More not always better

More Care Is Not Always Better

What’s the Issue?

It is easy to assume that the real problem with the healthcare system is “not enough” – not enough physicians, not enough MRIs, not enough money in the system. But what does the evidence show?  What is the right amount of healthcare?  And what kind of care are Canadians getting?

A growing number of studies show that more healthcare is not always better and the more expensive drug is not necessarily the right choice. In fact, the evidence suggests that sometimes more care, care that you don’t need, can be harmful and expose patients to unnecessary risks.

So what is the “right amount” of care? Getting the “right amount” of healthcare means that you are getting as much care as you need, but no unnecessary care. Here are some examples:  Getting antibiotics for an infection that is helped by antibiotics is the “right amount” of care. Getting antibiotics for a condition that is not helped by antibiotics – such as the common cold – would be unnecessary care.  Staying on schedule with the preventive care and screening tests that are recommended for your age and health condition is the “right amount” of care. Having preventive care and screening tests more often than recommended would be unnecessary care.

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Evidence

  • Reading the headlines on the US Preventive Task Force’s (USPSTF) update to its prostate cancer screening guidelines, you might come away with the idea that the task force has completely reversed its 2012 recommendation against broad-based prostate-specific antigen (PSA) screening.  But that would be the wrong impression.  Read more of the article by Kathlyn Stone here. 
  • Health care innovations and procedures spread unevenly across geographic regions, seemingly because of physician preferences, research suggests. Read this article The Puzzling Popularity of Back Surgery in Certain Regions by Austin Frakt and Jonathan Skinner
  • How much is a life worth? We are frequently confronted by sad stories of people who think they, or their family, might benefit if only someone – usually the publicly-funded healthcare system– would pay for a particular, usually expensive, treatment (often, but not always, involving a costly drug). Read the full essay by Raisa Deber. 
  • An avalanche of unnecessary medical care is harming patients physically and financially. What can we do about it? Read the article ‘Overkill‘ posted in The New Yorker.
  • Are breast cancer screening programs justified? Millions of Canadians happily sign up for breast cancer screening every year. After all, we’re told that it “saves lives” for women aged 50 to 74. Click to read more.
  • For detailed information on overuse in the healthcare system, visit Lown Institute – Overuse 101. Overuse is a catchall term for medical tests, treatments, and other services that patients don’t need or don’t want.
  • A March 2014 editorial published in Annals of Internal Medicine has examined the problems of figuring out how much is enough medicine and how to think about guidelines. See: Controversy Over Clinical Guidelines: Listen to the Evidence, Not the Noise by Dr. Eliseo Guallar and Dr. Christine Laine, Editor in Chief.
  • Tools for Practice provides biweekly articles for its members that summarize medical evidence on a clinical question. Tools for Practice is sponsored by the Alberta College of Family Physicians (ACFP).
  • Doctor (123456789), a parody of Tommy Tutone’s song Jenny (867-5309) addresses the critical information we need to know about cardiovascular disease risk prevention. Bottom line, we need to know our percent risk of heart attack/stroke with NO treatment versus our percent risk ON treatment and the chance of harm.
  • Journalist Ann Silversides in the article Mammography screening: Weighing the pros and cons for women’s health, wades through the recent controversies about mammography screening, explaining the issues and summarizing the evidence. This article won the “Best Online Story” at the 2012 Media Awards sponsored by the Registered Nurses Association of Ontario (RNAO).
  • Many Canadians believe we have one of the best health care systems in the world, but in recent international rankings for health care quality, Canada places in the middle or at the bottom of the pack. So it is not surprising that provincial and territorial governments are increasingly focusing on quality improvement to move their systems towards better quality and at the same time find efficiencies and cost savings. This 2013 report, “Which way to quality? Key perspectives on quality improvement in Canadian health care systems“, builds on the Health Council of Canada’s interviews and surveys of senior Canadian health care leaders about their perspectives and experiences with system-wide quality improvement. It highlights activities and approaches being taken across Canada, and reveals innovative practices and initiatives in different jurisdictions for readers. To see the infographic “Which Way to Quality?” click here.

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