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Mrs. B's Story: How Excessive Testing Can Do More Harm Than Good

Posted By Administration, Wednesday, August 31, 2016
Updated: Wednesday, August 31, 2016

When it comes to medical procedures, always do your homework and speak honestly with your doctor about any concerns you have. 

by Michael Kelleher, MD


There are many medical situations where more care and more testing does not translate to better care. The American Board of Internal Medicine (ABIM) and its partners, through the Choosing Wisely campaign, have compiled lists of tests and procedures that should be carefully considered.


Let’s take a look at how excessive testing and procedures can do more harm than good. This is the case of a real patient. We’ll call her “Mrs. B.”


Physicians often perform tests

of marginal value because of
patient demands.

Mrs. B’s Multiple Procedures

Mrs. B had been experiencing upper abdominal pain after meals. Her ultrasound test revealed gallstones were the cause. One of her liver tests, a gamma-glutamyl transpeptidase (GGTP), was also mildly abnormal, so her husband, who had been a critical care nurse, pressed the gastroenterologist to proceed with more testing. Her husband wanted to exclude the possibility of her bile duct being blocked by a gallstone.


The physician performed an endoscopy test called an ERCP as a prelude to surgery. That ERCP test revealed no abnormality, but within an hour after the procedure, Mrs. B begin having severe abdominal pain and very low blood pressure. Her daughter alerted the nursing staff, and Mrs. B was rushed to the operating room for repair of a ruptured loop of bowel, a known complication of ERCP, which extended her recovery by three months and caused several postoperative infections.


What Went Wrong?


First, the ERCP test was not necessary in this case. It caused a serious complication, which was preventable. The mildly elevated GGTP test by itself did not suggest blockage of the bile duct with a stone, and is not recognized by experts as an indication for ERCP testing.


Secondly, physicians often perform tests of marginal value because of patient demands, to reduce their perceived risk of a malpractice lawsuit. Neither patient nor physician are well-served by such misguided testing.


Finally, over-testing can have negative results for patients. Screening tests for healthy patients represent a special challenge for shared decision-making. It is imperative for clinicians to make sure that patients have a thorough understanding of the risks, benefits, and limitations of such testing.


Low-Value Testing

Consumer Reports has worked with the Choosing Wisely campaign to create patient-friendly summaries of more than 50 medical tests and procedures that are of low value. Before agreeing to treatment, patients can look through evidence-based information on what may or may not be appropriate. There’s a wealth of information on procedures from colonoscopies to Lyme disease tests.


The campaign is meant to empower patients to start a conversation with medical staff regarding which treatments are appropriate or necessary. When it comes to medical procedures, always do your homework and speak honestly with your doctor about any concerns you have. 


This post was adapted with permission from Avoidable Medical Mishaps: A Patient Guide.


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Michael Kelleher, MD, past member of the Massachusetts Medical Society's Quality of Medical Practice Committee, has 34 years of experience as a physician and medical executive responsible for patient safety and quality of care in large group practices.




Tags:  overtreatment 

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Getting the Right Care, Every Time

Posted By Administration, Wednesday, September 2, 2015

Right Care Action Week Is October 18-24


Almost 20 years ago, the Institute of Medicine (IOM) targeted the overuse of health care services as a potential source of patient harm. An IOM consensus paper on health care quality attributed many problems in health care to overuse, underuse, and misuse of services, with overuse defined as “a health care service [that] is provided under circumstances in which its potential for harm exceeds the possible benefit.”


Since then, several efforts have been undertaken to raise awareness of unnecessary care—and the potential harm it affords. For example, the Choosing Wisely campaign, an initiative of the American Board of Internal Medicine Foundation, was started to promote conversations between patients and their health care providers about whether treatments and tests are truly necessary, not duplicative of other tests or treatments, and supported by evidence.


The Lown Institute, meanwhile, has taken on the issue of overtreatment and undertreatment as a major focus of its work and a priority issue. In a recent Health Affairs piece, the leaders of the institute highlighted how little research has been done into overtreatment in medicine.


Next month, the Lown Institute is leading Right Care Action Week, October 18-24, to raise awareness of the importance of the appropriateness of care for each individual patient.


The Lown Institute encourages organizations to develop programs and activities to fit their local community’s needs. To get involved in this effort, visit the website and commit to take action during that week to help result in better, safer, more appropriate care. For example:

  • Direct patients to the Ask Me 3 video on our website. Asking questions can help patients become more engaged in their care, more knowledgeable about their health conditions, and better able to follow treatment plans.
  • Report a case where overuse or underuse of services presented a safety issue. Currently, few safety reports are related to overuse and the risks of unnecessary care. As you become more aware, think about speaking up to prevent harm.
  • Visit the Right Care Action Week website to find out what others are doing or to share your own ideas.

NPSF is encouraging members of our community mark the week by taking action to help ensure the right care for everyone. We hope you’ll take part. 


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Tags:  overtreatment  undertreatment 

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To Improve Patient Safety, Start With Avoiding Unnecessary Treatments

Posted By Administration, Wednesday, March 4, 2015
Updated: Wednesday, March 4, 2015

By Shannon Brownlee, MS

Every year, hundreds of thousands of Americans experience avoidable harm in our nation's hospitals, and estimates suggest that tens of thousands of those people die. Medical errors and unintended harm in the US health care system are driven in part by the breakdown in the relationships that ought to be the foundation of good medicine.

   Shannon Brownlee, MS
Part of the tragedy of harmful medical care is that often treatments that end up causing harm weren't needed in the first place. Unnecessary medical procedures are shockingly common. Unnecessary or ineffective medical treatments, tests, drugs, and days in the hospital account for anywhere from 10 percent to 30 percent of total medical expenditures in the US. Examples range from PSA tests to CT scans, medication for mild blood pressure, and cardiac stents for patients who don’t have symptoms of heart disease. A recent analysis found that in a single year, about 40% of Medicare recipients received at least one from a list of just 26 examples of useless or low-value procedures.

Asking questions can help patients better understand their treatment options. Patients and families can reduce their risk of suffering an error or hospital infection by avoiding unnecessary medical treatment in the first place. Here are five questions to bear in mind when discussing your treatment options with your doctor:
  1. What are all of my options for treatment? For many conditions and illnesses, there can be more than one treatment. Sometimes changing your lifestyle (diet and exercise) can reduce your symptoms or the risk of a bad outcome. Sometimes, not getting treated at all is a reasonable choice. Ask your doctor what all of your options are, and ask for clear explanations you can understand for each.

  2. How exactly might the recommended treatment help me? 
You need to know exactly how you might benefit from a treatment. Even if you think you know, it’s important to ask. A hip replacement, for example, might allow you to walk again with greater ease, but it won’t cure your arthritis. In fact, you may need another replacement in 10 to 20 years. A drug might relieve some of your symptoms and not others. Other treatments have no effect at all on how you feel now and are supposed to help prevent a disease from harming you in the future. Ask how the proposed treatment is supposed to help you.

  3. How good is the evidence that I’ll benefit from the treatment or test?
 Many treatments and tests that doctors prescribe have never been fully tested to see if they work, or have been tested, but not in patients like you. Find out if the treatment or test your doctor is recommending is a proven therapy. If not, your doctor should explain why he or she thinks it’s a good idea for you. 

  4. What side effects can I expect, and what bad outcomes might happen? 
Every test, drug, surgery, and medical procedure has side effects, and some can be serious. Simply being in the hospital exposes you to medical errors and hospital-acquired infections. You need to know the risks so you can decide if the danger or discomfort of your condition is more concerning than the risks of the proposed treatment. If it’s a test, ask how often it’s wrong, and what will happen if it shows you’re sick when you’re really not. If it’s a drug or surgery, ask what all the serious side effects can be, and how often they occur.

  5. If it’s a test, what does your doctor expect to learn from it, and how might it change treatment? 
If a test won’t change the way you’ll be treated, or if you’ve already decided you don’t want the possible treatment, ask why you should be tested.

We salute the National Patient Safety Foundation for promoting Patient Safety Awareness Week. We hope this week helps everyone in the health care system—patients, doctors, nurses, and everyone else—to focus on the critical mission of keeping patients as safe and healthy as possible.

To learn more about unnecessary treatment, and what you can do to protect yourself from it, read Overuse 101 or explore the Lown Institute website at


The Lown Institute hosts the Road to RightCare Conference in San Diego from March 8-11, 2015. For more information, visit, and follow the conversation on Twitter at #Lown2015.


Shannon Brownlee, MS, is senior vice president of the Lown Institute. Ms. Brownlee has been a national leader in highlighting the scope and consequences of overuse in health care. An internationally known writer and essayist, her book, Overtreated: Why Too Much Medicine Is Making Us Sicker and Poorer, was named the best economics book of 2007 by New York Times economics correspondent, David Leonhardt. Her articles and essays have appeared in such outlets as The Atlantic, New York Times Magazine, The New Republic, Time Magazine, and The Sunday Times of London, among other publications.


Tags:  overtreatment  undertreatment 

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