Overtreatment: The lesson of McAllen, Texas

McAllen, Texas, in the impoverished Mexican border region of Hidalgo County, is an unlikely place to find the nation's most expensive health care. But that's exactly what Dr. Atul Gawande did, and wrote about in a fascinating article in the current issue of New Yorker magazine. In McAllen, he found doctors and hospitals who had discovered a guaranteed path to riches: give unsuspecting patients many expensive and profitable tests and treatments, whether they need them or not. Here's a quote from the article that highlights the issue:

I gave the doctors around the table a scenario. A forty-year-old woman comes in with chest pain after a fight with her husband. An EKG is normal. The chest pain goes away. She has no family history of heart disease. What did McAllen doctors do fifteen years ago?

Send her home, they said. Maybe get a stress test to confirm that there's no issue, but even that might be overkill.

And today? Today, the cardiologist said, she would get a stress test, an echocardiogram, a mobile Holter monitor, and maybe even a cardiac catheterization.

"Oh, she's definitely getting a cath," the internist said, laughing grimly.

If this theme sounds familiar to Consumer Reports readers, that's because we've been writing about it for years. We've warned people away from treatment traps that do nothing except run up your bills. We've investigated how too much treatment can paradoxically make people less healthy by exposing them to poorly coordinated care, side effects of unneeded tests and medications, and hospital infections.

If you're curious how your region stacks up in terms of aggressive vs. conservative treatment, you can look it up on our free compare hospitals tool. I checked out McAllen's stats just now: just like Dr. Gawande said, it's practically off the charts in aggressiveness of care it gives.

One thing we've discovered in years of looking at this subject: it's really hard for patients to figure out if they've been overtreated. What do you think? Do you suspect you've ever been overtreated? Tell us about it.

—Nancy Metcalf, senior program editor

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