“The Best Care May Be No Care”

The above title is the headline of a recent op-ed piece in the New York Times by cardiologist Sandeep Juahar. It’s right up my philosophical alley. Juahar is referring to the fact that, as a result of the pandemic, people have been avoiding medical care. Nevertheless, “a vast majority of patients seem to have fared better than what most doctors expected.” In fact, he says, “perhaps Americans don’t require the volume of care that their doctors are used to providing.”

Juahar maintains that a substantial amount of health care in America is wasteful. He cites a number of reasons: doctors practicing “defensive” medicine to avoid lawsuits; a reluctance to accept diagnostic uncertainty, which leads to more tests; exorbitant prices; lack of consensus about which treatments are effective; and the pervasive belief that newer, more expensive technology is always better.

Doctors themselves admit that 15 to 30 percent of health care is probably unnecessary. And studies suggest that up to 20 percent of surgeries in some specialties are unnecessary. A long list of medical societies, such as the Society of General Internal Medicine and the American Academy of Neurology produce lists of procedures to avoid. You can see these lists at choosingwisely.org. The lists run to more than 65 pages!

As Juahar says, “If beneficial routine care dropped during the past few months of the pandemic lockdown, so perhaps did its malignant counterpart, unnecessary care. …More care doesn’t always result in better outcomes.”  You go, Dr. Juahar!

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