The Curbsiders Internal Medicine Podcast #189 Medical Overuse: Common Cases of Overtesting, Overdiagnosis, Overtreatment
Dec 23, 2019
In this engaging discussion, Dr. Daniel Morgan, an expert in epidemiology and public health, and Dr. Deborah Korenstein, an internist and health services researcher, tackle the complexities of medical overuse. They explore the pitfalls of overt testing and overdiagnosis, particularly the risks of incidentalomas found during imaging. The hosts delve into the controversies surrounding procalcitonin testing and unnecessary antibiotic prescriptions for viral infections. The conversation offers valuable insights into the urgent need for better medical decision-making and patient-centered care.
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Medical Overuse Defined & Prevalent
- Medical overuse is care where harms equal or outweigh benefits. - It occurs frequently, with estimates ranging from 10% to 30% of medical care.
Human Factors Drive Overuse
- Overuse often stems from cognitive biases and uncertainty, not just financial incentives. - Physicians may order unnecessary tests to reduce uncertainty or to 'do something.'
Procalcitonin Testing Disappoints
- A 40-year-old patient with fever and productive cough underwent procalcitonin testing to guide antibiotic therapy. - A large trial showed procalcitonin testing did not change antibiotic prescribing behavior.
