The concept that if some health care is good, more must be better is over-simplistic, and often wasteful, even harmful. This applies to treatment interventions and diagnostic testing, which can lead to a cascade of unplanned interventions. In this session, three front-line doctors, working in disparate fields (Emergency Medicine, Dermatology, and Family Medicine), will present evidence demonstrating that prevailing practice norms often put patients at risk of unintended harms. Discussion will focus on opportunities to redress these concerns. We’ll discuss strategies to protect you, your family and patients from low-value, high-cost profiteering.
Dr. Adler will review cancer screening and demonstrate that:
- Benefits of cancer screening are less than thought.
- Harms of cancer screening are greater than thought.
- To counter uncritical promotion of cancer screening, all stakeholders must be re-educated.
- Pictorial representations help communicate challenging concepts.
- Shared decision-making (SDM) is the proper approach to cancer screening.
- Decision aids facilitate SDM.
Dr. Elpern will discuss changes in dermatological practice since 1980.
- Cutaneous malignancies have become cash cows.
- Skin cancer screening is aggressively promoted.
- Low-value cryotherapy became CPT heaven. Colleagues rush through patients, spray guns in hand, to maximize production.
- Mohs surgery is a cottage industry.
Dr. Fraiman will discuss how:
- Radiation is often the only risk considered when obtaining a CT scan
- Harms of false positives and overdiagnosis frequently outweigh radiation risk
- In low-risk patients, CT scans can be more harmful than beneficial
- Accounting for all risks challenges many mainstream medical approaches
- A healthy fear of these risks is essential to protecting patients