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One-fifth of medical care is unnecessary, doctors say in new survey

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Clinicians are on the front lines of medical care. They are the ones interacting with patients, recommending treatment, and providing services. Doctors see overtreatment happen every day, so why not ask them what they think about it? 

Dr. Heather Lyu, a surgery resident at Brigham and Women’s Hospital, and co-authors including the Lown Institute’s Vikas Saini and Shannon Brownlee created and implemented a new survey to do just that. Their online survey, which included responses from 2,106 physicians, was the first nation-wide survey to ask doctors in a range of specialties about overtreatment.  

On the left, estimations of how much medical care is overtreatment. On the right, a breakdown of this estimation by procedures, tests, and medications.

 

 

 

 

Here are some of their findings:

  • When asked to estimate the amount of unnecessary care in their specialty, a majority (64.7%) answered that at least 15-30% of care is unnecessary. On average, doctors said that 20.5% of care is unnecessary. Less than 5% of doctors surveyed said that there is no unnecessary care in their specialty.
  • On average, doctors estimated that 22.0% of prescription medications, 24.9% of tests, and 11.1% of procedures in their specialty are unnecessary.
  • When asked what causes overtreatment, the two most popular answers were fear of malpractice (84.7%) and patient demands/requests (59%). More than a third of doctors also said that the following play a role: Difficulty accessing medical records, borderline indications, inadequate time to spend with patients, and lack of adequate information about the patient.
  • Most respondents believed that financial incentives impact overtreatment; more than 70% said that some doctors perform unnecessary procedures when they profit from them. About half of respondents said that at least 15% of doctors do this.  

 

This survey sheds light on doctor perceptions of overuse, but also shows what we need to research more. For example, most doctors believed malpractice was a big concern that caused unnecessary care; however, the real threat of malpractice is small. This might indicate that doctors aren’t talking that much to each other about overuse and what drives them and other doctors to order unnecessary services.

Also, most doctors said that they believe doctors offer more services when it benefits them financially, but less than 10% of doctors said they think that financial security for physicians drives overuse. Perhaps we need to create a new narrative and a safer space for doctors to talk about overuse, in which they can discuss systemic and cultural factors that drive overtreatment, not just perceptions of defensive medicine.

“It’s great this level of awareness is happening, but now we have to start peeling back the onion of why overtreatment is so prevalent,” said Vikas Saini.