Four ways to shift the culture of overuse

If you’re a regular reader of our blog, you know that medical overuse is a widespread, costly, and harmful problem. At least 20% of all health care spending goes towards treatments, drugs, tests, or surgeries that patients do not need, wasting hundreds of billions of dollars and sometimes causing serious complications for patients.

Clinicians themselves recognize that overuse is prevalent. In a 2017 survey of physicians, on average doctors estimated that 20.5% of care provided in their specialty is unnecessary. However, even for doctors who want to reduce overuse, there are still plenty of barriers to providing the right care, including perceived patient demand, fear of malpractice suits, safety concerns, and discomfort with uncertainty.

In a new article in the Journal of Patient Safety, medical students at the Icahn School of Medicine Sara Pasik and Sigal Israilov, chief of internal medicine at the Memorial Sloan Kettering Cancer Center Dr. Deborah Korenstein, and Assistant Professor of Hospital Medicine at the Icahn School of Medicine and Lown Institute Fellow Dr. Hyung Cho offer four tips for addressing these barriers and countering the culture of overuse from the clinician side:

  1. Focus more on value and less on cost. We often talk about the financial cost of waste in medicine, but this might not be the best way to get doctors to listen, the authors say. Doctors are trained to do everything they can for their patients’ health, no matter the cost. We should be supplementing our cost arguments with stories and evidence around the physical harm we could be causing patients by performing unnecessary services.
  2. Get patients involved in overuse conversations. Doctors may be willing to reduce unnecessary care, but often are afraid that patients will react badly or even sue them if something goes wrong. “Improving communication with patients about overuse as a threat to safety is the antidote to both clinician fear and patient mistrust,” the authors write.
  3.  Address clinician fears of underuse. The fear of harming a patient by missing something or neglecting care they need should not go unnoticed. The authors suggest tracking certain outcomes as overuse initiatives are implemented, to make sure that there is no negative effect on patient health from underuse. Also, “developing a forum for reporting and discussing adverse events may prove helpful,” the authors write.
  4. Tell stories that show overuse harms. Clinicians and patients hear stories of how someone’s life was saved by a certain screening test or immunotherapy, but stories of harm caused by “everyday overuse” are much less prevalent. That’s why the authors suggest sharing stories like these and exploring cases of overuse in the same way doctors discuss medical errors. 

By considering the thought processes, concerns, and cultural influences of both clinicians and patients, we can create more effective interventions to reduce overuse.