Intolerance of failure blamed for epidemic of overtreatment

Cultural shift called more important than malpractice reform
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Think doctors overtest and overtreat? Blame "intolerance of both uncertainty and error," according to an analysis published online in BMJ.

The "shame and blame" medical culture "fed the pretension that modern medicine is based on perfected science, which in turn implies that any error, and indeed any adverse outcome, represents unacceptable failure," Jerome Hoffman, M.D., professor emeritus of medicine at the University of California, Los Angeles, and Hemal Kanzaria, M.D., a Robert Wood Johnson clinical scholar at UCLA, write in the analysis.

Defensive medicine--ordering tests and treatment out of a fear of malpractice suits--is part of the problem, the scholars contend, punishing doctors primarily for "sins of omission." Reforming malpractice law could help minimize the problem of "too much medicine," they say, but it wouldn't be enough.

They advocate continued education on unnecessary tests and more patient involvement in decision-making. But mostly, they say, the medical community needs to be "more open about the inevitability of failure, and even of error," begin to define an "acceptable miss" rate, and stop thinking that in medicine, more is always better.

Hoffman and Kanzaria aren't alone in their thinking. Cardiologist and Nobel laureate Bernard Lown recently said that hospitals have to eliminate overtreatment if they want to improve patient outcomes.

In hospital-rich New York and New Jersey, meanwhile, a recent article suggested that highly trained specialists trying to find a solution to every problem order more tests, treatments and prescriptions because the resources are available.

For more information:
- here's the analysis

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