Overtreated

OVERTREATED….A new report from the Institute on Medicine as a Profession concludes that doctors could stand to police themselves a little better:

46 percent said they had failed to report at least one serious medical error that they knew about, despite the fact that 93 percent of doctors said physicians should report all significant medical errors that they observe.

….A majority said they would refer patients to an imaging facility in which they had a financial interest, but only 24 percent would inform patients of that financial tie.

….More than a third of physicians, 36 percent, said they would order an unneeded MRI (magnetic resonance imaging) test if it were requested by a patient with low back pain, though most doctors say they do not want to waste scarce resources.

I’m not sure where the Post got these numbers. I don’t have access to the journal article this is based on, but the accompanying chartbook (here) says that 40% of physicians knew of a serious error in their practice in the last three years, and of those 31% failed to report it. That’s 12% of physicians, not 46%. The imaging facility number is 26%, not 24%. And the MRI number is 42% not 36%.

I’m not sure who’s wrong here, the Post or the folks who put together the charts. But in any case, it gives me an excuse to comment on the imaging stuff. Back in September, when Shannon Brownlee was blogging here about her book Overtreated, I hadn’t yet received a copy of the book and so I wasn’t able to comment about it. I’ve since read it (it’s very good), and one of the things she discusses in some detail is the fact that a huge number of MRIs and CT scans are ordered not because they’re necessary, but simply because they’re available (and, of course, very, very cool). A little bit of this is malpractice-driven defensive medicine, but the vast majority isn’t. Doctors do it because it’s convenient, because they don’t want to say no to patients, and because it’s a moneymaker. The IMAP study seems to bear this out.

Anyway, read the book. It’s good. Nickel summary: Hospitals are about as likely to kill you as to cure you. Stay away if you can.