Does More Care Do More Good?

When we are sick, how much health care is good health care? These days when we call an ambulance, the medics rush in with all sorts of equipment and medications — called advanced life support, which replaces the basic life support that many of us learned in CPR classes.

Doing More for Patients Often Does No Good, a January 12, 2015 article appearing in the New York Times, makes the point that more advanced therapies and medical care do not guarantee higher quality or better outcomes. Written by Aaron E. Carroll, M.D., the piece shares a study in the journal JAMA Internal Medicine that compared the outcomes for patients who had received life support — basic or advanced — before being admitted to the hospital. He also writes about other studies that appear to show how the most advanced emergency care does not necessarily mean longer survival.

Dr. Carroll, a professor of pediatrics at Indiana University Medical School, further reinforces this “more may be less” point of view by describing studies that show how women with breast cancer receive complex and also more expensive breast surgical cancer treatments that are no more effective than outcomes with a more standard breast conservation therapy.

This article requires readers to process fairly complex explanations about medical care, and it may be necessary to read some paragraphs more than once. Yet, it’s worth taking the time to understand that doing more medical care in many cases will not give us extra quality or a better outcome.

Effectiveness – A Frustrating Concept in Medical Care

Over the past several years we’ve heard a lot about the effectiveness of medical treatments. It’s frustrating to put together the puzzle parts on this issue, but especially so when a family member is ill with a serious disease. Sometimes going forward with a treatment feels better than seeming to do nothing. When aging issues are added to the thinking mix, decisions become even more complex.

Check out this Scientific American article.

In her New York Times Well blog column, When Less Treatment is More, Pauline W. Chen, M.D., points out that it’s often necessary for a physician to figure out when less treatment is better than more. Although quite a bit of research provides evidence and identifies treatments that are less effective, patients continue to receive those medical treatments, sometimes at great risk, because they or their doctors believe those are better care.

A medical treatment or surgery is considered effective if the desired outcome is achieved.

Dr. Chen describes research at Yale University School of Medicine that investigated whether radiation treatments after surgery were effective for women over age 70 with less invasive breast cancers and whether the patients lived longer. After examining the records of 13,000 women, the researchers found that the addition of radiation therapy to their treatments made little difference in their survival rate. Continue reading