Choosing wisely

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White medical pills.

Doctors have long overprescribed antibiotics.

Big versus small, more versus less; having it all versus having just the right amount. There is a tension in America between these two mentalities. If some is good, more must be better: big houses, big cars, big meals. Meanwhile, Americans also embrace the notion that small is beautiful;  self reliance and simplicity are deep rooted values in America.

This tension between more versus less is reflected in the healthcare we receive. The United States is known for spending the most per capita on medical care in the world. Traditionally we have wanted all that medicine has to offer with nothing withheld, and we have wanted it in a timely fashion with little regard to cost. Meanwhile, not providing a medical test or treatment traditionally has been associated with governmental interference, rationed care, or because it helped the bottom line of insurance companies.

Can there be too much care?
However, quantity does not always translate into quality, in life as well as in healthcare. There is a growing “less is more” mentality in medical practice, and this time, “less” medical intervention means “just right,” with the ultimate outcome of healthier people. Medical research is bringing to light that certain medical tests or treatments, when done too often or when not needed, can result in unnecessary medications or operations that cause harm. “Too much” medical care is not beneficial, and can be bad for one’s health.

I’ll share some examples.

Antibiotics: Doctors have long overprescribed antibiotics while patients have unknowingly contributed to the problem by insisting on being treated with antibiotics. And now we are paying the price: many bacteria are resistant to antibiotics, and antibiotics can adversely effect the “healthy bacteria” in our body. Most doctors in 2016 are more careful about prescribing these powerful medications;  the goal is to prescribe antibiotics only when it seems clear they are absolutely necessary.

Cancer Screening: Research is showing that if tests are done too frequently, or at too young or at too old an age, they can result in worse health outcomes. Rather than helping, testing too much can result in medical interventions that are not necessary, and these unnecessary interventions sometimes lead to complications that can harm the body.  Today doctors are doing PAP tests and mammograms less frequently for women, and screening for prostate cancer with the PSA test for men is no longer routinely recommended.  Less tests in 2016, because less means just right.

The less-is-better movement
It is an exciting time in medicine. More is not better. Instead, the focus is on determining what just the right amount is. The motivating force behind this new perspective is not the federal government’s budget or insurance companies’ bottom lines, but rather it is on improving health and reducing harm.  Because of the underlying- what is best for health- motivation, this “less is better” movement will only continue to grow. The list of medical tests and interventions that should be done less often, or not at all, is quite extensive.

There is a website I encourage you to check out that embodies this new mentality and is endorsed by over 70 medical organizations, including The American Academy of Family Physicians, The American Board of Internal Medicine, and The American Academy of Pediatrics; it is called “Choosing Wisely.”  Go to www.choosingwisely.org and see for yourself.

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