

The idea that more is not always better in healthcare is also the topic of the NPS Choosing Wisely program.

There you can find a suite of resources for clinicians, consumers and organisations to facilitate conversations about what care is needed. This includes a conversation starter kit which was co-designed by NPS MedicineWise and the Consumer Health Forum of Australia. In it they suggest an additional question to ask - what are the costs? (financial and otherwise). There are also case studies and CPD activities.

As I reflect on this, I think the key thing for me, is that medicalisation of problems is so deeply ingrained in our society that there is no straightforward solution to this. It requires a collective effort for sure. As a pharmacist, I suppose I see my main role in this as helping people to have realistic expectations of their medicines (realistic about efficacy as well as risk) and supporting them in communicating with their care providers.

I’m very interested to hear other people’s perspectives. Please feel free to share below what you think are opportunities and challenges to achieving this cultural shift.

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I flagged something by mistake. Please ignore :see_no_evil: I’m a great believer in “less is more”

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A nice follow read up to complement this