Overtreatment is a pervasive problem in healthcare.
But hospitals wouldn't have to invest much to tackle the issue, a group of physician experts said on Thursday as they addressed the issue at a Kaiser Health News even in Washington, D.C.
In fact, all it might take is adding a few more chairs in the hospital room to make sure doctors are sitting down to have real conversations with patients about their treatment goals, said Jacqueline Kruser, M.D., a critical care physician at Northwestern Memorial Hospital.
“So just like we have all of the emergency treatments readily available at the bedside for patients who are very sick, one of the things that it’s even hard to find in ICU or on a hospital ward is enough chairs for everybody to sit down with a patient in their room with their family, their doctors and talk about what’s most important to them,” Kruser said.
It was among a collection of simple solutions offered by a panel of experts for the event on overtreatment, which can drive up healthcare costs and make a patient’s condition worse, not better—particularly in the elderly. A recent estimate suggests that unnecessary or unneeded tests and procedures cost the health system $282 million per year.
Among the ideas?
Ranit Mishori, M.D., professor of family medicine at the Georgetown University School of Medicine, said primary care doctors—who typically have yearslong relationships with patients—should collect a rundown of some key points about a patient’s lifestyle, care goals and personal values into his or her history.
That can help guide the conversation about whether a patient wants to undergo the lengthy process of recovering from surgery or pursue a less aggressive option after an injury. Having that information in their electronic health record can later ensure that information sticks with them no matter where the patient is treated, Mishori said.
Panelists suggest taking into account the amount of time patients have to live and what they want to do with the rest of their life when considering further treatment. #choosingwisely #KHNewsLive pic.twitter.com/0OxmArmnAE— NCQA (@NCQA) September 27, 2018
When interacting with doctors in a less familiar setting, such as an emergency department, patients should feel empowered to have hospitalists contact their regular doctors to ensure the care they receive is more individualized.
“That’s a conversation that needs to happen,” Mishori said.
The need for that individual approach is especially true in oncology, a specialty that can drive unneeded testing, said Barry Kramer, M.D., director of the division of cancer prevention at the National Cancer Institute.
Tumors come in three basic “forms,” he said: “birds, bears and turtles.” The “birds” are tumors that metastasize and become fatal before they’re caught in screening, while “bears” are those are likely to spread but may be caught just before. A “turtle” tumor, he said, isn’t likely to grow and change at all.
Routine cancer screenings aim to catch the “bears,” he said, but they’re not equipped to effectively suss out which type of tumor a patient has, which can lead to an avalanche of further testing and procedures.
“The benefits of testing are delayed, but the harms are front-loaded,” Kramer said.
A video of the full event is embedded below: