Gilbert H. Welch, MD, MPH

 

General internist and Professor of Medicine

Dartmouth Institute for Health Policy and Clinical Practice

Geisel School of Medicine

 

Professor of Public Policy, Dartmouth College

Professor of Business Administration, Amos Tuck School

 

9:30 a.m.

Friday, June 29, 2018

International Academy of Endodontics, Annual Meeting

The Scottsdale Princess

Scottsdale, Arizona, USA

 

 

Many doctors are worried about the problems caused by too much medical care. A recent survey suggested that nearly one-half said their patients received too much medical care. But it is hard to communicate the nuances – that medical care can do a lot of good in selected settings, but can also do harm in others – during a 10-15 minute clinic visit.

Doctors like to blame lawyers for the problem of too much medical care. But ask yourself this: Would the problem of overuse disappear if the lawyers disappeared? Economists like to blame economics. But the recipe of adding fee for service to third-party payment to cook up too much medical care would not work without strong underlying beliefs about the value of the product. The general public harbors assumptions about medical care that encourage overuse.

I’m not blaming the public; many of these assumptions flow directly from information provided to them – be it from the news media, talk shows, advertising, PR campaigns, disease advocacy groups, public service announcements or doctors themselves.

Regardless of their source, these assumptions lead individuals to have an excessively optimistic view of medical care. That leads them to seek – some would say to demand, others to accept – too much care.

 

Objectives:

To consider 7 assumptions that drive too much medical care:

1. All risks can be lowered

2. It’s always better to fix the problem

3. Sooner is always better

4. It never hurts to get more information

5. Action is always better than inaction

6. Newer is always better

7. It’s all about avoiding death

 

 

Dr. Welch is a general internist and professor of Medicine at the Dartmouth Institute for Health Policy and Clinical Practice in the Geisel School of Medicine.  He is also a professor of Public Policy at Dartmouth College and a professor of Business Administration at the Amos Tuck School.

For the 25 years he has been practicing medicine, Dr. Welch has been asking hard questions about his profession. His arguments are frequently counter-intuitive, even heretical, yet have regularly appeared in the country's most prestigious medical journals — Annals of Internal Medicine, Journal of the American Medical Association, the New England Journal of Medicine and the Journal of the National Cancer Institute — as well as in op-eds in the Los Angeles Times and the New York Times.

He is the author of 3 books – each expanding on the argument of the one before it. Should I be tested for cancer? Maybe not and here's why (2004) deals with the narrow question of early cancer diagnosis. Overdiagnosed: Making people sick in the pursuit of health (2011) expands the discussion to include the early diagnosis of any disorder. His newest book “Less Medicine, More Health – 7 Assumptions that Drive Too Much Medical Care" (2015) expands the discussion explore other ways that too much medical care can cause harm – and is intended to be more approachable for general readers.

Dr. Welch is very much part of the “Dartmouth School” that questions the assumption that more medical care is always better.  His research has focused on the assumption as it relates to diagnosis: that the best strategy to keep people healthy is early diagnosis – and the earlier the better. He has delineated the side-effects of this strategy: physicians test too often, treat too aggressively and tell too many people that they are sick.  Much of his work has focused on overdiagnosis in cancer screening: in particular, screening for melanoma, thyroid, lung, breast and prostate cancer.