One-fifth of medical care is unnecessary, physicians say—fear of malpractice and patient pressure are main reasons

At least 15% to 30% (median 21%) of overall medical care is unnecessary, said most of the 2,100 physicians who responded to a survey conducted by researchers from Johns Hopkins and Harvard Medical School.

Respondents further estimated that about 22% of prescription medications, 25% of tests, and 11% of procedures that are given are not needed, according to the findings of a recent study published in PLOS ONE.

Physicians cited three top reasons for overtreatment:

• 85% said fear of malpractice
• 59% said patient pressure/request
• 38% said difficulty accessing prior medical records

Respondents’ other reasons for overtreatment included “borderline indications” (37.7%), “inadequate time to spend with patients” (37.4%), “lack of adequate information/previous medical history" (36.7%), “pressure from the institution/management” (20.8%), as well as other reasons.

“To our knowledge, this is the first study to survey physicians on overtreatment in a range of specialties and on a nationwide level,” the authors noted.

Overtreatment is an enormous problem in health care spending. “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 at the Johns Hopkins University School of Medicine, in Baltimore, MD.

Unnecessary services represent the largest share of wasted health care resources, accounting for about $210 billion of the estimated $750 billion in excess spending per year, according to a report from the Institute of Medicine.

Importantly, overtreatment is associated with direct harm to patients, Dr. Makary and colleagues noted in their study.

The survey also revealed that 71% of respondents believed that physicians are more likely to perform unnecessary procedures when they profit from them. Attending physicians with at least 10 years of experience and specialists were more likely to believe that physicians perform unnecessary procedures with an eye toward profit.

“Interestingly, but not surprisingly, physicians implicated their colleagues (more so than themselves) in providing wasteful care,” said Daniel Brotman, MD, Professor of Medicine at Johns Hopkins University School of Medicine and an author of the paper. “This highlights the need to objectively measure and report wasteful practices on a provider or practice level so that individual providers can see where they might improve.”

The study authors pointed to the American Board of Internal Medicine’s (ABIM) Choosing Wisely campaign, which seeks to raise awareness of overtreatment and unnecessary care.

Based on the success of that campaign, Dr. Makary and other Johns Hopkins researchers are working on an Improving Wisely campaign, which develops physician-endorsed metrics of overtreatment and wasteful care, applies them to big data, and sends confidential notifications to doctors who are extreme outliers.

“Most doctors do the right thing and always try to; however, today ‘too much medical care’ has become an endemic problem in some areas of medicine,” Dr. Makary said. “A new physician-led focus on appropriateness is a promising homegrown strategy to address the problem.”

The survey asked respondents to identify possible solutions to overtreatment. Their top three potential solutions were “training residents on appropriateness criteria” (55%), “easy access to outside health records” (52%), and “more practice guidelines” (52%).

Also, 76% of respondents believed that de-emphasizing fee-for-service bonus pay would reduce unnecessary utilization and lead to a reduction in national health care spending.