“More Care is Better Care” is Dangerous Mythology

by James Couch, MD, JD


At least since the beginning of third party payment of health services, the myth has grown that “more care is better care.” The default position has always been that it is better to be safe than sorry when it came to ordering tests, procedures or consultations. The “more care is better care” mythology has also been driven by “defensive medicine” where providers of care seek to protect themselves by obtaining as many tests as possible, even those of marginal value In the name of providing better care, many physicians did not consider enough the extra time, hassle, medical risk (from invasive procedures and false positive test results), uncertainty and anxiety that those extra interventions may have caused patients and their families.

No matter how good the sensitivity, specificity and positive predictive value of diagnostic tests and procedures, there is always an irreducible possibility of false positives. These faulty findings may send patients and their families off into yet additional blind alleys of hassle, time wasted, anxiety and distractions away from their activities of daily living and quality of life. Plus, with the rapid growth of high deductibles and other cost shifting health plan features, patients and their families will have to absorb a steadily increasing proportion of those costs.

As the drumbeat to convert from a volume to a value-based system has grown louder, the medical establishment has begun to move the profession in anticipation of this inevitable transformation.   The American Board of Internal Medicine (ABIM) Foundation has served as the convener for the “Choosing Wisely” campaign. This campaign has also been supported strongly by the leading medical journal JAMA Internal Medicine and its Editor-in-Chief, Rita Redberg, M.D., M.S., professor of medicine and director of Women’s Cardiovascular Medicine for the University of California San Francisco School of Medicine.

A total of 60 medical and surgical specialty and sub-specialty societies have each identified the five most commonly overused and abused tests and procedures in each of their specialties and pledged to find ways to reduce the use of them.

More on the “Choosing Wisely” campaign can be found at its website: http://www.choosingwisely.org.

In his new book, Achieving the Quadruple Aim in a Technology-Driven Transformed Health System: Better Care, Improved Health, Lower Costs and Decreased Medical Liability, James Couch, MD, JD, explores the questions in America’s medical liability system and how they relate to the current effort to transform the health care system.

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