7 Assumptions That Drive Too Much Medical Care
by H. Gilbert Welch
(The following is taken from the book's introduction)
The central problem with healthcare is that too much medical care has too little value, too many people are being made to worry about diseases they don't have an are only at a low risk to get. Too many people are being tested and exposed to all the harmful effects of the testing process: the anxiety of false alarms and the vulnerability caused by ambiguous findings, not to mention the complications of diagnostic procedures.
Too many people are being given treatments they don't need or can't benefit from. Treatment interventions can have substantial physical harms such as medication reactions, surgical complications, even death
It's not lawyers who are the problem; it's economics. Physicians are paid more to do more and insurance, not the patient, foots the bill. Paying physicians a fee every time they provide a service encourages them to order more tests and procedures. Because patients are shielded from the costs by a third-party, they have little incentive to scrutinize the value of the services.
To complicate this more, the general public harbors assumptions about medical care that encourages overuse. Assumptions like the following are extant: it's always better to fix the problem, sooner is always better or it never hurts to get more information. These assumptions flow directly from information provided to the public from many sources (doctors, drug and device makers, the media, the Internet). The public winds up with assumptions that lead to an excessively optimistic view of medical care. That leads them to seek too much care.
This book is about challenging these assumptions – and helping all of us to avoid too much medical care. As a society, we have overstated the benefits of medical care and underplayed its harms. It is possible that in many cases less medicine would be better for our health.
Less Medicine, More Health gives a few simple strategies to avoid too much medical care.
What Walsh wants from medical care is a system that excels in the care and treatment of acutely ill and injured persons. This, in his opinion, is the most important activity of medical care, but is not what most medical care is about. Much of medical care doesn't reliably lead to better health.