Cite ‘fear of malpractice’ as top reason for unnecessary care
by Debra Beaulieu September 10, 2017

Despite years of emphasis on curbing costly and potentially harmful unnecessary care, physicians believe that overtreatment remains an ongoing problem, according to research from Johns Hopkins University published this week in the journal PLOS ONE.
The findings, based on a survey of 2,106 physicians, revealed that most of those surveyed (64.7%) believe that at least 15% to 30% of medical care is unnecessary. Participants were from a subgroup of the American Medical Association’s Physician Masterfile.
The top three “culprits” cited were:
• Tests (24.9%)
• Prescription medications (22%)
• Procedures (11.1%)
“Unnecessary medical care is a leading driver of the higher health insurance premiums affecting every American,” said the study’s senior author, Martin Makary, MD, MPH, professor of surgery and health policy Johns Hopkins.
Makary and colleagues also collected physicians’ opinions as to why overtreatment occurs, and found the following perceived reasons:
• Fear of malpractice (84.7%)
• Patient pressure/request (59%)
• Difficulty accessing medical records (38.2%)
In addition, most respondents (70.8%) said they believed that physicians are more likely to perform unnecessary procedures when they profit from them. And most respondents believed that de-emphasizing fee-for-service physician compensation would reduce healthcare utilization and costs.
The top three potential solutions for eliminating unnecessary services were:
• Training medical residents on appropriateness criteria for care (55.2%)
• Easy access to outside health records (52%)
• More evidence-based practice guidelines (51.5%)
“Addressing overtreatment can have a major impact on rising healthcare costs in the U.S.,” the authors wrote. “Using the Institute of Medicine’s estimate of excess costs arising from overtreatment, a 50% reduction in ‘unnecessary services’ would result in $105 billion in savings each year, or about 4% of total national healthcare spending.”
While initiatives such as Choosing Wisely and (Makary et al’s) Improving Wisely — which aim to reduce unnecessary tests and procedures — have raised awareness about overtreatment, future work should focus on the most high-volume over-utilized tests and procedures by specialty, the researchers said.
Finally, physicians should be taught about appropriateness early, beginning in medical school and continuing in residency, the authors urged, noting that healthcare utilization by physicians may be influenced by the cost environment in which they trained as residents.

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• Primary Source
PLOS ONE
Source Reference: Lyu H, et al “Overtreatment in the United States” PLOS ONE 2017; DOI:10.1371/journal.pone.0181970.