Including Patients in Decisions Could Reduce Overtreatment

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Most opioid prescriptions are written by primary-care clinicians.
Most opioid prescriptions are written by primary-care clinicians.

HealthDay News -- Updating malpractice laws and including patients on medical decision making may help reduce overdiagnosis and overtreatment, according to an article published online in The BMJ.

Jerome R. Hoffman, MD and Hemal K. Kanzaria, MD, from the University of California in Los Angeles, discuss ways to reduce overdiagnosis and overtreatment, focusing on changing professional and public attitudes toward uncertainty and medical errors.

The authors noted that although the best protection against harm from medical errors is to identify them in order to design systems that can catch or mitigate errors, the medical culture of shame and blame can lead to practitioners denying and hiding errors. 

Physicians agree that defensive medicine is the leading cause of medical excess, but the majority of physicians report engaging in defensive medicine. To reduce overdiagnosis and overtreatment, reform of malpractice laws may be necessary, although this is likely to be insufficient to drive such change.

An additional change would be to include patients in the medical decision making process, making sure they understand the uncertainty attached to each benefit-risk profile.

"We need to go beyond these ideas and start to change the culture of medicine, and even the wider culture," the authors write. "This will require us to be more open about the inevitability of failure, and even of error."


  1. Hoffman JR, Kanzaria HK. BMJ. 2014;349:g5702
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