Overuse costs the US economy anywhere from $200 billion to $800 billion in waste annually. But the waste from overuse is more than dollars down the drain; it causes real harm to patients.
Read these personal stories to learn about overuse, how it can injure patients, alter an individual’s end of life experience, and in some cases, result in an untimely death. These patient accounts were told to Shannon Brownlee, SVP, Lown Institute for her book Overtreated.*
A sophomore at the University of Mississippi, Justin had been a good student, a soccer player and an avid kayaker. But like many students, Justin was having trouble sleeping. He went to the student health center, where the doctor gave him a thorough exam. She also questioned him to find out whether he was depressed and then prescribed Ambien to help him sleep. In Justin’s file, the doctor noted he expressed no desire to kill himself.
Justin returned to the clinic a few days later complaining that the sleeping pills left him feeling groggy and “depressed.” This time, the doctor diagnosed depression and gave him the antidepressant Paxil. Justin told his mother that the drug made him feel “awful,” wound up, jumpy, and unable to sit and concentrate. His mother, a pediatric nurse practitioner, assumed his symptoms would ease once the drugs began to take effect. She gently suggested he give it a few days.
At his one-week follow-up visit, Justin told the doctor he couldn’t stand how he felt. She instructed him to stay on his current does of Paxil rather than ramping up to the next, as planned. A week later, Justin was still feeling no better. The doctor told him to stop taking Paxil and handed him Effexor, a similar antidepressant. A day after starting Effexor, Justin fell to the floor and suffered a seizure but refused to go to the hospital. After talking to his mother, and telling her he still felt “really, really, bad,” he declined her offer to make the two hour drive to campus.
Three weeks after Justin swallowed his first antidepressant, his roommate walked into their apartment to find his friend dead from an apparent suicide.
There is no way to know for certain if the drugs that Justin was taking caused him to commit sucide, or if he was hiding a profound depression from everyone around him—his family, his girlfriend, his friends. Even so, perhaps, the most troubling aspect of this teeneager’s story is the fact that he was given three different, powerful psychoactive drugs to treat what began as mild insomnia, which may itself have simply been a side effect of another drug. He was suffering from a bout of sleeplessness, an afflication that has plagued generations of college students.
Sam was an older man in good health except for a hernia. When he went to the hospital for surgery on his hernia, he was given a cardiac test to see if his heart was in shape for the surgery. The test showed a slight abnormality, so Sam underwent catheterization. The catheterization showed a blockage in a coronary artery, and he was scheduled for bypass surgery.
Before Sam could undergo bypass, he was given a test of his carotid arteries, which showed a slight blockage. He suffered a stroke during the carotid endarterectomy, which delayed his heart surgery for six months. A year later, Sam was almost back to normal. His doctor noted that his hernia (still unrepaired) was not bothering him as much, because of his decreased activity. Here is the scariest part of the story: he was grateful—“thankful that his doctors found it in time.”
What Sam failed to realize was that the procedures performed on him, the catheterization, the bypass, the endarterectomy, probably did nothing to lengthen his life but instead led to a stroke that left him paralyzed for more than a year.
What we’ve come to believe is that if a test can be performed, it should be performed if a treatment can be used to lengthen life, no matter how incrementally, it should be used, regardless of whether the intervention will improve the patient’s sense of well-being or is what the patient really wants.
Henry was an 88 year old man who had been diagnosed with metastatic prostate cancer and suffered from heart disease, which his doctor was treating medically. While in Florida one winter, Henry suffered a heart attack and underwent bypass surgery. Back in Boston in the spring, he came to his doctor’s office with a postsurgical infection in the sternum.
Every day, for several weeks, Henry and his wife came to his doctor’s to have his wound drained. The doctor noticed that Henry and his wife, a previously happy couple who had been married for decades, were now bickering constantly.
The doctor never understood how a harmonious marriage could fall apart so completely so late in life, until he began reading the literature on bypass surgery. Half of bypass patients over sixty-five, he learned, suffer from some sort of dementia as a cognitive impairment. “The reason he was fighting with his wife was he had cognitive impairment,” said the doctor.
Henry died a year later from prostate cancer.
Facing metastatic prostate cancer, and in his late 80s, Henry was subjected to bypass surgery when it compromised his cognition and ultimately impeded his end of life quality. Not to mention, the quality of his marriage.
*Names have been changed to protect patient identities.
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