MedCity Influencers

Next medical school, CME assignment: Read Shannon Brownlee’s ‘Overtreated’

Healthcare reform is just a recent buzzword. But there are some people who have for years seen the real reason why medicine is broken. Shannon Brownlee’s book that looks at the disturbing amount of excess medical care should be required reading in medical schools and for other healthcare professionals.

My daughter, Elana, home from college on winter break, offered me a book to peruse from one of her classes. She correctly suspected that her father, the Whistleblower, would enjoy reading a book authored by a Whistleblower pro.

The book, Overtreated, by Shannon Brownlee, should be required reading for first year medical students, who have not yet acquired views and habits that promulgate excessive medical care and treatment. For those of us already in practice, this book should be a required element of board recertification. The theme of the book appears as a subtitle on the cover.

Why Too Much Medicine is Making us Sicker and Poorer

Brownlee understands the medical system well and describes a culture of excess, conflicts of interests, absence of universal quality control mechanisms and fractured and disorganized care with no one in charge of a particular patient. She presents some chilling anecdotes of medical tragedies that have occurred at our most prestigious medical institutions. And she introduces us to reform leaders who understand the system’s inherent deficiencies and their proposals to remedy them.

Brownlee states that explanations for waste in the health care system include:

  • Cost of a gargantuan bureaucracy
  • Medical malpractice fear and defensive medicine
  • Incentives for patients with medical insurance to overutilize care
  • Rising medical costs

The most important cause, she argues, is unnecessary medical care, which costs the nations hundreds of billions of dollars and exposes patients to the risk of harm from medical complications. She writes: If overtreatment were a disease, there would be a patient advocacy group out there raising money for a cure. She points out numerous conflicts of interest in the system where medical incomes rise when medical outcomes decline. She shares the views of early medical reformers, iconoclasts, who are now firmly in the mainstream of medical reform efforts. She gives the history the development of the understanding of geographic variability in medical costs and outcomes. She explains why spending more on health care oven leads to worse health for patients. The reader will see the familiar statistics comparing the United States to other nations who spend far less than we do and enjoy better health.

The book was published in 2007, before the divisive national debate on Obamacare took place. But, the book is not dated and the issues are highly relevant. The book reminded me of Atul Gawande’s remarkable and influential essay published in New Yorker Magazine in 2009. Gawande’s piece impressed one reader so powerfully, that he required his entire presidential cabinet to read the article.

I haven’t finished the book yet, but I intend to. I award Brownlee’s book with the coveted Whistleblower Seal of Excellence. Even a perusal of the first few chapters would be worthwhile.

I hope that you will consider reading it and recommending it to others. Why not leave a copy in your medical office waiting room or on your coffee table at home? You might consult it before you sign up for the total body scan being advertised in your newspaper.

My deep concern is that Overtreated will be Underread.

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