How Much Does Too Much Medicine Matter?

Dr Amy Price

Medicine needs to fit and not just multiply

We face the challenge of the century, knowledge about medicine and healthcare is growing faster than the systems that support it. Clinicians and academics struggle to keep

up. The argument that too much medicine provides too little care and at great cost is significant. The counter argument is that a person has value as an individual and if a few persons in a thousand are spared we need to save them. This quote by Margaret McCartney sums things up:

“Too much testing of well people and not enough care for the sick worsens health inequalities and drains professionalism, harming both those who need treatment and those who don’t.”

McCartney eloquently states the broad problem. Health care money is limited and when it is spent on a focus that is not sustainable, patients will suffer and die.

Mapping the route to a solution requires more. Sir Muir Gray proposes we attend to allocative, technical and individual values during structural change to preserve engagement. Decision-making is not only about patients or doctors; it is integrated throughout our society and we need to consider how these values will surface and influence the process.

Abraham Verghese reminds us that in medicine, “We are all fixing what is broken and it is the task of a lifetime”.

Information is not enough when it lives alone

Health researchers might look to solutions like data mining and new systems to manage literature and yet neglect the greatest resource we have in health science which is the public we serve. Nurturing these relationships will propel last century tradition beyond useless debate into evidence based practice. As E-Patient Dave says, “Let Patients Help.”

In 2010, it was estimated that 75 RCTs and 11 systematic reviews are produced daily.

Donald Lindberg at the National Library of Medicine reports “If I read and memorized two medical journal articles every night, by the end of a year I’d be 400 years behind. The challenge is that medicine changes rapidly and the rules that fit yesterday may be out of context today.

Getting to grips with growing pains

The sheer volume and complexity of possibilities makes taking a road that is new and untested both exciting and overwhelming. Proactive change in the health sciences is inevitable. From passengers to Co-pilots, patients’ roles expand according to Anderson et al.  Encouragement to proceed can be gleaned from the history of Mother Teresa who changed the future for lepers in Calcutta by starting out to help just one. Google became the largest search engine in the world with the simple concept of having the public type in questions to a blank page and through this they used public interest and priorities by adding search terms to a database to build powerful algorithms.

Thinking through solutions

Don Berwick in this JAMA article challenges us all with nine points to consider to usher in the next era in medicine. They are listed verbatim. To find out why read the paper, it is free:

1. Reduce Mandatory Measurement
2. Stop Complex Individual Incentives
3. Shift the Business Strategy from Revenue to Quality
4. Give Up Professional Prerogative When It Hurts the Whole
5. Use Improvement Science
6. Ensure Complete Transparency
7. Protect Civility
8. Hear the Voices of the People Served
9. Reject Greed

The other points become viable with this quote shared by Berwick:

“Everything possible begins in civility” (Robert Waller, MD, former president and CEO of Mayo Clinic, written communication, January 31, 2016)

At Evidence Live you can learn to build a protocol, teach about evidence, engage patient reviewers like they do at BMJ,launch rapid reviews, master the nuts and bolts of how guidelines work and get your academic papers accepted. You might attend and be an answer others have waited for.

Information alone is worthless until it is shared. Conversational insight and powerful research about research quality, communication, informed shared decision making and ways to practice patient and public participation are in the works at Evidence Live 2016, June 22-24. Come and get involved through workshops, discussions, and conversations. Health care is changing, you can build it, we can help.

References

1       Glasziou P, Moynihan R, Richards T. Too much medicine ; too little care. Br Med J 2013;347:1–2. doi:10.1136/bmj.f4247

2       Gigerenzer G, Muir Gray JA. Better doctors, better patients, better decisions; Envisioning health care 2020. The Ernst Strüngmann Forum 2009. MIT Press 2011.

3       Purkayastha S, Price A, Biswas R, et al. From Dyadic Ties to Information Infrastructures: Care-Coordination between Patients, Providers, Students and Researchers. Contribution of the     Health Informatics Education Working Group.Yearb Med Inform 2015;10:68–74. doi:10.15265/iy-2015-008

4       Verghese A. Cutting for stone : a novel. New York: : Alfred A. Knopf 2009.

5       DeBronkart D. Let Patients Help ! 2013.

6       Bastian H, Glasziou P, Chalmers I. Seventy-five trials and eleven systematic reviews a day: how will we ever keep up? PLoS Med 2010;7:e1000326. doi:10.1371/journal.pmed.1000326

7       Anderson M, Mccleary KK. From passengers to co-pilots : Patient roles expand. Sci Transl Med 2015;7:1–3.

8       Berwick DM. Era 3 for Medicine and Health Care. JAMA 2016;315:1329–30. doi:10.1001/jama.2016.1509

This blog was originally posted on http://www.cebm.net/much-much-medicine-matter/.

Cite as Price A (2016): How Much Does Too Much Medicine Matter? CEBMJ http://www.cebm.net/much-much-medicine-matter/ DOI: 10.13140/RG.2.1.3562.5367