In the United States, there is a widely held belief within our health care system more care leads to better quality clinical outcomes. More care can be defined as more use of technology, more use of advanced imaging and more medical or surgical treatments.
The idea more care always provides better care has been recently challenged as physicians actively explore and discuss options in partnership with patients. Multiple examples in clinical care have come to light that illustrate the notion that sometimes less is more.
Those case studies, as well as some of the patient-doctor conversations you may have had with your physicians about treatment options, illustrate a real shift in health care to shared decision making. Patients should ask for information regarding their health care options.
Patient No. 1: A 45-year-old man was evaluated for symptoms of diarrhea that seemed consistent with a stomach flu. The patient was quite concerned his symptoms might indicate a more serious underling health condition. He requested that his doctor order more in depth testing. His doctor ordered a CT scan of the abdomen, which did not indicate any cause for the diarrhea, other than the stomach flu. However, when a cyst on the adrenal gland was noted, further testing of the adrenal gland was done, which indicated that this was not a significant problem.
There is a term used by radiologists called incidentaloma. This refers to an abnormal finding on an X-ray test that was unrelated to the original reason the test was requested. As a general rule, these abnormalities are often of questionable clinical significance. When these incidentomas are identified, most commonly on CT or MRI scans, patient anxiety increases and further testing is carried out in order to try to determine if the incidental finding on the imaging test is important or not.
Patient No. 2: A 66-year-old woman developed chest pains. She underwent heart testing which revealed that she had two blocked coronary arteries. Her physician discussed this with her, giving her several options for treatment. When given the information that taking a prescribed medication would be as effective as a surgical procedure to treat the blockages, she opted for the medication. Research studies in recent years corroborate this option in selected cases, avoiding complications that could occur with surgical procedures.
Patient No. 3: A 70-year-old woman was evaluated for a breast lump and it was determined that she had an early stage breast cancer. Her breast care specialist informed her she would be a good candidate for a lumpectomy, a limited surgical procedure, also considered a form of breast conserving therapy. In the past, women with early stage breast cancer underwent a mastectomy, but based on the latest research, lumpectomy can, in many cases of early-stage breast cancer, give results that are as good as a total mastectomy, with less distress and many less side effects.
There are many other examples of less is more in clinical medicine and it is reassuring physicians and health care systems are constantly looking to explore, discover and learn from those emerging trends in treatment and communication.
Dr. Mark Roth writes about internal medicine for the Cleveland Jewish News. He is an internal medicine physician with University Hospitals in Cleveland.