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. 2017 Sep 6;12(9):e0181970.
doi: 10.1371/journal.pone.0181970. eCollection 2017.

Overtreatment in the United States

Heather Lyu  1 , Tim Xu  2 , Daniel Brotman  2 , Brandan Mayer-Blackwell  2 , Michol Cooper  2 , Michael Daniel  2 , Elizabeth C Wick  2 , Vikas Saini  3 , Shannon Brownlee  3 , Martin A Makary  2   4
Affiliations

Overtreatment in the United States

Heather Lyu et al. PLoS One. .

Abstract

Background: Overtreatment is a cause of preventable harm and waste in health care. Little is known about clinician perspectives on the problem. In this study, physicians were surveyed on the prevalence, causes, and implications of overtreatment.

Methods: 2,106 physicians from an online community composed of doctors from the American Medical Association (AMA) masterfile participated in a survey. The survey inquired about the extent of overutilization, as well as causes, solutions, and implications for health care. Main outcome measures included: percentage of unnecessary medical care, most commonly cited reasons of overtreatment, potential solutions, and responses regarding association of profit and overtreatment.

Findings: The response rate was 70.1%. Physicians reported that an interpolated median of 20.6% of overall medical care was unnecessary, including 22.0% of prescription medications, 24.9% of tests, and 11.1% of procedures. The most common cited reasons for overtreatment were fear of malpractice (84.7%), patient pressure/request (59.0%), and difficulty accessing medical records (38.2%). Potential solutions identified were training residents on appropriateness criteria (55.2%), easy access to outside health records (52.0%), and more practice guidelines (51.5%). Most respondents (70.8%) believed that physicians are more likely to perform unnecessary procedures when they profit from them. Most respondents believed that de-emphasizing fee-for-service physician compensation would reduce health care utilization and costs.

Conclusion: From the physician perspective, overtreatment is common. Efforts to address the problem should consider the causes and solutions offered by physicians.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Physician perceptions on overtreatment.
(A) Percentage of Overall Medical Care Considered Unnecessary (N = 2,106) (B) Percentage of Medical Care Considered Unnecessary by Type (N = 2,106).
Fig 2
Fig 2. Physician perceptions on percentage of physicians who perform unnecessary procedures when they profit from them (N = 2,106).
See this image and copyright information in PMC

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