Friday, March 04, 2011

Overtested and overtreated

Infertile patients can be desperate for a diagnosis. They naively feel that once they know what the problem is, we'll be able to find the solution !

This leads to testing - which has now become an epidemic of overtesting.

Let's see why. Patients still have unrealistic expectations from IVF treatment. Doctors often do not bother to counsel them. They are so focused on "grabbing patients" to do one IVF cycle, that they overpromise success. They make tall claims during the IVF cycle to keep the patient's hopes high - everything is going very well- you will definitely get pregnant ! Then, when the cycle fails, the doctor becomes inaccessible ! Patients get disillusioned and hunt for a new doctor. The new doctor needs to do something more - something different - as compared to the old one - after all, he needs to show the patient he is better !

The new doctor will then order a whole panel of expensive new tests. Many of these are completely irrelevant and do not affect fertility or the IVF treatment, but patients are quite clueless and do not know any better. They are happy to do whatever the new ( and improved !) doctor suggests - after all, aren't more tests a sign that this new doctor is very thorough and competent ?

An excellent example of this is : PCR for TB testing in India; immune testing for killer cells in the US; and sperm DNA fragmentation tests.

All doctors know that if you do a lot of tests , it's a matter of statistical certainty that you will find an abnormality. Once this is found, this is considered to be the problem causing the infertility which then needs to be fixed ! The new doctor is triumphant ! See, the earlier doctor was incompetent and did not bother to test you properly which is why the cycle failed. Aren't you glad you came to me ? Now that I am treating you , this problem will be solved and you will get pregnant !

Patients are happy too ! They are impressed by how well-informed and thorough the new doctor is. In fact , is sometimes seems that the more the tests - and the more expensive they are, the happier the patient - and the happier the doctor !

This leads to a negative vicious cycle of overtesting and overtreatment. Doctors often end up "treating" red herrings. All this just wastes time and money - and then the new doctor fails, then
patients lose confidence in doctors - and in themselves !

Caveat emptor - do your homework before agreeing to do tests ! And always ask this simple question - How will this change my treatment ?

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1 comment:

  1. What an insightful article!
    As you put it the problem is failing to educate and counsel the patient regarding the reality of the situation and not practising evidence based medicine. Its easier for doctors to play with the patients hopes whether out of incompetence or malice rather than educate and empower patients.
    I think you are doing an amazing job in educating patients with your books,articles,blog,website and providing the resources they need to make informed decisions regarding the healthcare.
    An empowered informed patient is the best antidote to the rampant unethical medical practices. Unfortunately the patient is as likely to be misguided by the information available on the web but rather that than the current sorry state of affairs.


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