Testing 1, 2, 3: Is overtesting undermining patient and system health?

Margaret J. McGregor; Danielle Martin

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Re:The Drivers of%
Margaret J. McGregor

Published on: 06 December 2012
Re:The Drivers of Overtesting
Margaret J. McGregor

Published on: 06 December 2012
Re:The Drivers of%
George A (Bert) McBride

Published on: 03 December 2012
The Drivers of Overtesting
Mark Dermer

Published on: 29 November 2012

Published on: (6 December 2012)
Page navigation anchor for Re:The Drivers of%
Re:The Drivers of%
Margaret J. McGregor, Clinical Associate Professor and Family Physician
Like Saskatchewan, BC physicians receive annual printouts of the costs generated per patient and the physician's rank score in relation to his/her peers. Sadly, like Saskatchewan, few BC physicians seem to look at these reports. Even fewer discuss their results with their peers or with those who collect the metrics. This absence of interest is perhaps a reflection of the current delivery model of primary care, where famil...
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Like Saskatchewan, BC physicians receive annual printouts of the costs generated per patient and the physician's rank score in relation to his/her peers. Sadly, like Saskatchewan, few BC physicians seem to look at these reports. Even fewer discuss their results with their peers or with those who collect the metrics. This absence of interest is perhaps a reflection of the current delivery model of primary care, where family doctors receive public funding, to deliver health care as a small privately-run business. In this model the accountability is to both professional integrity and running the business. Broader system accountability is far less on the radar. Such reports are an interesting potential focus for collective self-appraisal and we appreciate you pointing out their existence.
Conflict of Interest:
None declared
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Competing Interests: None declared.
Published on: (6 December 2012)
Page navigation anchor for Re:The Drivers of Overtesting
Re:The Drivers of Overtesting
Margaret J. McGregor, Clinical Associate Professor and Family Physician
Other Contributors:
Thank you for your letter identifying vested economic interest as an important additional "driver" of over testing, over diagnosing and over- treating. There has been good documentation of this by a number of scholars (1;2) and we agree such interests are a major factor in the medicalization of healthy people. A policy approach that might begin to address this problem would be a complete ban on direct to consumer adverti...
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Thank you for your letter identifying vested economic interest as an important additional "driver" of over testing, over diagnosing and over- treating. There has been good documentation of this by a number of scholars (1;2) and we agree such interests are a major factor in the medicalization of healthy people. A policy approach that might begin to address this problem would be a complete ban on direct to consumer advertising of pharmaceuticals in both Canada and the US. There is little evidence that such advertising improves health outcomes, and good evidence it drives up medical activity - whether it be testing, (over) diagnosing, or prescribing (3;4).
Reference List
(1) Godlee F. Who should define disease? BMJ 2011;342:d2974.
(2) Moynihan R. A new deal on disease definition. BMJ 2011;342:d2548.
(3) Mintzes B. Direct to consumer advertising is medicalising normal human experience. BMJ 2002;324:908-9.
(4) Mintzes B, Barer ML, Kravitz RL, Kazanjian A, Bassett K, Lexchin J, et al. Influence of direct to consumer pharmaceutical advertising and patients' requests on prescribing decisions: two site cross sectional survey. BMJ 2002;324:278-9.
Conflict of Interest:
None declared
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Competing Interests: None declared.
Published on: (3 December 2012)
Page navigation anchor for Re:The Drivers of%
Re:The Drivers of%
George A (Bert) McBride, physician
Thank you for your recent article on overtesting. Society will eventually demand an accounting from physicians for the costs generated by the tests they order. Saskatchewan physicians get a printout periodically of the costs generated per patient and the physician's rank score in relation to his/her peers. I believe few physicians pay attention to them. Unfortunately patients often praise family doctors for the number of...
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Thank you for your recent article on overtesting. Society will eventually demand an accounting from physicians for the costs generated by the tests they order. Saskatchewan physicians get a printout periodically of the costs generated per patient and the physician's rank score in relation to his/her peers. I believe few physicians pay attention to them. Unfortunately patients often praise family doctors for the number of tests and referrals they do. If we are going to rely more on good history taking and examination skills we must find a way that provides physicians the required time to do them and be able to demonstrate the value of the time spent. Unfortunately, all the time in the world doesn't take the place of a PSA, though a rectal exam may give some clues.
Conflict of Interest:
None declared
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Competing Interests: None declared.
Published on: (29 November 2012)
Page navigation anchor for The Drivers of Overtesting
The Drivers of Overtesting
Mark Dermer, Family Physician
I strongly applaud McGregor's and Martin's commentary, which highlights a long-standing but worsening problem in healthcare. As innovation and technology produce new forms of investigation and treatment, each has the potential to produce important benefit to patients. However, not all that is new is better, which means that many new interventions achieve nothing or worse, cause aggregate harm. As the authors rightly not...
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I strongly applaud McGregor's and Martin's commentary, which highlights a long-standing but worsening problem in healthcare. As innovation and technology produce new forms of investigation and treatment, each has the potential to produce important benefit to patients. However, not all that is new is better, which means that many new interventions achieve nothing or worse, cause aggregate harm. As the authors rightly note, we need to carefully evaluate both our established practices and any new innovations to assure that they can deliver meaningful, rather than just statistically significant or "false endpoint", improvements to outcomes.
I would like to point out one significant contributor to the issue of overtesting that the authors fail to mention: economic interest. Any process that consumes resources creates beneficiaries along the supply chain. For testing, that is the producers of the equipment, the consumable supplies and the companies that provide direct service to patients. In the case of treatment, it is the drug and device supply companies, their distributors and pharmacies. Unfortunately, this business influence seems to be becoming both more widespread and more subtle, including contributions to universities, research organizations and non-profit charities. Regrettably, these same entities are heavily involved in producing the guidelines that support what the authors term "creep" in preventive screening and diagnosis. Unless we can be sure that we can create evaluation processes that are free from influence by parties who are in economic conflict of interest, we will not be able to address the problems of overtesting and overtreatment, nor prevent them from undermining patient and system health.
Conflict of Interest:
None declared
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Competing Interests: None declared.