April 2016News

Excessive medical treatment can be hazardous, doctor warns

When illness occurs, fixing the problem is always the ideal strategy, right? Wrong!

As a precaution, shouldn’t a disease be identified as early as possible? By no means!

Isn’t fighting an illness always preferable to doing nothing? Not at all!

Over and over, Dr. H. Gilbert Welch presented reasonable-sounding statements and then promptly refuted each of them, insisting that these assumptions can be hazardous and are too readily accepted by well-intentioned healthcare consumers. All too often, he said, these notions result in excessive medical treatment, which has the potential to be as harmful as too little care.

“Medical care can do a lot of good in selected settings—for instance, in treating the acutely ill or the badly injured,” Dr. Welch told the audience that packed the Block Amphitheatre in November 2015 for the second annual Goldie Raymer Memorial Lecture.

“But in many other settings,” he said, “we’ve exaggerated the benefits of medical care and we’ve understated its harms. There’s a growing recognition that the conventional concern about too little medical care needs to be balanced by a concern about too much. While some is good, more is not necessarily better.”

The lecture, organized by the JGH Divsision of Geriatric Medicine, addressed certain concerns of the elderly, but it also took a broader view of medical problems throughout society. These matters have been the focus of much of Dr. Welch’s work as Professor of Medicine at the Dartmouth Institute for Health Policy and Clinical Practice in Dartmouth College in Hanover, NH.

Over the course of an hour, Dr. Welch presented seven cautionary statements of his own—which he described as “disturbing truths”—that he backed up with references to medical research and statistics:

  • “Not all risks can be lowered, and trying to do so creates risks of its own.” Treatment is definitely needed for people with diseases such as hypertension or diabetes, Dr. Welch said. But among individuals whose risk for a particular illness is low, trying to further reduce that risk creates potential for harm.
  • “Trying to eliminate a problem can be more dangerous than managing it.” Welch explained that some cases of heart disease are best handled with a healthy diet, regular physical activity and a few good medications. Yet, many individuals whose heart disease is not life-threatening are putting themselves in danger by choosing to have stents, wires or balloons inserted in their coronary arteries.
  • “Early diagnosis can needlessly turn people into patients.” Welch cited cases of individuals who became needlessly distressed when told they had cellular abnormalities, even though these abnormalities were unlikely to become cancerous. He said early detection may make sense in some instances—especially among people with a dramatically elevated risk—but its widespread adoption has been “a recipe for making people sick.”
  • “Data overload can scare patients and can distract a doctor from what’s important.” In other words, a bounty of information—notably, material on the internet—is not necessarily helpful, unless it is evidence-based and can be directly related to the condition of a specific patient.
  • “Sometimes doing nothing is exactly the right thing to do.” There is a strong case to be made for not proceeding with surgery in some cases, such as lower back pain, Dr. Welch noted. Patients need to consider alternatives to medical intervention, which can sometimes result in hospital-acquired infections or other serious consequences.
  • “Newer is not always better.” Welch urged members of the audience not to be too eager to submit to new procedures or technologies that are touted as breakthroughs. The best strategy, he said, is to opt for time-tested tools and techniques, because “new interventions are typically not well tested and often wind up being judged ineffective and even harmful.”
  • “A fixation on preventing death diminishes life.” In some instances, Dr. Welch said, patients are beyond medical help, but extraordinary measures are still taken to extend their lives. As a result, the quality of their lives is greatly diminished during the time they have left.

TD

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1 Comment

  1. Elizabeth (Aust)
    March 29, 2016 at 10:28 pm —

    Thank you, Dr. Welch, there are a few in my medical Hall of Fame, and you’re one of them, along with Prof. Michael Baum, Dr. Margaret McCartney, Prof Robin Bell and a few others.

    My great-aunts lived to a great age, in good health and spirits, they only saw a doctor when they were unwell, that usually meant when they’d been ill for a few days, they’d always give their body time to recover.
    No screening apart from blood pressure.
    The idea of seeing a doctor when you were well would have been considered bizarre. I think they largely had the right idea, health to them meant looking after yourself, decent diet, not carrying too much weight, get some rest, watch stress levels etc.
    So often now we think screening makes us bullet-proof and our perception of risk has been skewed. I know my aunts didn’t give cervical cancer a second thought, why would anyone worry about a fairly rare cancer? Now women hear the most about this still fairly rare cancer, the focus of our healthcare is the pap test. Breast screening is pushed as well but the most pressure is reserved for pap testing.

    I rejected both tests, informed decisions, that meant ignoring the screening “stories” released by the programs (instead of real information) and standing firm in the consult room.

    Women are just expected to screen, scolded if we don’t, we might even be called names, be sacked by our GP or denied the Pill. It’s hard to understand why so many think this is an appropriate way to treat women.
    Young women are being scolded here in Australia for “failing to have” pap testing, of course, it’s been known for many years that the test does not benefit those under 30 and leads to a lot of excess biopsies and over-treatment.
    Bad medical advice coming from these programs is never challenged; our medical leaders are silent. These tests are not presented as an option or a choice, it’s all MUST or SHOULD.
    Celebrity endorsement is used to promote breast screening, how is that respecting informed consent?

    In my opinion, it’s profits that matter, women do not…
    Hopefully, these programs and attitudes and conduct will be addressed before too much longer.
    I’m sure my health and well-being have benefited from rejecting these programs.

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