Here on the Mais Saúde blog we do our best to keep you informed of the latest trends in medicine, including what is happening in North America and Europe, and one of the subjects now trending is how “excessive medicine” results in unnecessary risk for the public.
On July 31, Dr. Sanjay Gupta, Chief Medical Correspondent for CNN, published an article in the New York Times titled “More Treatment, More Mistakes”, and while Dr. Gupta was talking about medicine in the U.S., it is likely the same forces may be shaping medicine here in Brasil.Dr. Gupta mentions a report issued in 1999 by the respected Institute of Medicine, which estimated, shockingly, that 98,000 people were dying each year in the U.S. as a result of medical mistakes (including reactions to medications). The Institute has not issued a follow-up report, but Dr. Gupta says a current “reasonable estimate” is 200,000 deaths per year, making it one of the main causes of death in the country.
How can that be? The number of deaths from medical mistakes has doubled in the past 12 years? He points out that since 1996, the percentage of doctor visits which resulted in the at least five medicines being prescribed has more than tripled, and the number of MRI scans has increased by four times. One might think that with all this additional medical care and testing, that the medical mistake death rate would have gone down, but instead it has increased.
The answer lies in the fact that often more testing, treatment and medications leads to more mistakes, more side effects, complications and deaths. For example, when an MRI scan is studied, the scan is so good at finding “abnormalities” or indeed, anything out of the ordinary, that typically when such an abnormality is found, the next step is to investigate: what is that shadow on the scan? Is it a growth, perhaps a cancer?
And that often leads to more testing, often-invasive procedures including surgical biopsy to find out what was the “abnormality” that showed up on the MRI scan (and ironically, often the scan was performed to look at another organ, but the abnormality showed up in a different, unexpected area). So a surgery might be performed, and each time a person is cut, or receives anesthesia, or goes into a hospital or surgical center, there are risks involved, and sometimes, complications occur.
It is ironic that many doctors in the U.S. practice “defensive medicine”, that is, order tests or procedures to investigate something so that they don’t “miss” anything (to avoid lawsuits), and in the process of investigation—which often may ultimately find nothing seriously wrong—the patient undergoes more risk.
“Excessive medicine” is a hot topic now in the U.S., not only because of the concern for unnecessary complications, but with U.S. healthcare the most expensive in the world, there is concern regarding unnecessary spending.
But what can the smart patient do at this point? If a doctor asks you to do a test, procedure, biopsy, or take a new medication, you might ask “what are the possible risks (or side effects)” and “are there other options that might be safer” and “what is the risk of not doing anything and just ‘watching it’ ”.
This subject is complex, and today we are only introducing the topic. We will expand on the issue in future posts here in Mais Saúde.
by David Harsany
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