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Too many doctors can be bad for your health

The more physicians you see, the greater the chance of miscommunication and overtreatment

Consumer Reports on Health: August 2012

In this Office Visit column, Consumer Reports Medical Adviser Orly Avitzur, M.D., discusses the problem of having too many doctors.

My colleague referred her father to me with apologies. The 78-year-old retired businessman was visiting from Florida for the month, and had asked her to set up appointments for him with a half-dozen specialists. Other than well-controlled high blood pressure, an enlarged prostate, and a history of occasional bouts of pneumonia, he was in good health. But he was worried about cancer, a topic of all-too-frequent conversation in his retirement community. He came to see me complaining of recent headaches and fears of a brain tumor. He had already seen a cardiologist, an internist, and a urologist during his visit and was taking a variety of painkillers and muscle relaxants.

An article in the Sept. 26, 2011, issue of the Archives of Internal Medicine confirmed what doctors have long known—that many patients are suffering from too much care. According to the survey, 42 percent of primary-care physicians in the U.S. think that patients in their own practice are receiving excessive care; only 6 percent said they were receiving too little. Physicians sometimes have their own incentives for seeing patients too frequently or ordering too many tests—such as financial rewards or fear of malpractice—but patients might also contribute to the problem by mistakenly believing that more visits or more tests will keep them healthier.

In fact, when it comes to your well-being, less is often more. The combination of overtreatment and poor coordination of care by physicians, a threat that rises with the number of practitioners you see and health-care systems involved, leads to a higher incidence of medical problems and increased dependency, especially for the chronically ill. That’s according to a March 2012 report in the Journal of the American Medical Association. Some specific risks include:

Medication problems. When reviewing a new patient’s medication list, it’s not unusual to run across a duplication, as I did recently when seeing a patient for vertigo who had been prescribed Antivert, a brand-name drug, by her primary-care doctor, and meclizine, the generic equivalent, by her ear, nose, and throat doctor. It’s even more common to find people who are already on multiple medications being prescribed the same drugs again, such as the patients I see after car accidents who are oversedated from multiple prescription muscle relaxants and painkillers. The likelihood of being on too many drugs increases with the number of providers you see. Keeping a list of medications that includes brand and generic names, and making sure all your doctors review them, can help. But there’s no substitute for streamlining the number of physicians you see.

Too many tests. It’s not uncommon for a doctor to reorder a test that another doctor has just had done. Moreover, even minor abnormalities or incidental findings can lead to increasingly invasive testing with a risk of serious complications. In a health survey last year for Consumer Reports, 87 percent of respondents said they completely or somewhat agreed that “it’s better to have a scare that turns out to be nothing than to not get tested at all.” But only 18 percent recognized the risk of having a false alarm.

Waste of time and money. While genuine medical problems should never be ignored, overtreatment takes time away from more pleasurable endeavors. It’s estimated that overtreatment alone was responsible for $158 billion to $226 billion in wasteful spending in 2011, while failure to coordinate care cost $25 billion to $45 billion. Besides the overall implications for health-care spending and the threat to worthy government programs, your own pocketbook is affected. Even with the best insurance plans, copayments for office visits, tests, procedures, and pharmacy bills can add up quickly.

Too much stress. Undergoing frequent tests, waiting for results, and trying to make sense of conflicting opinions can cause undue tension. In the case of my colleague’s father, stress undoubtedly contributed to his headaches. And the multiple painkillers he was taking had contributed to a rebound effect. With reassurance and gradual discontinuation of the drugs, the headaches eventually resolved.

Orly Avitzur, M.D.

Medical Adviser
Editor's Note: This article first appeared in the newsletter Consumer Reports on Health.
   

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