Medicine
"Don't just do something, stand there." This deliberate rephrasing of "don't just stand there, do something" reminds me that the typical impulse of a physician to take immediate action in the face of clinical uncertainty can sometimes lead to a worse outcome than exercising patience, collecting more information, and waiting for any harmful conditions (if present) to declare themselves in time.
However, as I explained in this week's MD Global Health podcast, powerful monetary and psychological incentives present throughout the health care industry push physicians, advocacy groups, and medical institutions to aggressively seek out and treat persons with "underdiagnosed" diseases, expand the definitions of existing diseases (e.g., pre-osteoporosis, or low bone density), and sometimes, create new diseases (e.g., restless legs syndrome) out of whole cloth. Recognizing that these issues are often exacerbated by expert consensus recommendations of dubious quality, a distinguished international working group recently proposed a short list of questions that, if properly implemented, could permit clinicians and patients to evaluate financial conflicts of interest in clinical guidelines.
Conservative Medicine will not only outline a list of problems that result from overtesting and overtreatment, but offer a set of solutions in the areas of medical education, public policy, regulation, and patient advocacy. Who needs to read it? I believe that my book will appeal to a broad audience of health professionals, journalists, policymakers, and ordinary people with and without defined health problems who wonder if they actually need "preventive health care," and if so, how much.
**
This is the sixth and final entry in a series of brainstorming posts about a book that I am writing titled Conservative Medicine.
- The Best Recent Posts You May Have Missed
Every other month or so, I post a list of my top 5 favorite posts since the preceding "best of" list on this blog, for those of you who have only recently started reading Common Sense Family Doctor or don't read it regularly. Here are my favorites...
- Conservative Medicine: Why Is Now The Right Time For It?
Forty years ago, Dr. Jack Wennberg and colleagues at Dartmouth Medical School published the first of a series of groundbreaking studies of medical resource utilization and practice variations that would eventually become the Dartmouth Atlas of Health...
- Conservative Medicine: Why Am I The Best Person To Write It?
In a recent New York Times editorial about exorbitant healthcare costs, Dartmouth professor H. Gilbert Welch (the author of Overdiagnosed: Making People Sick in the Pursuit of Health) asserted: "Medical care in America could use a dose of moral outrage."...
- Conservative Medicine: What's The Book About?
Renowned American surgical pioneer William Halsted is probably best known for the cancer operation that bears his name: the Halsted radical mastectomy. First performed in 1882 and the treatment of choice for localized breast cancer until the 1970s, this...
- To Protect Patients, Practice Guidelines Must Meet Higher Standards
Recent news stories have suggested that many of the ills of our health system could be prevented if more physicians followed guidelines on appropriate indications for tests and treatments. For example, a Wonkblog post by The Washington...
Medicine
Conservative Medicine: Who needs to read it?
"Don't just do something, stand there." This deliberate rephrasing of "don't just stand there, do something" reminds me that the typical impulse of a physician to take immediate action in the face of clinical uncertainty can sometimes lead to a worse outcome than exercising patience, collecting more information, and waiting for any harmful conditions (if present) to declare themselves in time.
However, as I explained in this week's MD Global Health podcast, powerful monetary and psychological incentives present throughout the health care industry push physicians, advocacy groups, and medical institutions to aggressively seek out and treat persons with "underdiagnosed" diseases, expand the definitions of existing diseases (e.g., pre-osteoporosis, or low bone density), and sometimes, create new diseases (e.g., restless legs syndrome) out of whole cloth. Recognizing that these issues are often exacerbated by expert consensus recommendations of dubious quality, a distinguished international working group recently proposed a short list of questions that, if properly implemented, could permit clinicians and patients to evaluate financial conflicts of interest in clinical guidelines.
Conservative Medicine will not only outline a list of problems that result from overtesting and overtreatment, but offer a set of solutions in the areas of medical education, public policy, regulation, and patient advocacy. Who needs to read it? I believe that my book will appeal to a broad audience of health professionals, journalists, policymakers, and ordinary people with and without defined health problems who wonder if they actually need "preventive health care," and if so, how much.
**
This is the sixth and final entry in a series of brainstorming posts about a book that I am writing titled Conservative Medicine.
- The Best Recent Posts You May Have Missed
Every other month or so, I post a list of my top 5 favorite posts since the preceding "best of" list on this blog, for those of you who have only recently started reading Common Sense Family Doctor or don't read it regularly. Here are my favorites...
- Conservative Medicine: Why Is Now The Right Time For It?
Forty years ago, Dr. Jack Wennberg and colleagues at Dartmouth Medical School published the first of a series of groundbreaking studies of medical resource utilization and practice variations that would eventually become the Dartmouth Atlas of Health...
- Conservative Medicine: Why Am I The Best Person To Write It?
In a recent New York Times editorial about exorbitant healthcare costs, Dartmouth professor H. Gilbert Welch (the author of Overdiagnosed: Making People Sick in the Pursuit of Health) asserted: "Medical care in America could use a dose of moral outrage."...
- Conservative Medicine: What's The Book About?
Renowned American surgical pioneer William Halsted is probably best known for the cancer operation that bears his name: the Halsted radical mastectomy. First performed in 1882 and the treatment of choice for localized breast cancer until the 1970s, this...
- To Protect Patients, Practice Guidelines Must Meet Higher Standards
Recent news stories have suggested that many of the ills of our health system could be prevented if more physicians followed guidelines on appropriate indications for tests and treatments. For example, a Wonkblog post by The Washington...